The process of Welsh devolution and its culmination in the formation of the National Assembly for Wales, the introduction of Local Health Groups, and the establishment in Cardiff of permanent premises and secretariat for the Royal Pharmaceutical Society's Welsh Executive are all significant events which will have an impact on the political and professional landscape of pharmacy in Wales in the new millennium
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The National Assembly for Wales was formed following the election of its members on May 7, 1999. Labour won 28 seats in the first Assembly elections, three short of an overall majority, and have formed a minority administration. Plaid Cymru, the Party of Wales, are the second largest party in the Assembly, holding 17 seats. Alun Michael, the Assembly's First Secretary, made much at the Assembly's inception of a desire to develop a new style of politics based on consensus between the parties, and it remains to be seen whether this erstwhile pledge will be carried out in practice.
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The proposed new home for the National Assembly is to be built at Cardiff Bay |
At this embryonic stage in the Assembly's development, much groundwork is still to be done, and the full implication of the Assembly's powers are not yet clear. One thing which is clear is that health is an issue of particular concern to the Assembly. The health of the population in Wales is worse than it is in England, and one of the Assembly's primary objectives is to achieve an overall health gain for the people of Wales
The Assembly has already signalled an intention to get to grips with preventative healthcare; a debate at the start of July proposed the abolition of eye test charges in Wales and the Secretary for Health and Social Services (Ms Jane Hutt) promised that the Committee for Health and Social Services would consider the proposal. However, it is not yet clear whether a similar move to reduce or abolish prescription charges in Wales would be within the Assembly's limited range of powers.
I spoke to Mr Geraint Davies, AM, a proprietor pharmacist with two shops in the Rhondda valley in South Wales who is also a Plaid Cymru Assembly Member, representing the Rhondda constituency. I asked him about the impact that the Assembly would have on pharmacy in Wales.
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Geraint Davies, AM: an asset to the profession |
The health budget represents over one-third of all public spending in Wales, and control of this budget is one of the Assembly's biggest responsibilities. Mr Davies saw a prominent role for pharmacists in helping to reduce the prescribing budget in Wales, a reduction which the Assembly's health committee is already pushing for.
Moving on to the thorny issue of remuneration, I asked Mr Davies if the Assembly could introduce a new remuneration model for community pharmacy contractors in Wales which was separate from the English model, should it so desire.
Mr Davies said that this would almost certainly be within the Assembly's remit, and that he felt that there was scope for the Assembly to look at remuneration models which are particularly suited to the practice of pharmacy in Wales. For example, in some areas of Wales, such as the south Wales valleys, Mr Davies suggested exploring the idea of having community pharmacists salaried by the National Health Service.
I also spoke to Mr Colin Ranshaw, chairman of the Royal Pharmaceutical Society's Welsh Executive, who was similarly enthused about the Assembly's role in implementing new remuneration models for pharmacy. Mr Ranshaw said that he would like to see a system introduced whereby the fees paid to pharmacy contractors took account of the services they were providing in addition to the number of prescriptions they dispensed.
I asked Mr Davies how he felt about pharmacist prescribing in the wake of the Crown reports, and whether this was an area that the Assembly might explore. He was enthusiastic about a prescribing role for pharmacists, and felt that a demonstration scheme within Wales could certainly be a possibility. However, given the Assembly's strong desire to drive down the drugs bill in Wales, pharmacists would have to be able to demonstrate the cost efficiency of such a scheme if it were to stand any chance of long-term success.
The Royal Pharmaceutical Society is represented in Wales by its Welsh Executive, which was formed in 1976 in anticipation of devolution, to implement Society policy in Wales. It is the only body elected by, and representing, all pharmacists in Wales. It consists of 12 elected members. In addition, the President and Vice-President of the Society are ex-officio members, as are any Council members resident in Wales.
The Welsh Executive also liases with a number of other pharmacy bodies in Wales, among them the Welsh Pharmaceutical Committee and the Welsh Committee for the Professional Development of Pharmacy. The Welsh Pharmaceutical Committee advises the Secretary of State for Wales on matters pertaining to pharmaceutical services in Wales. However, as many of the powers previously held by the Secretary of State have now been transferred to the Assembly, the role of the Welsh Pharmaceutical Committee is currently unclear.
