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Round table discussion: What are the opportunities for community pharmacy in the management of dry eye

Pharmacy in Practice recently hosted a roundtable discussion on behalf of Thea Pharmaceuticals on dry eye management. There was considerable pharmacy and optics expertise in the room so what were the thoughts on the opportunities for community pharmacy in this space?





The purpose of the roundtable event was to explore the challenges and opportunities for pharmacy particularly in the area of optics and specifically dry eye.


So is it time to focus on dry eye in community pharmacy?


What is the current situation?


The group discussed how funding for community pharmacy in England has been cut.


“This has left a gap of around £25-£30K per year in any given pharmacy. The effect of these cuts has already been staff losses. In this environment staff, education and training on over the counter (OTC) products are vital so pharmacies are able to compensate for the loss.”


There was a consensus that times are tough for community pharmacy at the moment.


“Local services have also been cut and services like harm reduction of substance misuse have now been passed to pharmacy.”


The group felt that motivation, in general, was a challenge for pharmacy teams given the current difficult business environment.


“Motivation is at an all-time low in pharmacy so leaders are trying to change efficiencies. Every prescription item counts and it is becoming very competitive. Pharmacies are competing hard. Community pharmacy is also becoming more fragmented than ever before and activity is increasing, so we are doing more for less. Pharmacists also have a battle about how much they get reimbursed for products. Some products they make a loss on but they are legally obliged to dispense the product.”



How is Scotland different?


“Patients register for long-term conditions with a pharmacy. This way loyalty is locked in for months. The chronic medication service (CMS) really helps community pharmacy in Scotland deliver excellent pharmaceutical care for patients.


“The funding for CMS spend is shared amongst community pharmacy in Scotland. Competition for this funding is encouraged and is driven by patient registration with the community pharmacy.


“By completely supporting and implementing the Scottish community pharmacy contract Bernadette has seen double-digit growth in her community pharmacy business. Using tools like CMS, the Minor Ailments Service (EMAS) and other Berni’s business has gone from strength to strength.”


Bernadette Brown believes that empowering staff through investing in their training and allowing them to be the best they can be. She believes that patients want face to face interaction and that her investment in this is paying dividends.


“Face to face interactions breed loyalty. This is the only way I see community pharmacy having a chance at getting a larger proportion of the government funding in Scotland. By upskilling staff and ensuring they deal with over the counter (OTC) transactions, the pharmacist in my business can deliver excellent pharmaceutical care. A clear referral pathway to the pharmacist ensures the patient journey is a great experience in pharmacy. Every patient can have a private conversation with the pharmacist when they wish.


“People don’t want to part with money but they do trust the pharmacist. If the pharmacist can say “the evidence says” that this is a trusted product the patient will pay for the OTC product, regardless of price. All of the above means you are educating the patient in the concept of triage and to come to the pharmacy first.”



How important is the flu vaccination service to community pharmacy?


“Flu is a very good example of how pharmacy can turn a service into a more accessible service for the public. There were 1.3 million flu jabs in delivered in pharmacy last year. With this model, they started off small on a local level and showed the government how this model can save the NHS.”


“Pharmacists are now offering different services like aesthetics. A good example of this is Botox. However, the average pharmacist will not engage with a patient as RX pays for their mortgage.”


“If you wrap the care for a patient around wellness and deliver a superior service to the patient, this will help with the all-round service and keep the patient loyal to you.”


The governance around the delivery of these relatively new services like flu vaccination was considered by the group.


“Standard operating procedure (SOP) competency frameworks must be in place to ensure compliance with recognised safe systems and patient care.”


How well do we manage eyes in community pharmacy?


“We [community pharmacy] are the most accessed health professional in the UK. Thousands of patients and customers come through our doors on a daily, weekly or annual basis. People can turn up and ask anything, absolutely anything. Dry eye presentations are very common.”


“I have to admit that largely out of habit I reach for hypromellose for dry eye. I think there is some patient confusion about dry eye but also there is limited community pharmacy knowledge about how to select dry eye products.


Sunil Kochhar shared some insight from his community pharmacy;


“We offer MURs but with eye products, we go a step on from MUR and offer a ‘MURDR’. This stands for medicine use review dry eye rash/skin. Medication use reviews (MURs) for eyes add value and drives patients through the door.”


