One of the major problems facing community pharmacies is the relentless ongoing increase in dispensing business.
A large prescription volume was once seen as the measure of success of a pharmacist.
It does not have the same lustre today.
However, it is core business, and it cannot be disregarded.
I recently had cause to visit four community pharmacy proprietors in a rural town.
Of the four, three were able to see me with varying degrees of difficulty, and the fourth was not available.
All of the pharmacists looked extremely worried and stressed, although the proprietor of the pharmacy with the smallest turnover began to relax (and actually smiled) after a few minutes.

I was truly sympathetic to all these pharmacists, trapped as they were in a dispensing grind that never seems to let up.
I even offered to help them out to engineer a clear moment in time, but all refused.

With this sort of pace, is it any wonder that pharmacists feel that they do not have any time to themselves, including weekend family time, when they are often too tired to interact properly with other family members.
What sort of a life is that?

The problem compounds because this is the single major reason that senior pharmacists are/will be retiring as soon as they can, never to return to their profession. In fact, they tend to seek a lifestyle that has nothing to do with their former professional activity.

So the problem compounds for the remaining pharmacists, where the available pharmacist pool, compared with actual demand, has been shrinking for some time.
There is little help available.

I wrote about this problem late last year after putting myself back into a community pharmacy one day per fortnight.
This pharmacy dispensed between 400 and 500 prescription items per day, with incremental compounding increases of around 5 percent per month. The working day was 9-10 hours and this senior pharmacist began to flag by about 3pm in the afternoon.
Basically, I was chained to one spot checking all this blur of dispensed items (most of the work being performed by very experienced dispensary technicians), and I began to discover muscles that had not been used for many years, and joints that rebelled at the pull of gravity.
I was definitely unsafe as a pharmacist, as I became fatigued.
I kid you not, I was also an absolute wreck the next day, not wishing to ever face the torment again.

I suggested to the proprietor that he might like to consider modifying his pharmacy slightly to be "senior pharmacist friendly", and to his credit, he took the suggestions on board.
Recommendations included:
* Dividing the working day up into six hour and four hour sessions and allowing two senior pharmacists to share the working day.
* Creating a "sit-down" area where the pharmacist could properly check prescriptions and counsel patients.
Although the pharmacy was not a "forward pharmacy" operation, it did have a desk that could be modified for this purpose.
The only other problem was in relocating staff from that particular workstation to another.
There was literally no room.

There are still spatial and workflow problems to be resolved, but at least this pharmacy now has the potential to recruit and retain pharmacists that may be lost forever.
At least there is someone there in a fit state able to supervise dispensing.

This caused me to think a little more about this problem, because it is impacting on all areas of pharmacy management.
* It is not allowing time to complete other business tasks, and work has to be taken home.
* It is not allowing time to train staff, or investigate new systems, or embrace continuing education.
* Accreditation processes aggravate the situation, when they should be part of the solution.
* It is creating an environment that is not staff-friendly, and definitely not pharmacist-friendly.
It is almost impossible for a pharmacist to honour legal/professional obligations under such conditions.
* It is causing pharmacists to abandon traditional retail markets because it is just "too hard".
This plays right into the hands of retailers such as Woolworths.
* Just about any and every pharmacy process is under pressure.

Normally, when pressure builds up in a business process, the first thing you consider is contracting the process out until the cost of employing an additional staff person becomes a cheaper option than retaining the contractor.

This used to occur in earlier days when we had manual PBS claims, and coding contractors sprung up to breach the gap.
Many pharmacies still contract out their stock-taking process at the end of the financial year.
Book-keeping is another workflow that is often contracted out.

So I began to think, why not the clerical aspects of dispensing?
With the advent of the Internet, it must be possible to create a "real-time" situation where prescriptions can be clerked at a remote location (for one or more pharmacies), with labels, repeat forms and maybe even the drug item, coming together in the actual pharmacy.
Currently, this would require some sort of television system to view the actual prescription, and an electronic conversion of that prescription that could be returned to the pharmacy for claim and record purposes.
If prescriptions were generated electronically on doctor's desktops, then this would shorten the process.
This will happen eventually, but it is not known when.
Using a remote dispensing system would reduce pharmacy staff numbers and may even create a little extra floor space.

