Outsider.jpg

You can't miss it, can you?

Outsider.jpg

You can't miss it, can you?

It’s not always great to be working in a community pharmacy in summer. It’s a time when staring out of the window is like looking into a different world. Premises often lack air conditioning. Or you can’t set it to the right temperature. Everyone always looks as though they’re having more fun than you. And then there are people eating ice cream. A lot of ice cream.

One of the strange things about summer of course, is that everyone moves around. For six weeks, or longer, your regular patients disappear, and you get a bunch of new people to deal with. 

In some places, it’s like a school exchange; one group disappears and is replaced with another. In others, it’s like a mass migration. Towns and villages that are usually thriving empty overnight. Sleeping coastal towns see their populations explode. And everywhere, there is a community pharmacy. 

Working in my first ever pharmacy as a Saturday kid, summer was a graveyard. It was when the back room could be alphabetised for the arrival of the stocktakers. As a newly qualified pharmacist a few years later, I saw the opposite end of this migration, first in a tourist city and then on the coast.

"When you look at the numbers, you see that it’s the same pharmacies that are not engaging time and time again"

This was before the 2005 contract and there were very few services over and above dispensing. The most exciting it would get would be sorting an oxygen cylinder or pricing an emergency supply for a rather expensive inhaler. There were a lot of emergency supplies. If patients needed treatment, they could attempt to buy something from a pharmacy, but typically they would try to register as a temporary patient at a GP surgery or queue at Accident and Emergency.

If I could have described the Community Pharmacy Consultation Service to my newly qualified self, they would have been pleasantly impressed. If I told them the fee was £14, they would have been agog. And when they found out that half of all community pharmacies didn’t perform a single consultation in March, they would have been puzzled.

There are of course issues with the pathway, but that cannot be the sole reason for this lack of engagement. 

When you look at the numbers, you see that it’s the same pharmacies that are not engaging time and time again. In one town, there is a pharmacy that delivered over 200 CPCS interventions in March, yet the other four pharmacies in the same post code area did none. The first pharmacy was busier, yes, and closer to one of the GP surgeries. But the others weren’t tiny or completely out of the way, they just did no CPCS – just like they didn’t do much of any of the other clinical services.

There were 4,467 pharmacies in March that delivered fewer than 10 New Medicine Service (NMS) interventions. Again, a service with some critics of its specification and pathway, but a service which is evidence based, established, funded and demonstrably capable of being delivered at scale by high and low volume pharmacies. Tellingly, only eight per cent of the pharmacies that did fewer than 10 NMS interventions in March performed blood pressure checks, compared to 20 per cent nationally.

Perhaps the most successful service community pharmacy has managed to deliver and scale up in a relatively short time is the flu vaccination service, a service that generated £46.5 million in fees for community pharmacy – fees that were outside the global sum. However, it took a pandemic to really achieve that coverage and there are still 12 per cent of pharmacies who didn’t provide the service last year and a further 12 per cent that vaccinated fewer than 100 people.

Just like summer, across the healthcare landscape, new organisations are budding and coming into fruit. The first integrated care systems (ICSs) will have commissioning powers by the time these words are in print. They will become the new paymasters over the coming year and they will be equally as puzzled as my younger self at the seeming reluctance of some community pharmacies to engage with national and local services.

Emily Dickinson wrote that summer passes imperceptibly, that people fail to see the subtle changes around them and then they feel cheated when they realise it has ended. Let’s not cheat ourselves by failing to recognise the changes happening around pharmacy.  It’s time to embrace the summer. 

Outsider is a community pharmacist

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