‘Are there any ways of avoiding this demise?’

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A pharmacist has signalled concerns about the “demise of community pharmacy” in the UK

Community pharmacy may be under significant threat having been “damningly considered” as an “incomplete profession” over the decades, argues Dr Richard Cooper from the University of Sheffield in the UK.

“Despite funding concerns and varying political policies, it is tempting to think that within health care in the UK, the core professions remain enduring pillars of stability, and perhaps never more so than in the recent COVID‐19 pandemic,” says Dr Cooper, a former community pharmacist and Senior Lecturer in Public Health.

“However, the community pharmacy and community pharmacist professional role may be under significant threat.

“Enduring sociological criticism, failure to act on policy recommendations, remuneration issues, dispensing automation and ambiguous public health roles all conspire to threaten their existence.”

While there has been a rise of GP practice‐based pharmacists, non‐medical prescribing and advanced clinical practitioner roles, community pharmacists have had “little opportunity” to take on such roles, Dr Cooper writes in the International Journal of Pharmacy Practice.

He adds that recent threats have emerged in relation to online pharmacies and increasing use of hub-and-spoke approaches in the UK, making it more likely that medicines can be sent directly to patients without the traditional pharmacist involvement.

Within the ‘hub and spoke’ dispensing models, a ‘hub’ pharmacy dispenses medicines on a large scale, often by making use of automation, preparing and assembling the medicines for regular ‘spoke’ pharmacies that supply the medicines to the patient.

“Based on the aforementioned technological changes and potential separation of community pharmacy from medicines, will the public still use the physical pharmacy?” he asks.

“Why would the public be inclined to visit a community pharmacy if their medicines are no longer supplied there?”

MedAdvisor executive director and CEO Robert Read has previously warned of this same phenomenon potentially reaching Australia with the advent of e-prescriptions.

“Up until now it’s been a hard environment for online pharmacies, because not only do you have to order online but you’ve then had to send your script in physically to that pharmacy before it’s dispensed,” Mr Read told AJP in December.

“But if you can simply SMS or email you script to an online pharmacy, you’ve got rid of that barrier to usage. There will be online pharmacies that come out in Australia and they will market aggressively for patients.”

Mr Read encouraged community pharmacists to make sure they are offering their patients the convenience of an online solution in addition to the support of a physical pharmacist.

“That is something online pharmacies can’t do. Community pharmacy should leverage their strength as trusted health practitioners … and also provide the convenience of ordering, paying in advance and delivering to your home at the times you need it.”

Dr Cooper suggests that providing opportunities for the public to self-manage conditions and receive advice, for example through minor ailments schemes, also remain important activities which community pharmacies can provide.

“However, these still require adequate independent remuneration if they are to avoid issues of commercial and professional conflict,” he says.

“Despite the commendable current efforts of community pharmacy in the current COVID‐19 pandemic to ensure medicines are supplied and the public kept safe, the future is less optimistic. The roles and opportunities for pharmacists in hospitals and locations such as GP practices and primary care are more obvious and defensible but for the community pharmacist, they appear all too mortal.”

Australian pharmacist researchers have recently pointed to the importance of the upcoming 7CPA to secure viability for the industry and adequate remuneration for pharmacist roles.

“Without adequate funding and recognition of pharmacist’s contributions to primary care, it will be difficult to ensure integration [into primary health],” they said in Pharmacy Practice.

“It is clear that the next five years will be critical to lay the foundation for change that is needed to support further integration of community pharmacy into primary care.

“The [7CPA] and the Government’s 10-year Primary Health Care plan will become the determinant of sustainability for the profession.”

See the full editorial by Dr Cooper here

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