COMMUNITY PHARMACY MANAGEMENT

INTRODUCTION

• Basically, every organization is an “input – output” system
• The input – output system of a community pharmacy:

Functions of Pharmacy Management 

• The role of business and the functions of management are to ensure that this input – output system operates smoothly
• The most important  functions of pharmacy management  can be grouped as

          Accounting highly interrelated but separate activities

           Finance

           Human resource management

           Operations management

           Marketing management

• Finance Management in Community Pharmacy
• Planning, developing and operating a community pharmacy for long term rest on a solid financial foundation
• It takes money to make money
• The key financial issues that should be addressed are

ú  How much money is needed to start the pharmacy or fund the desired level of operations?

ú  Where will the money come from?

ú  How will the funds be used?

ú  How can additional funds be obtained in the case of an emergency?

ú  How will the money be paid back to lenders or adequate returns provided to investors?  

Determining Financial Needs:

• The  financial requirements of a pharmacy revolve around three interrelated needs as shown in the following table :
• The best way to determine the financial need is using the worksheet.
• Capital requirements should be estimated and planned for the next 2 to 4 years
• It is best to take conservative approach in projecting sales and a liberal approach to estimate expenses
• Once the financial needs are assessed the owner’s “equity position” should be determined
• This is the money the owner is able to commit to the business vs. the amount supplied by creditors and other investors
• If the personal contribution is insufficient to cover all needs for capital , the owner should begin to identify different sources
• Understanding the various sources of funds and their implications for the business are keys to successful capital generation and financial management
• The two main types of funding are debt and equity financing
• Debt financing can be grouped on the basis of the lengths of the loans as ‘Short – term’ and ‘Long – term’ financing
• Equity financing involves selling part of the ownership in the pharmacy to others (Possible only in partnership / corporation)

Financial Records:

• Records should be kept for internal and external reasons
• The basic books for record keeping are ‘Journals’ and ‘Ledgers’
• Journals are useful for initial recording of all transactions
• Ledger posting from journal, systematizes the financial activities
• Record transactions should be done systematically using the ‘double entry book keeping system’
• The three important financial statements for internal and external use are

Human Resource Management

• Recruitment and selection of employees has become one of the more complex elements of the staffing process in most pharmacies
• Errors made in hiring can have a significant impact on the pharmacy’s  ability to survive
• It cannot afford to hire a few bad employees before finding Mr. or Ms. Right 
• Modern staffing requires serious consideration of where good prospects are likely to be and development of an active recruitment effort
• Some of the most common sources of potential employees are
•  Pharmacy Employees – Current labour force for better opportunities and higher positions / salaries
• Referrals – Through friends, business associates, employees
• Employees of Other Companies – Hiring an employee from a competitor
• Employment Agencies – Both from Public and Private Agencies
• Educational Institutions – Through the placement cells of the universities /  colleges
• Labour Unions – if employees are or will be members of union
• Advertising – Newspapers, professional journals / periodicals
• Drop-ins – Sign boards in pharmacy’s window 
• The selection procedure need not be overly complicated, but it should be standardized to the extent possible
• The basic procedure consists of six steps, some of which can be undertaken simultaneously

Step 1: Provide the applicant with an application form

Step 2: Review the completed application form and administer a personal interview

Step 3: Check the references provided by the more promising applicants

Step 4: Administer a battery of skill or personality test, or both, to more promising applicants

Step 5: Take physical examination for the most promising applicant(s)

  Step 6: Decide which, if any, of the applicants to hire

• The Pharmacy should be managed under the overall supervision of a Pharmacist, who will have the final responsibility for all the professional activities and operations
• All personnel including newly recruited personnel should be trained as per the personnel-training program of the pharmacy
• All activities by the pharmacy personnel should be carried out as per well documented guidelines and procedures, which should have been developed by the management in consultation with the Pharmacist.
• Each personnel should have clear job description, which should be performed accordingly
• All personnel in the pharmacy must, at all times, wear a neat apron / coat
•  All personnel should additionally wear a badge prominently displaying their name and designation
• All pharmacy personnel should be medically examined and adequately immunized periodically and their health data should be archived
• Pharmacists working in the pharmacy should:

                                a. Hold at least a Diploma in Pharmacy

                                b. Be registered as a Pharmacist with the Pharmacy Council of India

                                c. Have undergone adequate practical training in a community pharmacy

                                d. Have communication skills & capabilities to give adequate and proper advice to the patients on illness and appropriate use of medicines so as to achieve optimal patient compliance

• Each Pharmacist working in the pharmacy must be competent enough to:

         a. Play a professional role to assess prescriptions

         b. Advise patients on appropriate selection and use of OTC medicines

         c. Advise patients on appropriate use of prescribed medicines

         d. Check and advice on drug-drug and drug-food interactions

         e. Be alert for adverse drug reactions

         f. Comprehend the client’s condition or illness and provide advice on proper medication and diet

         g. Assess the patient’s condition and decide when to refer him/her to the Doctor

         h. Perform the role of a healthcare provider and a counselor

Infrastructure Requirements

Selecting a Location

• One of the principal reasons for the success of a new pharmacy is good site location
• Despite this locations are too often selected in an unscientific manner

