One of the community pharmacy sessions held on September 13 focused on new roles for community pharmacists.
Chaired by Mr Gerald Zeidman (chairman, Community Pharmacists Group), the session featured presentations from Professor Michael Pringle (chairman, Royal College of General Practitioners), who urged pharmacists to give up their independence and join the core of the National Health Service, and Professor Michael Schofield (chairman, Dorset community NHS trust), who described a cardiac health promotion initiative in Dorset
Community pharmacists should surrender some of their independence as contractors to the National Health Service and join the core part of the NHS, as general medical practitioners had in the 1960s, Professor pringle told the Conference. Such a move would give them greater influence over how the NHS was run.
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Michael Pringle: community pharmacists must "come in from the cold" |
Looking at the present situation, he said that general practice had remorselessly moved into the centre of the NHS. This was evident from the fact that primary care groups now had control of around 80 per cent of the total NHS budget, with GPs at the centre of PCGs.
"Are you able to make that transit? Have you got the ability to change? Are you prepared to change from being independent to being part of the system?" Professor Pringle asked the audience.
Working with pharmacists
He went on to describe his own rural dispensing practice. The practice had established its own pharmacy two years ago, run by two part-time pharmacists, adjacent to the premises. The pharmacists were seen as part of the practice team. They had access to patient medical records via the computer system and attended practice meetings.
"Working with the pharmacists has been a terrific learning experience. They are a terrific resource to us. Now we have a source of knowledge and experience on medicines. All practices could benefit from this and primary care groups will increase the need for this advice," Professor Pringle said.
The pharmacists attended the practice's monthly significant event meetings where important patient diagnoses and dispensing or prescribing errors were discussed. Each case was discussed in detail, each one leading to a raft of questions and suggestions for better practice. "We are all there as a corporate enterprise for quality."
Professor Pringle said that community pharmacists would be able to play an important role in sorting out repeat prescribing, the current system for which was "a shambles and a shame". Many patients could not understand why a simple repeat prescription required so much inconvenience.
He said that, in Australia, a system for repeat dispensing through pharmacies had been running successfully for 25 years, "so it is not beyond us to sort it out".
Two-way information flow
He felt that pharmacists should have access to information about patients which was held by GPs, but, in return, GPs should receive information from pharmacists about patients' use of over-the-counter medicines, compliance with prescribed medicines and any advice given to them by pharmacists.
"We need to get together so that we are giving consistent advice to patients," he said.
Although he felt that patients should still receive their medication in monthly quantities, he said that he did not want to have to issue prescriptions for it every month. He wanted to give out prescriptions and say to the pharmacist: "Take this, dispense it as needed, and you handle it until there is a problem."
The Royal College of General Practitioners was supportive of the concept of dependent prescribing, proposed by the Crown review of the prescribing, administration and supply of medicines, but with some conditions which should be met before it could occur.
Pharmacist prescribers should have to follow the prescribing norms of the other medical practices in the area. To aid this he wanted to see closer links between small numbers of pharmacies and practices within defined "spheres of influence".
Like all independent prescribers, dependent pharmacist prescribers would have to be held accountable for what they prescribed and have to justify their decisions.
Pharmacies would need to have private areas, although not necessarily separate consulting areas, so that confidential details could be discussed. The open medicines counter was not the right place for these discussions to take place.
Pharmacists would need extra training before taking on prescribing roles, especially in the area of communication skills. The training of GPs in communication skills had been developed over a 25-year period and there was no need to repeat the mistakes of the past, he said.
Concluding, Professor Pringle said that the way forward for community pharmacy was to surrender its independence and join the core of the NHS system, working as part of the team rather than as individuals on the fringe. In this way the profession would gain influence and be consulted, rather than be dictated to by the Department of Health on health policy.
"It would not be a matter of being subsumed, but of joining the primary care team as respected professionals. If you turn your back on this you will be forever marginalised," Professor Pringle warned.
"All the other health care professions are willing you to take this step and now you have the opportunity."
New funding
During a question and answer session after his presentation, Professor Pringle said that one of the benefits to community pharmacy of joining the core NHS system would be access to funding which was currently denied to it. An example of this was the NHS research and development budget, so-called Culyer money. His own practice received £30,000 per year for conducting research, some of which was being spent on projects involving the practice's pharmacists.
One of the most promising things about the National Health Service was that, although it could undoubtedly use more money as a whole, in practice there was plenty of room to improve on its existing parts. Community pharmacy was a fertile area for support and development, Professor Michael Schofield said.
Although the National Health Service as a system stood comparison against any other health service in the world, it was not perfect. There were many impediments in the way of better services to patients, including the separation of primary and secondary care, fragmented staffing arrangements, and an attempt to create a distance between the public and private sectors which was no longer as appropriate as it had seemed in 1948.
Community pharmacy stood at the crossroads between many of these aspects, particularly the public/private sector and primary/secondary care divides.
Professor Schofield went on to describe a new initiative in Dorset aimed at bridging some of these divides with a view to meeting the Government's targets on cardiac care.
The local pharmaceutical committee, working with private computing and diagnostic testing companies, was applying to the health authority for funding to install touchscreen cardiac information systems in community pharmacies in Dorset. Local advertising would direct patients to these pharmacies where, if appropriate, they would undergo diagnostic testing.
Professor Schofield had recently been appointed a Privy Council nominee on the Royal Pharmaceutical Society's Council. He said that in the past decade the profession had had good leadership and he was proud to be joining the Council.