Early risers at the Conference on September 14 were able to take part in a 7am breakfast meeting facilitated by the journalist and broadcaster Vincent Kane. The title of the meeting was "Crowning the moment". On the panel were Mr Marcus Longley (associate director, Welsh Institute for Health and Social Care), Professor Clare Mackie (member of the Royal Pharmaceutical Society’s Council and a a member of the Crown review team), Ms Ros Meek (sponsorship and promotions director, Royal College of Nursing), Dr Bryn John (Welsh council chairman, British Mcdical Association) and Mr Gerald Zeidman (chairman, Community Pharmacists Group) |
The panel: (left to right) Dr John, Mr Zeidman, Ms Meek, Mr Longley, Professor Mackie |
To prescribe or not to prescribe - that is the question, said Mr Kane when he opened the discussion on the possibility of pharmacist prescribing in the light of publication of the Crown report. He invited members of the panel to give their views.
Mr Longley said that probably pharmacists should prescribe. What the public wanted was quality, good value and good access, which pharmacists could provide. But were pharmacists capable of taking up the opportunities set out in the Crown report?
Ms Meek said that she was not convinced that pharmacists could act as independent prescribers, but dependent prescribing was a possibility.
Professor Mackie was sure that pharmacists could prescribe with appropriate training. Indeed, she pointed out, many pharmacists were currently working as dependent prescribers in hospitals.
Dr John said that the British Medical Association supported extended roles for pharmacists but had reservations about pharmacists’ ability to diagnose. They might not be able to pick up on serious symptoms.
Mr Zeidman welcomed the Crown report. Community pharmacists were already prescribing over-the-counter medicines in their normal, everyday practice. Their role could be extended but proper training and accreditation would be necessary. Prescribing pharmacists would take an enormous strain off overworked GPs.
Mr Kane invited the audience to participate in the discussion.
Dr Alison Blenkinsopp (director, department of medicines management, Keele university) said that a key question was the best use of professional skills. Perhaps not all patients needed to see a GP and pharmacists could act as a filter.
Mr Robert Gartside (Gwynedd) made the point that every pound spent employing a pharmacist saved £5 on medicines. Doctors, therefore, should be taking in pharmacists as partners in dispensing practices. Also, he did not consider it a doctor’s job to manage repeat prescribing. Patients on repeat prescriptions needed pharmaceutical management.
Mr Kane wondered whether pharmacists would be tempted to "prescribe, prescribe, prescribe", given that they would gain financially from such transactions.
Mr Longley said that he accepted that pharmacists were currently paid for "churning out prescriptions". This had to change. Pharmacists should not be paid for "piece work".
Dr John said that doctors sometimes overprescribed, but they were trying more and more to take up rational prescribing. He accepted that a pharmacist working for a team of doctors could help make "enormous savings" for the National Health Service. But for pharmacists to prescribe, they would need access to patients’ medical records and this would result in huge confidentiality problems.
Mr David Morgan (Cardiff) said that the confidentiality issue was a red herring. Hospital pharmacists had always had access to patients’ medical records without problems. He wondered about the time scale for pharmacist prescribing.
Mr Longley said that that was difficult to specify. Crown offered an enabling mechanism but the onus was on the profession. Pharmacy had to push forward or it would become marginalised.
Mr Zeidman commented that time was needed for legislation to be put in place and for training and accreditation schemes to be set up.
Mr Hemant Patel (immediate past president, Royal Pharmaceutical Society) said that pharmacists were already trained clinicians and it was nonsense to suggest that they were unable to prescribe.
Dr Keith Holden (Durham & Teesside pharmacy practice unit) said that prescribing was poor in Britain, and pharmacists taking up the mantle of prescribing and clinical follow-up was essential.
Mr Mark Koziol (a member of the Society’s Council) said that he knew from personal experience that GPs did not have the time to look into chronic repeat prescriptions. Would it it not be better for that to be done by a pharmacist, who could refer the patient back to the doctor if necessary?
Ms Collette McCreedy (National Pharmaceutical Association) said that if pharmacists had learnt everything there was to know about medicines, then those skills should not be wasted.
Dr John said that there were some very good points in the Crown report. He felt that with proper co-operation between pharmacists and doctors a better deal for patients could result. But pharmacists would not be able to prescribe across all specialties.
Mr Zeidman repeated his assertion that training and accreditation schemes were vital.
Mr Kane wondered where the money would come from to set up such schemes.
That was a big question, said Mr Longley. He wondered, indeed, whether the Crown recommendations would ever be implemented, adding that there were some who would like to see Crown quietly disappear. There was a need to persuade the Government that Crown mattered, because without Government backing it had no future.