Balancing the ethical and commercial pressures of community pharmacy

In community pharmacy, there is a perception that pharmacists struggle with balancing commercial pressures with the safety and ethical aspects of patient care. Sean Quay and Mohima Akhtar ask whether it is impossible to be profitable while remaining professionally ethical. Or can the two co-exist? 

Facing current challenges

One of the questions frequently raised is whether or not there is an expectation for pharmacists to increase sales via upselling over the counter (OTC) products, especially during the holiday season. Some pharmacists also find themselves facing pressure from patients requesting a particular product advertised, regardless of appropriateness. Should we take advantage of this in order to meet an end-of-year Christmas sales quota? Here, pharmacists face an ethical and commercial dilemma.

Pharmacists working in both independent and large multiples also face the strain of low staffing levels. Overworking and compromised patient safety results from more prescriptions being dispensed by fewer members of staff. While pharmacy services are moving in a positive direction — with flu jabs, vaccinations, travel clinics and medicines use reviews (MURs) — staff shortages restrict provision as the services considered essential are prioritised.

There is also controversy around targets being used as performance indicators for community pharmacies. To budget their ‘pot of money’, the Department of Health started the Quality Payments Scheme to encourage the improvement of patient care in community pharmacies through paid incentives. For example, pharmacies are encouraged to make asthma referrals and share learning from near misses. Some pharmacists argue that targets are actually a ‘win-win’, because the higher number of services provided, or criteria set, leads to an increased pay-out, making the business profitable. This also improves the quality of patient care. However, lower motivation to exceed targets may manifest once the required numbers are attained, which defeats the purpose of the payment scheme.

Experienced pharmacists on balancing ethical and commercial pressures

We approached a number of experienced community pharmacists to determine their views on these issues. Many cited patient safety as their biggest concern. If a patient’s needs cannot be met, directing them to another pharmacy increases patient trust. Placing the patient’s needs first encourages patient loyalty and increases the likelihood of them seeking your expertise in the future.

The majority of pharmacists we spoke to do not feel pressured to sell OTC products. There is more emphasis on illness prevention through vaccination and encouraging patients to participate in other beneficial services. This approach helps to develop patient relationships and the business.

Sustaining the daily operations of a pharmacy with limited staff numbers will always be challenging. Many pharmacies want to improve time management by encouraging patients to visit the pharmacy during non-busy periods or to make appointments in advance. But increasing patient engagement can be challenging. Other efforts include training staff in several areas so they can operate in multiple capacities.

Investment in robotic dispensing is another strategy to free up dispensers and provides opportunities to upskill and accuracy check. Pharmacists will be able to interact more with patients and provide clinically oriented services thereby improving overall patient care while increasing revenue. Training and development is also key to increasing efficiencies.

Commercial pressures do not necessarily hinder patient safety. On the contrary, there is potential to enhance patient-centred care by encouraging pharmacists to seek opportunities to improve the existing pharmacy model.