Amazonification of Pharmacy in the UK

Yesterday, I did a check on my balance of payments at Douglas and it seems our profit margin in the past year has halved on NHS activity. This is not only a massive detriment to myself but the staff that I employ. Furthermore, waking up this morning to the news that Amazon has moved into the pharmacy sector has led me to write this article to try to figure out a strategy for my business to figure the best way forward.

PillPack holds pharmacy licenses in all 50 states, by Amazon absorbing them for $1 billion, the largest online retailer has officially entered the Federal Pharmacy business in the US. By looking at Amazon's progression of acquisitions it is probable that this is a proof of concept before Amazon roll pharmacy services out internationally. But what does this mean for UK community pharmacy?

The reaction of the US market today to the Pillpack news was a huge drop in share price of the big federal pharmacy players (CVS/Walmart etc):

In the UK, repeat prescriptions account for 77% of all prescribed medicine with an estimated 29 million people receiving repeat prescriptions at a cost of nearly £8 billion of NHS expenditure each year. 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 deeper it seems that these players are not profitable and seem to be hanging on in the market for an acquisition by a logistical network such as Amazon.

So what can we do?

I think a change in direction is needed, instead of focusing on prescription levels we need to look into other services that we can provide which remote prescribing cannot. This is my plan going forward:

1. Protect your NHS business, best you can.

Those patients who cannot, or do not wish to use digital technology including people with learning disabilities, cognitive impairment and the frail elderly, 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 of grave concern to our existing business.

2. 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. The resulting prescription is then sent automatically via the hubnet.io into my account.

Free online listings: If you run a Travel clinic with us join up to Getjab.co.uk or Traveljab.co.uk to get patients coming into your pharmacy for Travel services.

3. Get rid of the governance hassle.

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, our £30pm subscription remove the need for you to perform:

·            CPPQ Surveys

·            Clinical Governance

·            Audit Compliance

·            Standard Operating Procedures

·            Controlled Drugs Registers

·            Staff GPhC Revalidation Tracker

·            EPS Nominations and Repeats

Give us a call and we will digitize your entire pharmacy for you and put you on the right track.

4. Get rid of the paperwork.

A little known, free 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 your through the whole system and show the benefit it can have on your practice.

Who is Simon Dukes PSNC Chief Executive

Simon Dukes took over from Sue Sharp previous Chairman to the PSNC in 2017.

Simon was previously the as CEO at Cifas between 2013-2017. Prior to this, he worked for the UK Government in a variety of roles and specialisms including:

• Counter-terrorism
• Serious and organised crime investigations
• Defence and security policy
• Public affairs; media 
• Communications strategy
• Cyber security

As Head of Cyber Security for the Centre for the Protection of National Infrastructure, Simon worked on the first Cyber Security Strategy - focusing on increasing cyber security awareness in those companies of greatest value to the UK. In addition to being Cifas Chief Executive, Simon is also on the Oversight Board of the Home Secretary's Joint Fraud Task Force; and the Management Board of the NCA-led Joint Money Laundering Intelligence Task Force.

Independent Pharmacist Prescriber

Are you a pharmacist who is also a prescriber? We have grouped together to make an association and private WhatsApp group to share best practice, you can join using this link: hubnet.io/ipreg.

Demise of Pharmacy PGD

It is probably no surprise to you that PharmacyPGD.co.uk seems to have gone out of business. On the front page of their site it states:


We have done a little bit of research and pulled up some articles from the Chemist and Druggist, namely:

http://www.chemistanddruggist.co.uk/news/pharmacy-pgd-closes-down-reasons-beyond-control

In the article, it goes on to explain, not very much. Essentially, it seems like they have closed their doors due to unforeseen circumstance. In the wider community pharmacy arena there is much speculation on the topic.

Untethered Travel Clinic PGDs

You may have missed our launch of the all new Travel Core 2.0 so here are some of our product launch videos. The first one is for Pharmacists who are managers of pharmacies. The idea of the Travel Core 2.0 is to get as many pharmacists under one umbrella as possible, so we can all benefit from our economies of scale.

The second video is meant for pharmacies locums:

If you would like to sign up to the new Travel Core 2.0 please give us a call on: 

020 7971 7777

New Travel Clinic 2.0 Package

After 6 months of research, design and development, today we have released a brand new Travel Clinic package. It is far superior to our previous iterations as we feel we have improved on every aspect of the service. The package has been expertly curated by Mike Bereza our lead clinician.



Highlights include:

• 3 hours + of updated HD training videos, with real pharmacy practice examples.
• Online decision making tool to aid you in your clinical decision making.
• More PGDs, including the popular Meningitis B vaccine Bexsero.
• Prescriber phone support, which can send you private prescriptions directly if you are uncertain about specific patients.
• All yours from £300!

These are just some of the exciting new developments. If you are interested in signing up please go to voyagermedical.com or give Mike a call on: 020 7971 7777.

PGD and Independent Prescribing

Can independent prescriber nurses/pharmacists use PGDs in their daily practice?

In short no. PGDs should only be used in the absence of a prescriber, if the prescriber can write a prescription there should be no need for a PGD. However, as with most things in life, this issue is not so black and white. PGDs are generally used in primary care for those high volume, generally safe medicines which can be given to a well defined group of patients which is usually established via the Specific Product Characteristic (SPC) of the medicine. Whereas healthcare professionals who can prescribe, do not need a well defined group but base their decision on an individual basis i.e. writing a prescription is a type of Patient Specific Direction.

The only possible reason why a prescriber would use a PGD is that although they can prescribe any medicine, they can only prescribe within their own specialty. For instance, if a nurse prescribers specialty was diabetes you would assume that they could prescribe things like:

• Insulin  
• Oral hypoglycemics
• Needles
• Syringes
• etc

You would not expect them for instance to be trained to prescribe Emergency Hormonal Contraceptives (EHC) or Hair Loss medication as this would be outside of their scope of practice. In this case the prescriber is in limbo land on one hand they are excluded from using PGDs because they are a prescriber but they cannot prescribe the medicine as this is not in their scope of practice. The easiest answer to this is to undergo some sort of training as per best practice whether this is a course endorsed by the GPhC or NMC.