Of course, in the grander scheme of things we are talking about elements of the MediConnect system, which is now in doubt as to when it will actually appear.
It is talked as being completed somewhere towards 2010, and maybe beyond that date.

The experience in other western economies is similar to our own, and in America, prescription volumes are estimated to increase by 40 percent over the next three years.
They also have a national shortage of pharmacists.
We tend to follow American trends.
To meet the expected demand, robotic dispensing machines are coming into their own, with supermarket pharmacies leading the charge (no wonder Woolworths is interested in owning pharmacies).
The system of choice appears to be the ScriptPro 200 Robotic Dispensing System, which is rented to pharmacies at the rate of $12 per hour.
It is assumed that it is rented 24/7, so it would probably require an extended hours dispensary to make it economical.
One of its selling points is that it generates time for a pharmacist to counsel patients.
Its other selling points are that it reduces stress on pharmacy staff, and that it is affordable.

ScriptPro’s SP 200 with Automated Control Center automates the repetitive, manual dispensing tasks most subject to human error and automatically collates all prescriptions for each patient.

The SP 200 with Automated Control Center, interfaced with the pharmacy computer system, collates filled and labeled vials into 14 storage slots at a rate of 100 prescriptions per hour.
Each slot can hold a maximum of two vials and has a display that shows the patient name and prescription number(s). Upon selection of one prescription, all slot displays associated with that patient flash, directing the staff to the proper prescriptions.

The system contains 200 universal dispensing cells, which are calibrated by pharmacy staff on-site.
It handles tablets and capsules of all shapes and sizes, and supports standard pharmacy vials.
Because the system fills directly from the dispensing cells into the vial, there is no drug cross-contamination.
The system also prints and applies the prescription and auxiliary labels, and collates the uncapped vials into storage slots for final inspection using on-screen drug image verification.

Automated dispensing machines have been available for some time, with the better models coming out of Europe.
So it remains to be seen as to which system could best be adapted to the unique conditions existing in Australia.
You might also think that Australian "know how" is well behind the rest of the world.

Well I am pleased to report that this is not the case.

What we suffer from here in Australian pharmacy is a lack of financial resources, to nurture, support and develop pharmacy innovations.
Despite this, we do have an Australian group working on a remote robotic system to which I am offering as much encouragement to as I can.
It can be installed totally in-house with clerical procedures applied directly, or it can operate from a remote location, which would suit multi-group pharmacies, or contractors providing a service to one or more pharmacies.
There is also a partly selfish motive to this as well, because my own organisation has developed a connectivity component (encrypted document exchange) that would interface very well with this type of equipment.

And the whole system will be affordable, and looks like being cheaper than the American system illustrated on this page!

There is no doubt that pharmacies able to develop environments that are staff-friendly, will not only attract a major percentage of available staff, but will attract the best quality staff available.
This is because interesting jobs will be able to be developed with the new time made available.
Unless pharmacist thinking is concentrated on solving the prescription problem that exists today, new services such as the cognitive services, will never get up and go, because there is just not enough time left.
Dispensary automation is the only way to go in the quest to generate a surplus capacity.

Then, and only then, will we, as pharmacists, claim back our weekends.

However, we do need a coordinating body to work through.
Logically, this would be the PGA or the PSA.
It would also need for these bodies to retain an "arms-length" to any pharmacist innovation, because it would require the handling of "commercial-in-confidence" information.
Currently we see both the above bodies, particularly the PGA, endorsing software.
Involvement should go deeper than just endorsement, up to and including finding alliance partners and finance, also helping to market the end product through endorsement and promotion.
Recent events with PGA and the patenting of a system that resembles a government financed system, would tend to cloud the above recommendations, but it is not too late to sort out an open and transparent policy in this regard.
And in the interim, perhaps PSA could step in and fill the breach.