Three issues ago I wrote that nearly a third of people who don't use a pharmacy said they didn't know a pharmacy could help.
I've since been told, politely, that I had it slightly wrong. And the correction is more useful than the original point.
Stephen Toland is a pharmacist and independent prescriber, and the founder of ConsultTed. He put it like this:
"Patients are more aware than ever that a pharmacy can do a lot more than just prescriptions. But they still do not fully understand the extent of what is available. Are they eligible for a service? Is it a private paid service? How do they qualify for Pharmacy First?"
Read that again, because it changes what the problem is.
It isn't ignorance. It's uncertainty about entitlement, and uncertainty doesn't make people ask. It makes them go somewhere else, or go home.
Why that distinction matters commercially
If the problem is "they don't know we exist", the answer is advertising. Posters, leaflets, the window.
If the problem is "they don't know whether this applies to them, or what it will cost", then no amount of advertising fixes it. People don't walk into a shop to find out whether they are allowed to be helped.
That second problem is answered at the counter, by a person, in one sentence.
And it runs both ways
Stephen made a second point I hadn't considered at all:
"Patients are being turned away from the pharmacy counter when the patient could have been treated there. And equally, patients are being signposted to the pharmacy from the GP practice when they are not eligible for treatment at the pharmacy."
I asked him whether that's because the rules are genuinely complicated, or because the team isn't certain in the moment.
His answer: both.
And this isn't only his view. Community Pharmacy England has published guidance warning pharmacies about rejecting referrals too readily, pointing out that a patient who doesn't meet the criteria for a clinical pathway may still be seen under the minor illness strand of the service. A local committee's own guide this year noted that some referrals are being rejected when they could still have resulted in a claimable consultation.
So the sector's own bodies are saying it. Eligible people are being turned away, and claimable consultations are being lost.
The business arithmetic of "no"
Every time someone is turned away who could have been helped, three things happen.
You lose a consultation that may have been worth a fee.
You lose whatever they would have bought.
And you lose the thing that takes years to build: the belief that coming to you is worth the trip.
The third is the expensive one. A person who is sent away once does not come back to test whether the rules have changed.
Why it's nobody's fault
The pathways are narrow, and deliberately so. There are age limits. There are exclusions. There are red flags that must send someone elsewhere, and those boundaries exist for good clinical reasons. They are not up for commercial negotiation, by me or anyone else.
But look at it from behind the counter on a Tuesday afternoon. Pharmacy First, private services, prescribing, more products than ever. As Stephen put it, teams have been "bombarded" with new responsibilities while already under pressure.
In that situation, "no" is the safe answer. It's quick, it's never wrong, and nobody is ever reprimanded for it.
That's not a people problem. It's the same missing decision we talked about in Issue 4, wearing different clothes.
The one line that changes the outcome
What your team needs isn't a rulebook. It's one sentence to use when someone is not eligible for the thing they asked about.
Something that means: this particular route isn't open to you, but you have not come here for nothing.
Because "not eligible for that pathway" is not the same as "we can't help you". There may be another part of the service. There may be a private option, properly explained with its price. There may be advice and something to buy. There may be the right referral to the right place, which is itself a service worth doing well.
What the person must not hear is "no", followed by silence.
The Potheko Move
Ask the people on your counter one question, separately, and write down what they say:
"What do you say to a customer who asks about a service and turns out not to be eligible?"
You will probably get several different answers. Some will be good. At least one will be "I just tell them to see their GP."
Then write the one line you want them all to use. Not a script for everything, just a single sentence for the moment the answer is no.
One thing to do this week
Just ask the question and listen.
You'll learn more about how many customers you lose at the counter in ten minutes than from any report.
Hit reply and tell me what your team actually says. I'll publish the best version I'm sent, because this is one of those problems where the right sentence is worth more than the right analysis, and somebody out there has already found it.
Next week: January. The quietest weeks of your year are the only ones with enough time to fix anything, and almost nobody uses them that way.
Pollyanna
Thanks to Stephen Toland for the conversation that produced this issue.
Potheko also publishes the Pharmacy Profit Accelerator, an eight-module workbook for owners who want the whole system in one go rather than one idea a week.