With an underfunded NHS and aging population there are enormous challenges ahead for UK healthcare. But springing up to meet them are new technologies offering greater accuracy and efficiency, better ways to engage with patients and more personalised care as well as making better use of scant resources. It’s a form of digital disruption that will open up new opportunities as the role of pharmacies changes in line with NHS and patient needs. So how will tomorrow’s pharmacies use new technologies to empower themselves, their business and their customers? We take a look at some of the options.
The NHS Long Term Plan for the future, published in January 2019, includes the role of community pharmacies and how they will fit in to the future NHS. In short, pharmacists will need to make better use of technology and team members’ skills; they will need to interact with patients digitally as well as updating their own skills to provide the services required by the NHS. Another report by the Royal Pharmaceutical Society ‘Now or never: shaping pharmacy for the future’ similarly stresses a shift of focus away from the simple supply of medicines towards the provision of services based around people’s needs. It brings together practical ideas about future models of care and talks about the challenges and opportunities for the pharmacy profession against a background of NHS reforms and new possibilities offered by technology. In another article for Pharmacy Magazine Professor Darrin Baines, an expert in economics and health technology, suggests that community pharmacies should be transformed into “technology hubs” to allow patients to connect with their pharmacy, local doctors, the wider healthcare system, pharmaceutical companies, charities, as well as other patients. So, what kind of innovations are we likely to see?
Robots to make up your prescription
One of the areas in which intelligent machines can help pharmacists and reduce the possibility of potentially dangerous errors is in dispensing. As recently as April 2019 a 65-year old Kent woman died after a pharmacist dispensed a wrongly-labelled blood pressure drug instead of pain relief medication. Automated dispensing technology eliminates human error and though the initial cost is significant at between £50,000-£500,000, in theory they will pay for themselves within 1-3 years. Although the technology has largely been adopted in UK hospitals, in local pharmacies we’re currently lagging behind. In Denmark almost 70% of community pharmacies have moved to dispensing robots and the figure is an estimated 30-40% of pharmacies in Europe. In the UK it’s less than 10% but those who are using them are keen advocates. Aberdeenshire pharmacist and tech enthusiast Galen Will is one of market-leading medical tech company BD Rowa’s 8,000 UK customers, saying “There are many benefits, such as accuracy, safety, dispensing efficiency and date rotation”. Thackers Pharmacy in Manchester is another example cited by the Royal Pharmaceutical Society, installing a dispensing robot that speeded up dispensing times, improved stock control and saved space that was turned into three patient consultation rooms. It also allowed the pharmacists to focus on clinical services and other areas. An unexpected bonus is the interest the technology creates with the public – there’s been more than one ‘name the robot’ competition in the last few years.
Michel Jürgens, sales director at BD says that automated dispensing ‘offers an opportunity to change how dispensing works’. So, what’s holding UK pharmacies back? As well as the initial investment, it may be down to worries about reliability, though evidence suggests the automated technology is reassuringly stable and accurate, with service agreements covering rare problems. There are also worries about job cuts, though the experience of Galen Will negates that – in fact he had to hire more staff to deal with the increase in turnover that resulted from adopting the technology. Perhaps it’s also because there’s no government decree, it’s up to individual pharmacies and pharmacy groups to take action and so far, only a small proportion have been brave enough to make the investment and actually do it.
New ways to engage with patients
With local GPs and the NHS under enormous pressure, future pharmacies reinvigorated by everyday technology like text messaging, live chat and video calling combined with better delivery services could play a larger role in patient care. Treating everyday illnesses through digital channels would take the strain off local GPs – not to mention lessen the chances of patients spreading non-serious but tiresome ailments to those who may be more vulnerable in the GP’s waiting room. In the U.S. some pharmacy chains already provide ‘live chat’ with a pharmacist on their websites, and the NHS is also launching an online service, concentrating on two areas: contraception and colds & flu. In Scotland it’s easier for pharmacists to manage patients with long-term conditions or minor ailments because local pharmacies and GP practices are already electronically linked; this is crucial in the rest of the UK to enable pharmacies to take on a bigger role.
The growing need for long-term treatment management
The digital revolution has resulted in people wanting more control over their care. Many of us can’t resist consulting Dr Google in the first instance, but information on the internet is overwhelming and can be contradictory. There’s an increasing need for treatment management; our aging population means there’s a growing number of people with long-term health problems who are on numerous different prescription medications, with 24% of adults report taking three or more prescribed medicines. GPs are advised to prescribe the cheapest version of a drug at that particular time, meaning patients can be prescribed a different brand with a different name from one month to the next, a system that unsurprisingly leads to confusion. Then there’s the difficulty of understanding how different medications interact with each other, or whether it’s possible an overworked GP who hasn’t read their full medical history has prescribed something unsuitable because of a pre-existing condition. Although some if not all of this information may be included in the patient information leaflet that comes with prescription medicine, the small print and indigestible format may lead to it being ignored. There is an opportunity here for pharma brands in conjunction with pharmacists and other healthcare providers to provide the reliable, objective information and tools that patients are looking for. But they need to remember that if there’s any sense that they’re simply pushing product, adoption will be low. Only by supporting outcomes rather than specifically focusing on the medications they sell will pharma companies overcome issues of trust and reach a wider audience.
Big pharma brands are already making some moves in this direction. AstraZeneca’s Day-by-Day mobile coaching app, delivered in partnership with Vida, is designed for patients who are recovering from a heart attack. The app is unbranded and can be used by any user, not just those taking the company’s drugs. In return the company will learn how patients are using their medications as they recover. In the future a digital assistant powered by machine learning that could offer personalised advice based on someone’s medical history, current health and treatment could potentially provide an additional, perhaps even better service than overstretched GPs. But perhaps a more pleasing alternative for pharmacists might be to adopt the approach set out by Eric Kinariwala, founder and CEO of New York City-based Capsule pharmacy. In an article for virgin.com he said ‘Rather than trying to develop technology to supplant [pharmacists], we built a technology platform designed to turn them into super-pharmacists – able to quickly use data to give consumers the right advice based on their behaviours and history. We used technology not to replace people, but as a way to make people better.”
Changing times, changing roles
The role of community pharmacies and pharmacists is growing and changing, and pharmacists everywhere should be emboldened by the successes in both patient treatment and business shown by digital pioneers. Bringing in new technologies should not be a way of simply cutting costs but instead allow pharmacists to focus on other services provided within pharmacies or via digital means. There are opportunities to learn new skills and take on a new role, not trying to replace GPs but as a trusted advisor in what will become an ever more important part of the healthcare ecosystem. In addition, if they can learn how to do it successfully there are opportunities for pharma brands to engage directly with customers in a way that has always proved challenging.
This is digital disruption brought to the pharmacy’s door but ultimately it will mean better patient pathways, closing the circle between patient, pharmacy and doctor. Perhaps a return to the more personalised service of yesteryear when people would have a proper relationship with a family doctor they’d seen for years, rather than being given a maximum 10-minute appointment with a stranger. Of course, whether that’s provided by a super-pharmacist assisted by digital technology or an AI who knows which hay fever medication you’re allergic to remains to be seen.