Professor Darrin Baines
THANKS to worldwide action to make real the concept of pharmaceutical care, today pharmacists in most countries are looking forward to an expansion of their professional roles. In many healthcare systems, there is a growing realisation that pharmacists have much to offer and moves are being made to put into place the leadership, the retraining and the resources required to help them fulfil their potential, for the benefit of patients.
In the drive to ‘reprofessionalise’ pharmacists, there has been less action on creating an equally promising future for the community-based pharmacy. According to the thinkers behind the concept of pharmaceutical care, the pharmacist of the future will be less involved in dispensing, so little attention need be placed on rejuvenating community pharmacy premises because their importance will diminish as the profession focuses on patients and not dispensing. They believe the future of profession lies with the pharmacist not the pharmacy (1).
The demand for new roles for pharmacists against a background of relative disinterest in pharmacies as professional spaces is ironic: without local pharmacies, the profession of pharmacy might not have thrived over the past 200-plus years. If the pharmacy had not been such an important part of the landscape in our cities and towns, dispensing might have been performed in-house by doctors or vast publicly funded dispensaries might have become popular. In other words, there is a strong argument that suggests pharmacists only exist as a profession because of their pharmacies (2). Therefore, today’s pharmacists walk away from their professional “homes” at their professional peril.
From the perspective of pharmacists who have spent many years dispensing medicines, the idea that there is a professional life beyond the pharmacy is appealing. However, the concept that the profession can en masse exist outside its historical place of work is an unproven ideal. Given current demand, a proportion of the profession could work with patients on a regular basis, reviewing their medicines. But, there is a limit to the number of pharmacists that are needed to work as “knowledge managers” outside their traditional homes. Moreover, if money is released from dispensing to fund medicines optimisation and other activities for patients, healthcare commissioners may decide that doctors or nurses should be employed (instead of pharmacists) to do this work. Could it be easier to train a doctor or nurse in pharmacology and related skills than to train pharmacists in diagnosis, medicines and all the other things they need to know to work with patients safely and effectively?
Technology is everything
In any profession, the exploration of new roles must always be welcome. However, I suggest that an equal effort should be put into finding new roles for pharmacies. Throughout history, pharmacies have evolved in response to customer demands and changes in technology, from new drugs to the introduction of computers. The pharmacy profession should now ask how pharmacies should evolve. Just because the outside of a pharmacy remains the same, it does not mean that the inside must do so. Instead of walking away from the community pharmacy, there should be immediate action on how best to transform its space into a technology hub ready for the future. I will not expand fully on the technological future of pharmacy here, as I have considered that subject elsewhere(3), but the following trends are clear:
- Consumers will become more technology-enabled
- Healthcare will be built around the technology-enabled patient
- Medicines will move away from compounded powders into technology-assisted interventions (for example, the future patient will used mobile technology to assist in co-ordinating, receiving and reporting on their prescribed care)
As patients will need somewhere to go if their technology needs updating, reprogramming or fixing, perhaps the pharmacy should become the healthcare technology shop of the future. Think of banking and the grocery industry. Big banking and supermarket chains are reducing workforces in their local outlets and using technology instead. We can now do our own banking, without a member of counter staff; we can now scan our own groceries. In relation to pharmacy, this direction suggests that community pharmacy shelves should be cleared of commercial goods, turning the premises into a hub for technology-enabled patients. I suggest the following five steps for creating an innovative model of a technology-enabled pharmacy:
- Refit the “front of house” as a technology-hub that allows patients to connect with the pharmacy, local doctors, the healthcare system, pharmaceutical companies, charities, other patients and the like
- Exploit the time that patients wait for their prescriptions by connecting them to a technology-enabled task, such as reporting on their medicines use, watching an interactive educational programme, completing a questionnaire, or being an expert-patient in a study
- Network the pharmacy hub into the wider healthcare community, including providers, patient groups and private companies — and by doing so become the port of first call for patients — and coordinate their care through the pharmacy’s technology enabled network
- Retrain pharmacists in healthcare technology not just medicines optimisation
- Educate and enable the public to become technology-enabled pharmacy users
The notion of a technology-enabled pharmacy must prove itself in practice. However, the argument is clear: although individual pharmacists are focusing on new roles for the craft of pharmacy, there is now an urgent need to match this focus with a technology-enabled new lease of life — a renaissance — for the community pharmacy.
Darrin Baines is Professor of Health Economics at Coventry University. Follow Darrin @DarrinBaines
This article originally appeared in the International Pharmacy Journal. Professor Baines has written more articles about pharmacy, which are available on darrinbaines.net.
References
- Baines D. Dispensing: it’s time to let go. Pharmaceutical Journal 2015;294:113–14.
- Baines D. Pharmacists as dispensers and formation of the PPA. Prescriber 2014;25:33–4.
- Baines D. Has pharmacy run out of time? Pharmaceutical Journal 2008;281:21.