This article is the last in an article series attempting to summarise a focus for community pharmacy direction using an outreach Pharmacy-in-the-Home program as a driver of future directions.
We have identified two main demographics as being the driving forces – the ageing population and a younger time-poor demographic who have in their charge young children in the 1-5 age bracket.
Both of the above are traditional pharmacy markets and both require major restructuring to satisfy their needs.
The aged care segment needs a program to back their ageing in place, while the younger segment requires a convenience program to assist them in managing their busy lifestyle that underpins careers that financially provide the monetary backing to support “the good life”.
Because the senior citizen component is the face of chronic illness, particularly in the last decade of their lifespan, they are increasingly more dependent on clinical services.
It is well-known that consumers are looking more to pharmacists to fill this need, but pharmacy leaders have been too slow to formulate solutions to meet the clinical needs of aged care in the home setting.
The schematic that i2P has proposed over time can be simplified to the following elements:
* A whole of business approach to back an outreach “in-home” service.
While an outreach service represents an alternative to the established model of a highly accessible and very expensive retail shop model, you can’t go outreach unless you have a strong administrative centre and an actual service program to deliver.
So, if an outreach is not on your immediate agenda, make sure that in-house clinical services are upgraded rapidly.
* A marketing approach that contains the elements of:
(i) an expanded clinical service offering within the pharmacy but designed to extend to a patient’s home, assisted by technology (Telehealth) and an efficient logistics system.
(ii) A bricks and mortar pharmacy that is large in size (even multi-storey) that provides a “home” for subcontracted clinical service pharmacists as well as a range of other health providers (natural health plus allied health).
It should also have a large suitable space for an Internet retail service, as well as offices for administrative functions.
A seminar room is also a requirement for patient workshops/seminars which also doubles for staff training.
(iii) the location of the pharmacy to be as part of a health precinct centre that has less focus on retailing and more on health service provision (pathology, imaging, specialist medical practitioners, GP,s, respite service providers, community nurses etc.).
While the precinct is substantially comprised of health service provision operators, other services need to be provided e.g. coffee shop, light meal restaurant, basic needs supermarket – to assist the employees that work within the health precinct.
Rents for these location types would be more affordable and work to reduce patient out of pocket costs – particularly transport costs incurred by current GP “traffic-director” type practices that generate multiple referrals involving long distances.
(iv) The pharmacy offers a controlled retail offering that is highly competitive to all other retailers and attracts new customers who can be converted to registered patients.
This retail segment will be permanently run on a low margins – even accepting losses to create new customers. Patient conversion will balance out the gross profit requirement.
(vi) The promotion of all clinical services should form up under a Local Area Marketing program controlled by the pharmacy or local pharmacy groups.
* The clinical service management centre is formed up around an interview bench located near the front of a community pharmacy.
The function of this space is to conduct preliminary patient interviews and direct patients to appropriate spaces and human resources.
Attached to this system is a range of privacy areas with design features related to “privacy intensity”.
It should involve at least one space fitted out with “Switchglass” which creates a space that automatically advertises itself as private as the glass panels become opaque during interviews, and clear when the space is not in use.
The interview bench also handles enquiries for Pharmacy-in-the-Home requests and matches them to an appropriate resource.
It’s primary function is to systemise and promote a formal registration process that converts a “customer” to a “patient”.
* The emphasis in delivering clinical services is one of education, training and collaboration between pharmacies, pharmacists and other health professionals.
Even to the extent of creating cooperative enterprises to deliver these activities on a shared cost basis.
The principal format for training and clinical service development should be a workshop with an audience of combined pharmacy staffs of all types held on a cyclical and permanent basis.
The workshops need to be designed around problem-solving with the solution suggestions coming from the audience.
* The clinical services provided need to be organised into the following formats.
(i) A specialised “walk-in” clinic designed to promote a health service with a public health benefit e.g. obesity, anti-smoking, chronic disease support (diabetes etc.).
(ii) Consultations that are based on Health Literacy.
These types of consultations will help drive the Self Care market as literate patients tend to take control of their own health.
(iii) Patient seminars and workshops designed as health problem solutions.