Sunil continued;


“The average pharmacy contractor just ticks boxes and wants to get to their 400 MUR’s however only 70% achieve this.


How good are pharmacists and pharmacy team at selecting the right product for dry eye?


“Habit is the biggest hurdle in product selection and reaching for hypromellose for dry eye is always the easy option. Cost also comes into play and not knowing the benefits of other products are better. Is there any other product group we use that was developed in the 1950’s and we still use as the first choice?


“However, with the right tools, education backed by clinical evidence there is no reason why community pharmacists can’t sell OTC eye products for £15-£20 even in deprived areas. As community pharmacists, we need to think more along the line of “profit is the applause you receive for doing things right. The perception of value is important and disposable income is always a consideration. People will spend if it is the right product and if the advice going alongside on dry eye is excellent. We need to create an experience around the sale.”


“In the area of dry eye OTC sales, we need to figure out the ‘why’ and ‘how’. Why should we break the habit of selling the same product (hypromellose) that we have been doing so for many years? We also need to understand how to allow this to happen. We need to give ourselves and our staff permission to recommend and supply the best product.”


Sunil has taken steps to influence the decision-making process in his community pharmacy;


“We have taken away the hypromellose hurdle by taking hypromellose off the shelf. This works on our good better and best approach. I have replaced with the products that my local opticians stock. I have had meetings with local opticians to compare our business model. They have applied the gold, silver bronze approach to product selection. We did the same in the pharmacy. We are applying nudge theory to support counter staff make more informed selections.”


“Electronic point of sale (EPOS) is not in the average pharmacy so people give too much space to non-profit products. Category management advice is needed to the average pharmacist. Many don’t know what makes a profit. Everything on the shelf should be of value.”


“We are a scientific profession so have proof of efficacy matters.”


“Independent pharmacists tend to engage more with pharmacists so this is a very important sector and ac LPC tends to be generally Independent based this is the best route but front of house staff need to follow what the pharmacists advise. The best way to do this is to meet together and decide on product offerings and why so you are bringing the whole pharmacy staff along the path with you and endorsement and recommendation is higher resulting in better OTC sales.”



What needs to change in community pharmacy to improve the standard of advice and care around dry eye syndrome?


There was agreement on the day that there needs to be a culture change in community pharmacy in the area of dry eye management and others. The ‘why’ was deemed important.


“Pharmacists need to believe that a product is based on sound evidence before recommending. Pharmacy fails because they fall straight back into what they have been trained on – need to change purpose and belief. We need to gain confidence in making evidence-based recommendations.”


“Patients don’t want to be taking loads of medicines per day so the massive benefit of products like Thealoz Duo is fewer drops in the eye per day. It also aids compliance.”


“MURs are really important to drive quality conversations in patient loyalty. Upskilling of staff is essential as community pharmacy is stuck in dispensing. Advice – trust – purchase.”


“At worst dry eye drops will do no harm. Front of house staff need to know this so they know they won’t do any damage to the eye. This should help them overcome the fear factor of selling OTC dry eye products.”


“The public need to know that preservatives are in general bad, pharmacists don’t know this either.”


“There is a lot of ‘silo’ thinking in CCG’s on how to treat because of prescribing budgets rather than thinking about the long-term effects and benefits. What is the lifelong cost to the NHS of dry eye?”


“Knowledge of difference between blepharitis and dry eye in community pharmacy in practice is inconsistent. Teaching about Blepharitis is vital in community pharmacy.”


Key takeaway points from the day


  • It is tough out there. Community pharmacy faces challenges and financial pressure like never before.
  • Community pharmacy needs to ‘think outside the box’ to continue to drive revenue.
  • Community pharmacists need to think of innovative ways to capitalise clinically on the significant footfall coming through their doors.
  • Dry eye syndrome is common and patients often choose community pharmacy first when seeking advice about it.
  • Professional education is urgently needed around the tremendous variety of eye drops on the market at the moment.
  • There is an opportunity for community pharmacy to manage blepharitis better.
  • Networking with optician colleagues is advisable.


Due to the success of this event, the group will convene again in the new year to discuss progress on some of the action points highlighted.




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