Dr Kayne outlines many aspects of community pharmacy practice that can make it a satisfying career
It is estimated that over 70 per cent of our young graduates find their way into community pharmacy. Some make it their life-time career, starting out as employees and then becoming proprietors in due course. Others combine community pharmacy with teaching or become locums. One thing is sure: community pharmacy represents the "sharp end" of our profession and is the last link in a chain that seeks to bring relief in sickness and to promote good health.
In recent years, our activities have become far wider than the traditional compounding and dispensing and now demand a range of skills that would have mesmerised our predecessors.
No doubt the large multiple companies will continue to vie for the bulk of prescription business in the early years of the new millennium. They will grow bigger by acquiring more outlets in this and other European Union countries. Already more than 50 per cent of pharmacy businesses in the UK are owned by firms with five or more branches. Most of these are operating extended hours, so increasing numbers of newly qualified graduates are likely to be employed by multiples.
However, the scenario could change, for it is hoped that in future years the pendulum will swing back to encourage the establishment of a network of well equipped pharmacies with highly trained staff providing a range of specialist services to clients from different sections of the community. This could be achieved through amalgamation of existing small businesses to give two- or three-pharmacist units. Pharmacies might specialise in servicing specific diseases, eg, asthma or diabetes, or might carry out diagnostic testing or provide health information for travellers. An interest in sports care is another possibility.
All this means that there is likely to be a bright future for a select band of young and enthusiastic independent pharmacists, many of whom will not be as shy about charging for their expertise as their predecessors have been.
The key to these extended roles will continue to be an effective programme of continuing education.
A recent example of the possibilities is the development of a pharmaceutical care scheme which is being provided to selected patients free of charge at Abbey Chemist in Glasgow (PJ, November 13, 1999, p771). Initially, cardiovascular health, a major problem in the West of Scotland, will be targeted.
Undoubtedly, health authorities will eventually adopt an integrated approach to pharmacoeconomics, rather than consider primary and secondary care to be separate entities, as they frequently now seem to. They will come to recognise that allocating resources to support pharmacy initiatives will provide excellent value for money in the longer term. It will then be possible for pharmaceutical care to become a part of everyday practice throughout community pharmacy, so giving the opportunity to use the communication and clinical skills that form such an important part of modern teaching at university.
This will not happen overnight, and it will not happen without the profession demonstrating the financial savings to be made. There has been an important step forward in this area provided by a primary care group in west London. In an effort to reduce prescribing costs, pharmacists are to be paid for achieving a series of intervention targets while dispensing prescriptions (PJ, January 1, p5). Providing prescribing advice to general medical practitioners is also a small but growing area of involvement.
Becoming a proprietor pharmacist can be a particularly satisfying career development. There are few professions that can offer the mix of interests found in the average community pharmacy business. However, a substantial investment is required to obtain and run a thriving business that will yield a good return for the many hours of hard work necessary. A modest pharmacy with an annual turnover of £250,000 might be expected to cost about £125,000, depending on the geographical area. Bigger turnovers command increasingly higher prices.
Some types of pharmacy are referred to as being "professional", which suggests that there are others which are not. The term is normally meant to apply to pharmaceutical services but can also apply to business activities, of which retail marketing is just one example. Retail marketing includes market research, the design of a service or product, planning for its introduction through to its promotion and, finally, the sale. In the future more attention will need to be paid by all pharmacy businesses, whatever their turnover, to the external and internal marketing environments within which all these activities take place.
The external environment includes such factors as the economic situation within a country that controls disposable income, the activity of competitors and changing legislation. The switching of prescription medicines to pharmacy supply presents a substantial opportunity in this context. The necessary consultation process also places more pressure on the pharmacist's time. More switching will occur and I believe that prescribing rights are just around the corner.
Other external factors that have brought about changes in pharmacy practice in recent years include a shift in the demographic profile of the community (age distribution and racial mix, for example), producing changing health requirements and altered attitudes to health care among purchasers.
