The Pharmaceutical Journal
Vol 268 No 7189 p358
16 March 2002

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Can pharmacists be social entrepreneurs?

By Hooman Ghalamkari and Duncan Jenkins

In their Broad Spectrum article (PJ, 22/29 December 2001, p880), Bissell et al ask where pharmacy is in the agenda for tackling health inequalities and argue that pharmacy has a place in fostering social capital in a local community. We support their concepts of social capital and argue that the business element of pharmacy has much to contribute to the social capital of a community. We would like to introduce readers to the concepts of "social businesses" and "social entrepreneurs", which we used in our attempts to establish a healthy living centre and which could be used to further the contribution of pharmacy to health inequalities.

For survival all organisations, including pharmacies, need to make a financial profit on the capital that they have invested. There are businesses, however, that can potentially directly affect the health and social wellbeing of a population. For example a school with high standards of education and achievement will produce a qualified population with confidence and greater potential for success in future life. Similarly a supermarket selling quality, affordable food could potentially have a huge impact on nutrition and the future wellbeing of the local population. Businesses such as this can be referred to as "social businesses", which as well as producing a financial profit also make a social profit.

Pharmacy activities, such as provision of specific and individualised health information, help with treatment of minor ailments, and advocacy, in ensuring people make the most of their prescribed medicines, also produce a social profit. Pharmacy's social capital is the community pharmacist and employed personnel; its social profit is a health-responsible population with a greater capacity for self-care.

In this model, the financial business element of a pharmacy is a great asset. Most importantly, the financial business ensures sustainability of the pharmacy and the services it provides to a neighbourhood. In cash-strapped local authorities, sustainability of services is a major issue and, for local communities, there is nothing worse than establishment of new projects and schemes that are brought to an abrupt end because of cost-cutting measures. Sustainability of facilities such as pharmacies and post offices is closely linked to maintenance of local communities and has officially been recognised by the Government's rural White Paper. In terms of service provision Government encouragement of public-private partnerships, especially the formation of primary care funds, further exemplifies the importance of sustainability.

In our experience, completely new services, such as drop-in advice centres, have had limited success, due largely to the fact that the local community is generally unaware of the service. A further asset provided by the financial element of a pharmacy is the potential for community engagement: people already use pharmacies for both health and non-health related goods and therefore there is the potential to expose both the healthy and the ill population to innovative services. This characteristic has been successfully exploited in many health promotion projects but could be extended to social projects such as housing and benefits advice. This concept, similar to opportunity costs, is known as additionality, where introduction of new services or extension of existing ones can be achieved with minimum effort.

The position that pharmacy occupies in between the formal health care system and informal health networks of family and friends is also a major asset. For a population, this means that service provision is convenient, non-threatening, credible and thus accessible in every way. Finally the distribution of pharmacies, especially in areas where access to health is an issue, potentially provides a facility that can affect a population's wellbeing.

Reputation

Social and financial profit need not be at the opposite ends of a continuum. The goodwill of a pharmacy, with its added value services that ensure repeat business, is important. Activities described above that raise social profit will also raise financial profit in terms of the reputation of the pharmacy, relationships with other members of the health care team, introduction of new customers, retention of existing customers and thus the goodwill of the pharmacy. Local pharmaceutical services contracts may place more emphasis on community activities by providing direct payments for such services.

Entrepreneurs are usually the people who develop successful businesses. They tend to be proactive, determined, not limited to one field of business, well informed, forward thinking and have wide and varied networks. These are exactly the characteristics needed for developing a successful social business. Social entrepreneurs are able to identify the needs of a local population, enlist the help of other agencies and individuals, engage members of the local community, empower people to access services, enable agencies to identify and make contact with individuals and engineer pride in a local neighbourhood.

The gradual decline of the numbers of independent contractors and the growing numbers of employee pharmacists working for large multiples have meant that entrepreneurial opportunities in businesses have become limited. However, entrepreneurial opportunities in improving the wellbeing of individuals in neighbourhoods are endless for pharmacists working in a community pharmacy.

Pharmacists are ideally placed to champion improvements in a neighbourhood as long as they take a holistic view of wellbeing. Most pharmacists are aware of local health and social issues that directly affect their communities. Feedback of real and immediate issues can be given directly to the health and social care organisations, which would be grateful for this information.

Proactivity is a trait that many pharmacists are putting into practice, especially in the areas of health promotion. This coupled with the links that pharmacists have with GPs, nurses and health authorities, and the fact that many clients are known personally, places the pharmacist in an ideal position to become a social entrepreneur. Pharmacists' daily contact with people, their traditional role of advice giving and the credibility associated with this activity further contributes in terms of community engagement and uptake of advice or referral to other services. For individual pharmacists, as well as financial rewards, this wider remit of championing improvements is personally and professionally satisfying.

Given the potential advantages outlined above, the challenge for public health and community development as well as pharmacy organisations is how to encourage the social pharmacy model and involve pharmacists. Local pharmaceutical services may be a way forward in which public health organisations could focus pharmacy and pharmacist activities in more socially profitable activities.

Large multiple companies have already started to promote the social pharmacy model with slogans such as "In the heart of the community", "Delivering health care" and "Total health". However, local populations need to be able to trust individual pharmacists, who are the missing links in these marketing strategies. Pharmacists need to be enabled to take on the role of a social entrepreneur. For individuals to become social entrepreneurs, they need to take a holistic view of health, be proactive and committed to making improvements. Not every pharmacist will be a social entrepreneur. However, changes in job descriptions, additional training, especially in role making skills and formal incentives will orientate pharmacists towards a social entrepreneur role.

For public health and community development, pharmacies offer an established, credible and sustainable facility through which communities could become engaged in improving their own wellbeing. Lessons learnt from evolving community pharmacies into social businesses could then be applied to other neighbourhood facilities such as post offices, supermarkets and even local pubs.

Mr Ghalamkari and Dr Jenkins are pharmacists and directors of the MORPh consultancy, which provides strategic advice to stakeholders in medicines management