Like world peace and reducing carbon emissions, the transformation of a National Pharmacy Network in the United Kingdom seems logical, desirable and in the interests of all. At least it seems logical and desirable to governments, and there have been concerted moves across Europe to obtain added value from their pharmacy networks, with seemingly good support from pharmacy bodies. Pharmacy bodies, of course, realize that artificial intelligence, robotics and other technologies now allow for the “Amazonization” of medicine supply and therefore present significant threats to current networks. But, like world peace and reducing carbon emissions, what seems like a good idea at a higher level can appear less so when the detail is considered and it comes down to the level of day-to-day practice and how we get paid.
Ultimately, the pharmacy network must be plugged into, and aligned with, the direction of national health care policy. Without exception, across Europe, national health policy is transforming health services to become more patient and community focused, with a greater emphasis on primary and secondary disease prevention.
Ironically, while pharmacists publicly attest to transforming by adopting more patient-centred services, even when the opportunities exist, such as in the United Kingdom’s National Health Service, it seems they are resistant to change. Values and beliefs underpin individual attitudes, and ultimately our attitudes determine our behaviours—what we do, rather than what we say we do. This is the human condition. Pharmacists are not a homogeneous group, yet little attention has been given to what these differences are and how they might be studied.
Marketers use segmentation to better understand types within groups. As a thought experiment, I conceptualized pharmacist types using 2 continuums: professionalism and commercialism (see Figure 1). The segments are generalized—pharmacists tend towards a type and can change type, and I have tried to be descriptive, not pejorative, in my choice of names.
Figure 1.
Segmentation of pharmacy-contractors by commercialism and professionalism
The shopkeeper is low on professionalism and low on commercialism. He or she will obey the law and stick to a code of ethics but will seldom truly act in the best interests of the patient. Pharmacists need to be acting and practising more in the interest of their patients so that new professional norms can be achieved. When acting this way, we must be able to stand by our actions when asked to account for them by the courts or the regulatory body. Of course, the culture in the regulatory body will also say a lot about how pharmacy is practised in a country.
The grocer keeps a tidier shop. He or she is more focused on high throughput of goods as a means to commercial success. The businessman, high on commercialism and low on professionalism, has aspirations to be a multiple owner if he or she is not already. Businessmen are probably unwilling to risk their current commercial position for a change agenda that is uncertain.
The locum is reasonably professional but has no commercial sense, while the entrepreneur is sitting on the fence and could be more professional or more commercial depending on what motivates him or her.
The homeopath is high on commercialism but lower on professionalism. Homeopaths are in many ways like the semi-medics and appear to be adopters of new practice. They are, unfortunately, and this is because of their high score on commercialism, able to manipulate science into pseudoscience if it’s to their commercial advantage. (Think homeopathy, herbal remedies, CBD oil, Botox and other dubious New Age trends in pharmacy practice.)
The semi-medics consider the patient first and are the ones who adopt new services more easily and generally support change. They fail, however, to ensure that sufficient funding is retained to allow businesses to be sustainable.
The hero of this matrix is of course the community pharmacist. It’s the ideal cross between high commercialism and high professionalism. Pharmacists have more commercial expertise than the semi-medic.
If these pharmacist types are verified, they could tell us a lot about why, as pharmacists, we act the way we do. I have not done the fieldwork and therefore don’t know how many of each type we have in the contractor base. I predict that most are shopkeepers. By awakening the shopkeepers, getting them engaged and, in doing so, increasing their professionalism and commercialism, as well as aligning this to the national health policy, we have the possibility to bring about the transformation we desire. This requires a vision and strong leadership. ■