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Like many pharmacists, my attention was drawn to the Auspharmlist posting entitled "120 prescriptions and close the door", and the record number of responses that occurred.
This group of the more articulate members of the Pharmacy Profession were complaining quite loudly, about their unsustainable workload and loss of lifestyle.
Some offered suggestion fragments, but no one offered an overall strategy or a range of tactics to achieve the objectives of a strategy.
The topic and responses could be arguably a "snapshot" of the tip of the iceberg for pharmacy at large.

When I was initially asked to write for the newsletter, I was to fill the rather large shoes of Leigh Kibby, a specialist corporate consultant involved with social aspects of the workplace and "soft" management skills.
When Leigh first started writing, many pharmacists did not immediately appreciate the relevance of what he was talking about, because the stress problems of the pharmacy workplace had not exacerbated to the stage where they were trying to cope with GST and trivial details pertaining to Medicare cards.
Both the above are examples of government legislation to pass on unpaid work to community pharmacy, at a very high financial and personal cost, contributing to stress levels at a dangerous-to-personal-health rate.
Most of Leigh's articles were pitched at future corporate pharmacy, where larger groups of employees would be involved.
When I followed on, I brought the perspective back to the "here and now", because I was more familiar with the pharmacy workplace (Leigh is not a pharmacist). My first article related to "Improving Team Performance", because this was a good starting point.
It is worth revisiting as part of your strategy to get above the "120 prescription per day and close the door" syndrome, which I will now abbreviate to the "CTD120P" syndrome. This syndrome now seems set to be part of contemporary pharmacy folklore, and a valid extension of the "4-Wall" syndrome, which has also afflicted pharmacists for many years. The first article in this subset was entitled "Practice Management- a Model for Consultant Pharmacists".

My subsequent writings have been literally about strategies to avoid the above two syndromes, focusing on the role of a consultant pharmacist and building a set-piece pharmacy, detailing physical and human resource changes required.
My model was a hypothetical, but it is now looking a more solid example to adopt as a permanent strategy.
(See Bridging the Gaps , Extending the Boundaries , Integrating the People , Developing Services , Value Adding to Services )

My last article in the previous newsletter ("Innovative Workplaces") was designed to finish off the set that I had written. They are all designed to be read consecutively, and in context. They represent a basic strategy, and the tactics required, to make that strategy a reality.

To the list of suggestions outlined in those articles, I will add a few more suggestions, some borrowed from other writers to this newsletter.
I will leave it until 2002, to go into a new set of articles.

It seems to me that a very obvious addition is to consider a merger with one or more of your opposition. This to provide additional pharmacists and to concentrate a market share which provides a good scale of economy.

First step, form a local association of interested pharmacists who would consider a merger or an amalgamation of their businesses. Set up a framework for discussing the immediate and long term problems, and the potential solutions.
Decide where you want to be, how you wish to practice and what time frame you envisage these changes will need to be completed by.
This requires a detailed business plan.
Working back from the solutions, engage or employ various specialists to advise you of the options available and the appropriate pathways to achieve these solutions.
For example, a consultant accountant may be engaged to design a financial reporting system.
If he/she is competent, then an Internet based system would be advised where all participants could be initially involved. The strategy may be:

1. The system is built utilising Intranet technology where the basic hardware/software can be shared in cost by all, but each individual has their own "firewall". A single accounting software system to be adopted.
2. The system be designed so that it can be upgraded when a merger or an amalgamation takes place, and does not have to be dismantled or replaced.
3. The system be designed so that theoretically, everyone in a given town or region can participate, and eventually become one large business (even though the business may still comprise two or more strategically located pharmacies).

The association should be formally constructed with a constitution and a set of procedural by-laws and rules.
A formula should be worked out (probably based on turnover of each pharmacy), as to what annual subscription each pharmacist should contribute. The funds generated by this method should then be applied to the costs of consultants/advisers and the cost of physical systems, software, office rental, general overheads or any other expense incurred on behalf of the group.
Voting rights are attached to the subscription rate on the basis that, say, $100 creates one vote.
Decisions should also be made as to what will eventually happen to this association after it has served its initial purpose (it could be converted to a Division of Pharmacy Practice, or it could be incorporated as a service unit or the vehicle for mergers/amalgamations).

Once accounting procedures have been worked out, a similar process is then adopted for inventory control and purchasing.
A single inventory management system should highlight high volume products that can be amalgamated for bulk buying.
The best price is then negotiated for these orders and the purchase is completed, either direct from the manufacturer (involving a fulfillment service) or from a wholesaler, depending on price and service.

A lead time of 18-24 months would probably be a realistic time for the above procedures to be adopted and to be working smoothly.

The next step in the process is to begin to merge or amalgamate.
This process should be based on which people share similar values and vision, rather than the capital involved in merging assets.
Capital contribution in the form of assets or actual cash injection is also important, but takes second place to the new culture that is to evolve.
If by this time, pharmacies are legally allowed to incorporate, then a merger becomes a much simpler process, simply by the exchange of shares.
A new company is formed to take over the assets of those pharmacies involved, so that the liabilities of each individual pharmacy are not carried forward to the new venture.

This is the most crucial stage of the process because it involves people and possible job losses. Human resource strategies have to be carefully mapped out so that the skills required for the merged business, are available on day one of trading and are fully trained.
Once the merger is completed, expanded premises have to be considered and the funding of them. Venture capital or other forms of development capital need to be considered very carefully.

One of the first systems to be installed in the newly created pharmacy will be an automated dispensing machine. There are a few models that have been tested to a satisfactory level, and the decision to select this tool is a prime decision.
Before entering a binding purchase agreement, different members should trial a range of available equipment to ensure that local conditions are satisfied.
This process is designed to release pharmacists from the relentless grind of dispensing, or have to enter the CTD120P decision process (remember," Close The Door at 120 Prescriptions per day"!).
The decision to instal such a machine should also be coupled with the decision to totally delegate the dispensary to qualified technicians (see the Consultant Pharmacist Model- Extending the Boundaries ).
Training systems for dispensary assistants should begin immediately an association has been formed, and a workplace team should be nominated (for dispensing) as soon as the merged pharmacy opens.

Now, and only now is the pharmacy, and the pharmacists involved, ready to take on the new services in a proper framework and begin to develop creative extensions.

Any group of pharmacists contemplating an attempt to create the pharmacy model sketchily outlined above, would be advised not to do so without the help of skilled advisers, who have a total understanding of the pharmacy market.

Any group who may wish to move down this pathway can contact the editor of this newsletter. An alliance of consultants does exist to effect the appropriate processes, and some are already writing for this newsletter.

To me, 2002 brings the promise of rapid, but positive movement.
The unsustainable workload can be eliminated in two to three years time if the above processes are put in place now.
More, you are liable to emerge with an organisation that can take on the big end of town, because you will be quicker on your feet, and you will have adequate human and financial resources.
Unfortunately, there are no short cuts.
The status quo will not and cannot remain, as more pressure is put on pharmacists to compete on different levels, plus cope with government paperwork.
The existing model is not geared for survival, as it cannot ultimately pay its way.

I am looking forward to 2002, and I hope you are too.

All the best for the festive season and a safe holiday period. Peter Sayers

Ends

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