Factors to Consider in Selecting a Pharmacy Location

• Population Characteristics
•  Total size
• Growth trends
• Age distribution
• Income distribution
• Prescription buying power
• Occupation trends

• Competitive characteristics
•  Number of competitors
• Size distribution of competitors
• Location of competitors
• Competitive growth trends
• Physician Availability
• Number of physicians
• Types of physicians
• Financing
• Requirements
• Sources of funds / credit foactors

Premises:

• The location of pharmacy should be such that it is easily identified by the public. The neat and clean environment should be maintained at the exterior of the pharmacy. The facade should be clearly marked with the word “PHARMACY”, written in English as well as in  regional language
• The pharmacy should be conveniently accessible to people using prams or wheel chairs
• Pharmaceutical services and medicines should be served from an area which is separate from other activities / services. This facilitates the integrity and quality of service, and minimizes the risk of dispensing errors
• The pharmacist should be directly and easily accessible to public for information and counseling
• The pharmacy environment should be clean with minimum dust and should be maintained clean as per the cleaning schedules and Standard Operating Procedures (SOPs). The pharmacy should be free from rodents and pests/insects and pest control measures should be undertaken from time to time
• The premises of the pharmacy may be separated from other rooms for private use
• The premises shall be well built, dry, well lit and ventilated and of sufficient dimensions to allow the goods in stock especially medicaments and poisons to be kept in a clearly visible and appropriate manner
• The area of the section to be used as dispensing department shall be not less than 6 sq. mts. for one pharmacist working therein with additional two sq. mts. for each additional pharmacist. The height of the premises should be at least 2.5 mts.
• The floor of the pharmacy shall be smooth and washable. The wall should be plastered or tiled or oil painted so as to maintain durable, smooth washable surface devoid of holes, cracks and crevices 
• Adequate space as recommended by the regulatory authority is necessary (100 sq. ft), which should be enough for holding shelves, display counter, counseling area, and sufficient for movement of personnel and patients
• The dispensing department shall be separated by a barrier to prevent the admission of public
• The pharmacy should have a telephone service and constant supply of electricity, especially for the refrigerator(s)
• There should be a provision for drinking water to facilitate medicine administration to the patients and for use of the personnel
• The pharmacy should have:

   a. Sufficient place for patients to stand comfortably at the dispensing counter and for some to sit comfortably while they wait

     b. Space for patient information displays, including information leaflets / material

   c. A separate enclosure described as "Counseling Area" for patient counseling, storage of reference resources (e.g. books, internet access) is a fundamental requirement

• Counseling area should be a place where patients can talk freely with the Pharmacist. It should be away from the area otherwise normally accessed by the patients and should preferably be an enclosure with a door which can be closed for further confidentiality. It should be well lighted with comfortable seating for the Pharmacist and the patient/attendant
• A compounding pharmacy should also have sufficient additional space for making extemporaneous preparations, and the necessary equipment for doing so
• Separate waste collection baskets/boxes should be available for the personnel and for the patients
• The pharmacy should be air-conditioned and well ventilated. The medicine storage area should be protected from exposure to excessive light and heat. Ambient temperature in the pharmacy should be maintained within the stipulated range to prevent deterioration of various medicines stored at room temperature conditions
• Pharmacy providing related services such as doctors, clinics, and first aid and dressing services should manage them separately

FURNITURE & FIXTURES

• The pharmacy should have neat, well-placed shelves with provision for storage of medicines and other items in a neat manner, protected from dust, moisture, excessive heat and light. Adequate provisions should be available for storing various medicines at prescribed temperature conditions.
• The counseling area should at least be furnished with

                                a. A table

                                b. Chairs for the Pharmacist and a couple of patients.

                                c. Cabinet for storing Patient Medication Records (PMRs)

EQUIPMENTS

• The pharmacy should be equipped with refrigerated storage facilities (validated from time to time) and should be available for medicines requiring storage at cold temperatures

• The counseling area should be equipped with: 

            a. Reference material

            b. Demonstration charts, kits and other demonstration material

            c. Patient information leaflets (PILs)

           d. Some basic instruments e.g. sphygmomanometer, glucometer, thermometer and stethoscope

           e. Weight & height scale

• The pharmacy should preferably be equipped with computers and appropriate software (automation) that can

                                a. Manage inventory

                                b. Manage invoicing

                                c. Generate timely warnings for expiring medicines

                                d. Archive patient medication records

• The computers should also be equipped to give demonstrations to the patients and for maintaining database
• Compounding section of the Pharmacy should be equipped with appropriate apparatus required for the preparation
• List of  items given in schedule N of Drugs and Cosmetics Act should be available in the pharmacy

Please share your suggestions and comments

Thanking you

AKSHAYA SRIKANTH

Pharm.D Internee,

Hyderabad, India