Can we afford the future of pharmacy?

In August, Holly Young, a GP trainee at the King’s Fund, published a blog that set out four key ingredients for success for the future of community pharmacy. Leela Barham casts her economics eye over them

The King’s Fund is just one of many organisations thinking about the future of community pharmacy (there are almost an embarrassment of visions for the sector). Along with the Nuffield Trust, it recently published a 10-year strategy for the sector commissioned by Community Pharmacy England, calling for wholesale change to facilitate closer integration into NHS primary care.

With funding from Novartis, the think tank also ran a roundtable event with representatives from pharmacy, policy, the voluntary, community and social enterprise sectors as well as primary care leaders. Four key ingredients for success were identified for the future of the sector.¹ Yet with funding pressures inescapable, what are the economic issues that they raise?

First ingredient for success: Developing relationships 

In her recent blog, Holly Young, a GP trainee at the King’s Fund, talks about the importance of building a culture of collaboration, not competition. The reality is, at least in areas well served, that competition is inevitable.

That a big multiple like Boots is paying for Spotify adverts to tell people they can easily switch to get their prescriptions from Boots, shows us that it is economically worth chasing prescriptions.

It seems that in these tough financial times, every prescription counts. Competition between pharmacies works for the Government too; there are strong incentives for each pharmacy or chain to get the best price for a prescription medicine, for example.

Leaving that competitive mindset at the door of meetings with peers and other local stakeholders is an unrealistic suggestion. Instead, the powers that be need to ensure a fair playing field and provide incentives for the behaviours they want to see from community pharmacy, including rewards for working well with others, or penalties for not.

Young’s blog also talks about the unique insight of Local Pharmaceutical Committees (LPCs). That’s a good call; best to leverage that expertise, not ask for the time of others when they are so busy and when the cost of their time is high. 

Collaboration might come from the push set out in the blog for increasing the representation of community pharmacy in Integrated Care Systems and their boards. It’s hard to argue against that, but suggesting weekly meetings sounds like a high cost, let alone whether it’s feasible. Meetings when meetings add value, as hard as that is to define in practice, have got to be the way to go.

Second ingredient for success: Working with patients and the public

It’s an obvious call to make in today’s policy world that community pharmacy needs to work with patients and the public. But how best can this be done? Healthwatch North Yorkshire and Community Pharmacy North Yorkshire could provide an example to learn from. 

They are working together to find out about the public’s experiences of community pharmacies in their region using an online survey.² That could be a cost-effective approach. Results aren’t yet out though.

Confusing is the call for national bodies to share information and develop realistic expectations about local variability. Better to tap into local healthwatches, whose job is to connect patients and local people with health services. Let’s use them efficiently.

Third ingredient for success: Understanding the needs of the local area

The blog calls for an understanding of the needs of the local area and the desire for innovation. These are like motherhood and apple pie: who wouldn’t want them? But the example of innovation that was given in Young’s blog – namely a patient having conversations with the community pharmacist about Covid-19 vaccinations – isn’t all that inspiring. Here’s hoping that the sector has more innovations up its sleeve.

The blog also calls for creating capacity for innovation. It points out how commissioners need to tackle the digital integration of patient records and workforce issues. There’s a great reality check too: Young says that until these issues are tackled, community pharmacies will prioritise the fundamentals of access to medicines. But commissioners will need more money to deliver. 

Fourth ingredient for success: Evaluation and learning

Young suggests there are opportunities to learn from and to scale up innovative schemes – but without saying what these innovative schemes are. 

Innovation as a word is over-used and too often assumes that ‘new’ equals ‘added value’; new is not always better. Only if an innovative scheme adds value and at a cost that is worth incurring is it wise to scale it up. Even then it might not be feasible when an upfront investment is needed, which can feel like a big leap of faith for many contractors today.

Economic reality check

The King’s Fund is not alone in thinking about the future of community pharmacy. Anyone doing so needs to think about the future from multiple perspectives, including that of an economist.

[1] Young, H. (10 August 2023). The future of community pharmacy: four key ingredients for success. Available at: https://www.kingsfund.org.uk/blog/2023/08/future-community-pharmacy-four-key-ingredients-success

[1] healthwatch North Yorkshire. (6 June 2023). Community pharmacies – what are your experiences? Available at: https://www.healthwatchnorthyorkshire.co.uk/news/2023-06-06/community-pharmacies-what-are-your-experiences