The internal environment includes the organisational structure of a business, the day-to-day business activities, how time is organised and how the pharmacy is designed. Here, pharmacists have direct control over the factors involved in making their premises attractive and efficient - features increasingly demanded by the consumer.
Within the past few years a third and increasingly important marketing environment has been identified. This, the customer environment, reflects the importance of dealing with customers and understanding how they make buying decisions. Communication is the key skill in this environment. The choice of an appropriate marketing mix is vital in securing customer loyalty. One must make decisions on the portfolio of services and products to be made available, the exact characteristics of each of these services or products, the price to be charged, the types of promotional activities to be pursued, and the location or place of delivery (in the shop, in a consultation area, at home, etc). The added value element that can be offered in terms of advice and counselling within the wider context of pharmaceutical care gives us a competitive edge over health stores and supermarkets, many of whom also sell our "bread and butter" lines. The community pharmacist's day involves a trade-off between all the factors outlined above.
E-commerce is likely to play an increasingly important part in community pharmacy activities, with e-mail communication becoming the norm. Britain's first internet pharmacy has already opened for business (PJ, November 27, 1999, p849). The services on offer include the dispensing and delivery of private prescriptions, the sale of medicines and health care, personal care, beauty and lifestyle products and appliances. A planned future extension of services is to draw together a network of local independent pharmacies. This would make it possible for clients to place electronic orders for products and then collect them from a local pharmacy.
Complementary medicine will continue its rise in popularity in the years to come with herbal and aromatherapy remedies moving ahead faster than homoeopathy. The market value grew steadily from £15m in 1994, to around £20m in 1996 and £25m two years later. These figures pale into insignificance compared to some other European countries. France, for example, with a similar population to Britain, has a market value about 15 times our figure.
Over the same period, herbal medicines achieved 47 per cent market growth and aromatherapy an impressive 100 per cent increase. Although the homoeopathic market is still increasing, the trends show that its popularity is falling behind both herbalism and aromatherapy. Evidence shows that the public often turn to pharmacists for advice on complementary medicine and buy remedies as an alternative to orthodox medicines. With the inclusion of complementary medicine in most British undergraduate pharmacy courses and the recent positive attitude of the Royal Pharmaceutical Society towards pharmacy involvement it is likely that community pharmacy will see an interesting opportunity here.
Another interesting area is animal medicine. Just over half of all households in the United Kingdom are thought to own at least one pet, with companion species such as cats and dogs, being the most favoured. It has been suggested that over half a million cat or dog owners visit pharmacies daily, giving plenty of scope for new trading opportunities. Animals such as horses, cage birds and ornamental fish are also popular.
Much pet care is of a prophylactic nature and it is possible to satisfy requests for assistance without contravening the Veterinary Surgeons Act 1966. This law restricts diagnosis and treatment of animal diseases to veterinary surgeons and owners. However, pharmacists are able to advise on the availability of medicines when approached with questions such as "My dog has XYZ, what is available to treat it," provided that the owner makes the final choice. Pharmacists may not suggest cures in response to questions like "Can you tell me what is wrong with my dog and give me something to help?"
More than 90 per cent of companion animal products are currently sold from pet shops and supermarkets, with veterinary surgeons, agricultural merchants and pharmacies accounting for the balance.
The pet conditions most likely to be encountered by community pharmacists are those resulting from infestation with ectoparasites (fleas, ticks, lice, etc) and endoparasites (worms of varying types). Such conditions require a readily accessible, knowledgeable source of supply for the appropriate products. Pharmacies could become an important source of information and supply to pet owners, not only in traditional rural areas, but in the cities too.
There is much to commend the practice of community pharmacy in this country. It is not an easy option. Rarely - if ever - is a community pharmacist to be seen sipping coffee and reading the paper in the back of a pharmacy.
To survive in its highly competitive sector pharmacy must be actively engaged in offering added value to its health-care remit. The opportunities are there. If we do not grasp them with both hands other, possibly less well qualified people, most certainly will.
Steven Kayne is a community pharmacist in Glasgow and a freelance pharmaceutical writer. He edits the Agricultural and Veterinary Pharmacist