A financial health check

What does it take to acquire the business acumen needed to run your own pharmacy? Kate Hilpern finds out

Barry Shooter, whose chain of five pharmacies was voted as the fourth best small company to work for in a recent poll, says the amount of business training on his degree back in 1969 was negligible. "I gained my business skills from family influence, from observing other pharmacies as a customer, from critically evaluating my own bosses during my pre-registration period, and from trial and error when I decided to head up my own business."

While he insists all these methods are still valuable, he says that today's pharmacists have access to a far greater range of opportunities. "In 1992, many years after I'd started running my own pharmacies, I decided to do a Masters in health management. Others do MBAs. This kind of postgraduate business training has much to offer and has become a popular option for community pharmacists," he says.

He adds that there are a growing number of workshops, correspondence courses and classroom-based courses on the entrepreneurial side of pharmacy. "If you look around, they are there, but you have to seek them out rather than expect them to be presented to you," he says.

The National Pharmacy Association (NPA) is one such skills provider. Offering road shows, seminars and individual telephone support for members, the organisation also provides a range of written resources on issues such as "How to write a business plan" and "Negotiating skills." Meanwhile, the Pharmaceutical Press has recently published a substantial book on the subject, entitled Pharmacy Business Management, by Steven Kayne.

The best news for today's trainees, says Shooter, is that schools of pharmacy are finally beginning to recognise the need to provide skills in areas such as accounting procedures, staff recruitment and training, marketing and business expansion. Shooter teaches pharmacy management at the school of pharmacy at the University of London to under-graduates. "I used to come in and do one-off talks on how to be a community pharmacist. After a while, I persuaded them that it was an issue that was really important and they asked me to develop a course," says Shooter.

He believes the two most critical business skills that today's pharmacists should be taught are competitive strategy and human resources. John Gentle, a director of Lunts Pharmacies in Shropshire, adds a third - balancing the needs of customers with making a profit. "Possibly unlike any other business, there are many times when we refuse sales," he says. "If Beryl down the bingo has told your customer that she should try a certain medicine, and you don't feel it's appropriate, you would encourage her not to buy it. Pharmacists do that a lot with medicines."

He adds that pharmacies have changed their business focus in recent decades. "Back in the Seventies and Eighties, people going on holiday would buy everything from the local pharmacy - toiletries, camera film, the lot. Nowadays, they tend to get those things from supermarkets, which has forced pharmacies to have a different emphasis," he explains.

He believes this is a positive step. "Coupled with the new pharmacy contract, it's driven us to become more professionally oriented. In truth, I think it might not have been something pharmacists would have gone into voluntarily, but I think it's good for us in the long term."

Raj Nutan, pharmacy business manager at the NPA, explains, "There has been a greater push by the Government, because of the shortage of GPs, to let pharmacists carry out many more services than in the past. They are becoming important members of the primary healthcare team."

But they cannot forgo making a profit, which is why the business skills required are ever-changing. "Blood pressure and cholesterol testing are two examples of new things that some pharmacists are doing, which they need to work into the overall strategy of their business," explains Nutan.

These are exciting times for pharmacy, he says. "There are great opportunities for people interested in professional independence. We are beginning to see business training that really matches their needs."

Just what the doctor ordered: supplementary prescribing

As doctors' workloads become increasingly hectic, more and more pharmacists are stepping in to help with their clinical skills. Over 600 of the UK's pharmacists are now what are called "supplementary prescribers": once a doctor has diagnosed a condition, they take over the patient's treatment plan.

Helen Williams is one of them. A member of a multi-disciplinary team that runs a heart failure clinic at King's College Hospital in London, she believes the benefits of supplementary prescribing for patients are multiple. "They have a contact, someone who they can always call," she says. "It also means a reduction in hospital admissions because we are keeping a very close eye on drug therapy."

Sometimes, pharmacists are more likely than busy doctors to pick up issues about compliance and side effects, she adds. "I was finding that with one of my regular patients, who has high blood pressure, that his symptoms were fluctuating all over the place. It was only because I get to spend time with patients and really get to know them that I discovered he was taking his drugs every other day in the hope that it would reduce any side effects. The risk to him of doing that was higher than if he had taken no drug therapy at all, and we are able to tailor the programme to one that he felt he could comply with."

Karen Acott, who is a supplementary prescriber at a GP practice in Devon, points to another advantage for patients. "They have access to a different professional who has access to their full medical records. We usually find that people don't like to take up too much of their GP's time, and will even suffer the consequences rather than bother them."

Most supplementary prescribers work alongside hospital doctors and GPs in this way, although Acott remains a minority in being a partner of a GP practice. "I certainly hope to see more becoming partners," says David Pruce, director of practice and quality improvement at the Royal Pharmaceutical Society. "But that rather depends on whether GPs recognise the benefits of having a pharmacist as a key member of the team."

Fiona Reid, who is a supplementary prescriber and a primary care pharmacist for cardiovascular disease in Scotland, says that unnecessary delay in patients getting their medicine is being avoided. "Before I was a supplementary prescriber, I was still seeing patients, but I had to get the doctor to sign every prescription, so the patient had to come back for it. Now, that delay has gone and the GP's time is freed up to see patients who actually needed to be seen by a doctor."

So successful is her clinic, to which patients are referred by GPs, nursing staff or self-referral, that she believes supplementary prescribing - and eventually independent prescribing - will soon be common. The fact that the pharmacy undergraduate course is more clinically focused than in the past - with pharmacists training alongside other healthcare professionals - means that tomorrow's pharmacists will be ready for the challenge, she says.