Alphega is working hard to encourage members to be as efficient as possible and identify their priorities, says head of member engagement Neil Scobie. Interview by Arthur Walsh

The current contractual framework in England offers more opportunities than ever before for community pharmacies to develop their clinical practice and forge links with other NHS providers. However, the severe cost and staffing issues many contractors are facing can make it challenging to engage with the new commissioned services. 

There is a delicate balancing act to be struck here, something that Alphega head of member engagement Neil Scobie is acutely aware of. He and his team are in frequent contact with member pharmacies to try and understand their capacity constraints and the most effective way to work around them.

“Costs are just going up and up, so when staff are leaving, the pharmacy isn’t necessarily replacing them and is trying to get by without – but that is at complete odds with trying to deliver more services,” says Neil.

“What we’re trying to do is encourage members to be as efficient as possible and identify what is absolutely necessary for them. What should they focus on as a priority, and what services are nice-to-have but not essential?”

Neil encourages pharmacies to consider factors like the potential to boost footfall and service payments, as well as the “halo effect” that can make a patient come back to the same pharmacy again and again for their care.

Be realistic

It is about being realistic, he says. “We appreciate you might not be able to afford another staff member. So if that is the case, are you using everyone you currently have to the best of their ability?”

Alphega offers guidance and support, summarising the key documents to provide contractors with boiled-down, essential information and training requirements for themselves and their teams, he says.

“We try to take as much of the admin burden from pharmacies as possible – which can be very off-putting for independents – and leave them to deliver the actual services.” It is important to provide targeted briefs for the whole team, he says. “It is not just about pharmacists.”

In addition to an online member hub, Alphega reaches out to independents through newsletters and communicates directly with teams on a regular basis. 

“If a new service is launched, we jump on it straight away,” he says, citing as an example the serious shortage protocols for HRT products announced by the Government shortly before he spoke with Pharmacy Magazine.

Common queries

What questions are raised most frequently by members? “The most common queries are about the set-up of services. That can mean a number of things: what training do I need to do, how long will it take me – that sort of thing.” 

Getting the right equipment can also be an issue. Many pharmacies struggled with this when the hypertension case-finding service launched last year, he says, adding that Alphega managed to tap its links with suppliers to source some kit and get it out to members.

With some of the newer services, pharmacies are having to forge links with other providers such as GP surgeries and hospitals. Can this be daunting? “Definitely, particularly with hospitals.”

For example, with the discharge medicines service and the new smoking cessation service, pharmacies will have to identify points of contact who may have varying job titles depending on the hospital.

Then there is the fact that pharmacies are at the mercy of referrals from these people, who may be dimly aware of the service, if at all. “Where pharmacies have control over uptake,  they obviously prefer that because they can then manage workload. So if it is a service where they approach patients who may be eligible, such as BP monitoring, they can manage the delivery.” 

This is reflected in the uptake levels for the hospital referral services, which he describes as “nice-to-have” but not yet creating much activity for members. Neil stresses that this is the first time pharmacies have had to develop “strong links” with secondary and tertiary care, and says that despite the teething difficulties it may create more opportunities down the line.

When it comes to the GP referral arm of the Community Pharmacist Consultation Service, things are a bit more positive. In many cases, the relationship between pharmacy and surgery has been established by now with “regular dialogue” taking place.

However, the time when GP referrals – as opposed to those coming via NHS 111 – make a meaningful contribution to pharmacies’ bottom line is still “some way off ”, he says, as it is still the extended hour pharmacies gobbling up most of this revenue. “Nobody is going to be living off GP-CPCS, but the numbers are starting to get bigger.”

Allowing walk-in minor ailments services as in Scotland would help “within reason,” although he argues it could also exacerbate workload issues for teams that are already stretched thin.

The latter issue is reaching existential proportions for the sector, he says, pointing to PSNC’s recent findings on stress. “Pharmacy teams are just frazzled after the last few years.”The cost of living crisis is hitting pharmacies that didn’t have much financial wriggle room to begin with, he says.

“As a small business owner, if you can’t afford enough staff, then the people who are left are under even more pressure – it has been relentless.” Unsurprisingly, he is not hopeful that the NHS will “wave a magic wand” and boost the global sum significantly. 

Breathing space 

Working with a membership company like Alphega can offer some degree of breathing space to independents, he says. “We have the tools to help, whether that is staff training delivered by our field teams, support material for services or help to develop pharmacies’ retail offering, which can be a nice added extra.” 

It is about removing the blocks that stop pharmacy teams from delivering healthcare to patients, he says. “We are trying to create solutions for members to allow them to speak to as many patients as possible.” 

New BP service going well in Tamworth

Tamworth contractor and Alphega member Kieran Eason on his positive experience so far with the hypertension case-finding service: “I think I’m in the minority as most people I’ve spoken to don’t seem to be doing as well. The main difference is the surgeries are on board – 99 per cent of our referrals come from there.

“I went round and spoke to all the receptionists – they really are crucial when it comes to the referral services – and then when a patient comes in to them, instead of booking them in for a blood pressure check, they send the person to me, and I send back the results straight away or let them know the patient is going to come back later with their 24-hour monitoring data. I keep the communication lines open.

“It helps the link we are building with the surgery through CPCS and it takes appointments off them. My staff are very engaged with services, which also helps.

“In terms of numbers, it is not massive, but it is nice and sustainable – 10-20 blood pressure readings a month and maybe five ABPMs. Some surgeries are keener to refer than others, but generally it does link up with CPCS quite nicely.

“Patients appreciate the service. With CPCS, they’re more used to getting referrals from the surgery, so it is becoming more standardised. The hypertension service fits into that nicely, and patients much prefer to get their reading in the pharmacy because of the convenience.”