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Relationship building – with patients, families and myriad of relevant healthcare professionals (embedding in communities and local healthcare services)
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Use of key wholesalers/distributors – 1-2 WDs used as first-line options, protocol driven prioritisation of WDs (which to use when).
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Online information technology systems for stock management and ordering
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Time to delivery – same or next weekday delivery, multiple deliveries per day via multiple WDs.
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Sourcing stock from other pharmacies – networks run via instant messaging apps.
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Medicine shortages – a universal challenge, related requirement to seek out information via professional organisations. Lead to quotas (rationalisation), price rises and last resort a prescription change.
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Need to use multiple WDs – creates complexity (multiple supply routes) and onerous workload. Required because of Solus agreements and medicine shortages.
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Lack of communication and relationships with WDs and manufacturers – lack of meaningful two-way communication underpinned by trust with WDs and manufacturers, consequent lack of relationships. CP contact with WDs via telesales service centre staff, with no clinical insight and reliance on information technology systems.
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Shortcomings of ordering systems – despite the systems being a facilitator to supply, they could also act as a barrier as: systems not sufficiently live, CPs needed to phone WDs to try to find out information on a vast array of issues e.g. when a product would be back in stock, how long a product would take to be delivered if it had been switched to a different warehouse, brand availability, expiry dates.
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Disincentives to stock palliative medicines – for some CPs lack of stock turnover of such medicines (associated costs and lack of long shelf life), added issues with controlled drugs (e.g. need to store in locked cupboard, inability to return controlled drugs to WDs).
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Lack of weekend ordering and Sunday deliveries – requirement to wait for Monday's deliveries led to problematic supply over weekends.
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Issues with WD deliveries – medicines missing from the delivery (usually when the medicines had become out of stock at the WDs, but CPs did not know this until the delivery arrived), occasional other issues e.g. delivery drivers doing too many hours (so return to base without making deliveries).
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Relationship-building – importance of methods, contractual/informal communications and creation of feedback channels.
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Upstream relationships with manufacturers/suppliers – contractual relationships, information-sharing, supply certainty.
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Downstream relationships with pharmacies – responsibility to assure supply, timely information, middleman position.
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Collaborative relationships – collaborative good practice, working to common agenda, patient safety, roles of other parties.
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Investment in logistics infrastructure – choice of partners, development of logistics equipment, impact on service responsiveness.
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Demand and stock management – access to stock pools, supply continuity, impact of generics, sharing of demand patterns (WD and pharmacies).
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Buffer stock availability – in UK and Western Europe, additional resilience in the supply chain, changing roles of full and short-line wholesalers during stock droughts.
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Supply disruptions – United Kingdom regulations, pricing and value of sterling; medicine shortages.
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Strategic drivers – demand for generics, quotas and WD storage capacity.
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Downstream issues – export trading by pharmacies, geographical differences in palliative care medicine lists, speculative stockholding by pharmacies, stockpiling by patients.
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Upstream issues – inadequate forecasting, prediction of operational issues, manufacturing shortages, lack of timely information, product recalls, reputational damage, temporary stock shortages.
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