The independent community pharmacy sector is fast evolving into a more service-based model. With the impending acquisition of Pharmacy2U by Amazon and the meteoric rise of internet pharmacies such as Well and Boots… (see image below) We don’t have much choice.

Our representative associations have promised more commissioned services to compensate for this loss, but where are they? We are now on equal par with GPs abilities i.e. we have the means to supply medicines and care via PGD or Independent Prescribing but why does the NHS not look at community pharmacy as a low priced alternative to commissioning in primary care? To date we have seen the withdrawal of MUR and Minor Ailments, but where are the new services that will keep us financially viable?

Unfortunately, it seems a round table for commissioning doesn’t exist. The NHS is at the top commissioning services, the money for which flows its traditional course, roaring down to the CCGs and GPs and then lastly trickling to pharmacies.

How can we independent pharmacies keep up?

One way is to address a need of your commissioner, find where there is an issue in the system and create a solution. But where can you find an established need? One place is going direct and searching for local NHS tendering websites and procurement requirements. However, competition here is fierce from larger chains and medical agencies.

A fascinating place to find an issue which needs resolving is the Courts Tribunals Judiciary website. This site publishes a list of preventable deaths attributed to alcohol, drug and medication. Here is a quick summary of the latest entries… (Or make an entry yourself by clicking this link…

Many of the issues listed relate to overdoses with tramadol, even though the medicine was reclassified as Schedule 3 in June 2014. As a pre-reg tutor why not get your Pre-Registration student to go through this list, get them to pick one issue that a pharmacy could potentially resolve and design a solution. In the case of tramadol, why could there not be a specialised MUR-like service which audits patients who may be at risk of overdose?

PillPack holds pharmacy licenses in all 50 states in the US, by Amazon absorbing them for $1 billion today, the largest, global online retailer (Amazon controls about half of the U.S. online-retail market and takes in about 5 percent of the nation’s total retail spending) has officially entered the Federal Pharmacy business in the US. By looking at Amazon’s progression of acquisitions:

It seems like this new venture into the pharmacy sector is a proof of concept before Amazon rolls out its pharmacy services internationally.

But what does this mean for my UK based pharmacy? 

The only real indication of what would happen in the UK if Amazon announced a UK venture is the reaction of the US market today to the Pillpack-Amazon merger. The markets responded with a huge drop in the share price of the big federal pharmacy players (CVS/Walmart etc):

In comparison to the US, the UK seems more vulnerable to remote dispensing services as repeat prescriptions account for 77% of all prescribed medicine with an estimated 29 million people receiving repeat prescriptions each year which is about a third larger than our US counterparts.

The remotely fulfilled repeat prescription business is flourishing already in the UK, there are established companies such as Pharmacy2U which now do 330k prescriptions per month and newer players like the app based Echo.

However, if you dig a little deeper, on Companies House Pharmacy2U in 2016 had Net Revenues of £17M with a loss of -£2M in nearly 15 years of operation this is odd as you would expect a mature business to be in the black. It seems companies like this are hanging on in the market for an eventual acquisition by a logistical network such as Amazon.

In my opinion, when Amazon announces a UK pharmacy venture this will mean:

• A large drop in the resale value of a community pharmacy as seen by the US pharmacy market plunge.
• A greater use of repeat services by patients who are preexisting Amazon customers, unbelievably, based on statistics from the Office for National Statistics 33% UK households subscribe to Amazon Prime which enables same day delivery.

So what can we all do?

Sell? This is one option for some, however, I think the independent community pharmacy model is still viable, all we need is a nudge in the right direction.

As a profession we need to understand that we are valued by customers as we have a Unique Selling Point: We are the only regulated healthcare professionals on every high street in the UK– where there is a massive shortage of doctors, pharmacists are proving to the NHS to be a lower cost alternative to deliver accessible face to face healthcare services. Amazon will never be able to open a store on every high street (although they have had some success in the supermarket sector with the $13.7 billion acquisition of Whole Foods!).

Instead of focusing on prescription levels, we need to look into other services that we can provide which remote prescribing and centralised telemedicine cannot. Therefore, this is my plan for Douglas going forward:

1. Protect my NHS business, best I can.

Those patients who cannot, or do not wish to use digital technology including people with:

• Learning disabilities
• Cognitive impairment
• Fand the frail elderly

These types of patients will have their repeat medicines proactively managed by face to face community pharmacists who have access to their clinical record and communicate with these patients before their repeat medicines are next due. There is a drive here by the NHS to move these pharmacists inside of GPs centres which is a recognised concern to our existing business.

2. Enhance my service for internet savvy customers to compete with the Digital Competition.

Online pharmacies allow for some significant benefits to internet savvy patients over regular bricks and mortar pharmacies. For each benefit, hubnet.io has created a tool so that our subscribers can better compete:

• Repeat Prescriptions – Pharmacy2U and Echo have a seamless repeat prescription service. HubNet.io subscribers get access to an online repeats module which they can embed into their website and receive digital nominations and repeats.
• Online NHS Complaints and CPPQ survey – we not only do your NHS CPPQ remotely we also handle any patient complaints in an NHS compliant manner.

3. Make use of passive income streams.

• Embed an online doctor: douglaspharmacy.com already has an online doctor we have recently changed the algorithm so that it matches other low cost prescribing services and only charges the patient £5 per consult which goes to the hubnet for providing the service. The resulting prescription is then sent automatically via the hubnet.io into my account which is dispensed to the patient at a charge of my discretion.
• Free online listings: If you run a Travel Clinic with us, join up to Getjab.co.uk to get paid referrals of patients coming into your pharmacy for Travel and Occupational Health services.

4. Get rid of the governance hassle.

Use a service such as Avicenna, Cambrian or Numark to manually handle your paperwork or combine this with our digital tools to go fully hands off. To refocus, we need to get rid of archaic practice and focus on new private and NHS revenue streams such as starting a travel clinic or looking at local commissioning via the NHS procurement portal or directly going to the CCG with proposals. To do so we need to streamline. Using HubNet.io tools you can get rid of the need to do:

• CPPQ Surveys
• Clinical Governance
• Audit Compliance
• Standard Operating Procedure Digitisation
• Controlled Drugs Registers
• Staff Revalidation Tracker
• EPS Nominations and Repeats

Our system works beautifully in combination with other buying group services, the subscription allows me to concentrate on new NHS and Private revenue streams presented by the hubnet.io.

To subscribe is simple, it costs £30pm, which is fully refundable if you are not happy with your subscription all you have to do is click the button below and fill in your details.

Alternatively, give us a call on 020 7971 7777 and we will put you on the right track.

5. Get rid of the paperwork.

A little known, free to use feature of the HubNet.io is our iPMR. Using this tool you can digitize your entire workflow including influenza and travel consultation risk assessment forms, in the coming months we will be releasing new how-to videos to walk you through the whole system and show the benefit it can have on your practice. This is a FREE service which is available to all current hubnet.io members.

The ultimate purpose of the HubNet.io is to create a digitally enabled pharmacy community which has low cost, easy to use tools to deliver safe care to patients and protect our vulnerable margins. All revenues generated via hubnet subscriptions are being plowed into creating new services and options for the wider community pharmacy sector.