These provide the equivalent of a group consultation at a lower cost while also driving further the private health literacy consultations.
This activity creates opportunities to collaborate with patient self-help community groups and they can be mobile as well as in-house static activities.
(iv) Brochures, booklets, and patient registration documents form part of a systemised marketing program that underpins existing services and announces new services.
* A pharmacist presence in a patient’s home is a cost that has to be underwritten with appropriate funding.
This may eventuate as part of government funding under MyAgedCare funding designed to allow senior citizens to age in place.
Our leaders need to focus on this and mark it up on their agenda.
In practical terms, the pharmacy will have to generate independent funds to support the program.
This is the reason why pharmacy can never divorce itself from retailing, because traditionally, retailing has always been the funder of new professional services.
So, to establish an outreach service into a patient’s home you need to couple the well understood pharmacy skills of logistics support, plus a “key item” product or service that is a basic repetitive need.
This is why i2P has suggested a key item represented as a gourmet quality, snap frozen nutritious meal, that comes preservative-free and is tailored for certain consumer need e.g. gluten free, lactose free, low GI, low salt etc.
The link to one such wholesale provider is www.gourmetmeals.com.au .
Try them yourselves – you could be pleasantly surprised.
So the key to community pharmacy direction lies in building larger pharmacies located in cheaper rental spaces and preferably surrounded by other health services to form up a “precinct”.
i2P notes that some Chemist Warehouse sites appear to be embracing the precinct concept and this reasoning may have been behind their investment into the now defunct Masters Hardware sites.
As we have often commented, you cannot sustain deep discounting forever and you have to provide other market supports to disengage from profit shrinkage as other outlets challenge your price leadership.
As an aside, i2P was the first publication to alert community pharmacy to the opportunities that could arise from engaging in the medical cannabis market and encouraging pharmacy leaders to assist by ensuring appropriate Poison’s Schedule listings, particularly for CBD oil (only needs Schedule 3).
Apart from a watching brief, there is little visible movement among pharmacy leaders, except to trumpet the propaganda line (by global pharma’s) that cannabis be restricted to medical specialist prescribers and that it only be used after all mainstream medicines have been utilised.
What utter bulldust for a substance that has less harms associated with it than your average mainstream medicine plus an exceptional safety record (no death ever recorded from cannabis toxicity).
Pharmacy’s future is really joined to this substance as a safe means of supporting chronic illness and as a means of reducing our PBS costs because of its unique character.
Because of the Location Rules and structure of Australia’s community pharmacy system, pharmacists are the best positioned health care professionals to create consumer accessibility, patient education, secure cold chain storage and the ethical marketing to reach the entire community.
Pharmacy needs to prioritise its focus on medical cannabis because it represents the real opportunity to replace a moribund and expensive PBS system with a health system actually contained in a plant that is self-contained.
As we have often noted, the PBS, as a product, has reached the end of its life cycle.
Medical cannabis has the capacity to replace and renew a substantial segment of the PBS while simultaneously stimulating Health Literacy consultations.
Using the natural product full spectrum formats it also opens up a market for specialised compounding solutions.
And on the investment side it provides opportunities in growing, manufacturing and distribution of a range of cannabis products.
The recent announcement by Chemist Warehouse that they have signed up to distribute medical cannabis (including its natural form) comes as no surprise, and simply highlights the awareness of its management skills compared to official pharmacy leadership skills.
Chemist Warehouse is very much creating a future to preserve and increase its market share and that includes a slow progression to what we might describe as a mainstream model of community pharmacy, with global aspirations.
We have already predicted and provided analysis on the direction of Chemist Warehouse as it left the folds of Sigma and go to Symbion.
Part of that analysis predicted a possible merger with the Terry White franchise.
As you would know, Symbion has now purchased Terry White Management and is now in a position to create a single dominant franchise within Australia that would truly represent a springboard for a full global expansion.
It would come as no surprise to see the Terry White segment of that franchise devote itself primarily to clinical service development and delivery.
While that model virtually creates a large segment of the Australian community pharmacy market concentrated into a few hands it also highlights how little effort and thought that official pharmacy leaders have devoted to their membership future benefit.
How does that make you all feel?
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