When I spoke to Mr Ranshaw I started by asking him how devolution would affect the workings of the Executive. Mr Ranshaw told me that, in the newly devolved Wales, the Welsh Executive was finally coming into its own. Until recently, the Welsh Executive was administered by a secretary based at the Society's headquarters at Lambeth, but in early 1999 the Executive appointed Mrs Erica Barrie as the first secretary of the Executive resident in Wales. The Executive also acquired premises in the popular Cardiff Bay area, only a few minutes' walk from the home of the National Assembly for Wales. This leaves the Executive in a strong position, well placed to brief Assembly members and to react swiftly to Assembly decisions.
Mr Ranshaw explained that, in implementing Society policy in Wales, it was often necessary to tailor the policy to reflect the situation in Wales, if it was different to that in Britain as a whole.
For example, the recent sexual health policy document was illustrated largely with statistics calculated from figures for England, or England and Wales. This document was used by the Executive as the basis for its own specific document, using Welsh references. This new document was then distributed to Health and Social Services committee members.
This example illustrates the current state of play between the Royal Pharmaceutical Society and its Welsh Executive. Policy from Lambeth is implemented within Wales by the Welsh Executive, having first been adapted if necessary to take account of issues specific to Wales. However, Mr Ranshaw foresaw a shift in the Executive's role in a devolved Wales, such that its function would become less predominantly administrative, and more strategic. The Welsh Executive would increasingly be relied upon to formulate policy within Wales, in addition to implementing policies handed down from Lambeth. At this stage, Mr Ranshaw said, the Welsh Executive had to work hard to establish its position within the new political landscape carved out by devolution.
Mr Ranshaw explained that the landscape of the NHS itself would change in Wales following devolution. Wales was adopting a single unitary budget for health, rather than separate budgets for primary and secondary care. This was in line with Labour's pre-election promises to provide seamless patient care.
In addition, Mr Ranshaw believed that the Assembly would amalgamate the five current health authorities in Wales to form one single Welsh health authority. This would allow Wales-wide strategic planning of health services, and would reduce the need for unnecessary duplication of expensive regional services such as burns and renal units.
Although the Welsh Executive gives pharmacy in Wales an important opportunity to further review policy prior to implementation, such opportunities are not new, nor are they afforded solely to the Welsh Executive. Of all the recent examples of Wales benefiting from a second bite of the cherry, few can be of such profound importance as the consultations at the Welsh Office which led to the inclusion by right of a pharmacist on the board of each of the local health groups (LHGs), the Welsh equivalent of primary care groups.
Wales has twenty-two LHGs. Each LHG has a board made up of six general medical practitioners, a pharmacist, an optometrist, a dentist, two nurses and other lay members. The LHG pharmacist is selected by other pharmacists within the area that the LHG serves. Each LHG has an executive committee of five or six members. The chairman of this executive is usually a GP, although two LHGs have pharmacist chairmen.
The presence by right of a pharmacist on the LHG board is clearly of fundamental importance. It ensures that pharmacy is not sidelined in discussions, and allows promotion of the numerous areas in which pharmacists can offer a skilled and unique service within primary care. Some LHG pharmacists have experience in prescribing advice and formulary development, although it is expected that many LHGs will buy in expert advice on such matters as it is needed, possibly co-opting a prescribing advisor onto the appropriate sub-group as required. This advice is expected be become even more valuable as GPs move towards cash-limited budgets for the first time.
In July, 1998, the Welsh Committee for the Professional Development of Pharmacy (WCPDP) was established as a non-departmental public body, charged with introducing a rolling strategy for continuing professional development of pharmacists and their support staff. It purchases education and development activities in line with the strategy through the Welsh Centre for Postgraduate Pharmaceutical Education (WCPPE). It also advises the Welsh Assembly on the postgraduate education and training needs of pharmacists and their support staff in Wales.
The WCPPE, based at the Welsh school of pharmacy at the University of Wales College of Cardiff, has been catering for the continuing education and professional development needs of pharmacists in Wales since 1979. The most significant difference between the WCPPE and its English counterpart is that the Welsh centre has the complete remit for all pharmacy staff in Wales, with the exception of community-based preregistration trainees.
This "one stop shop" approach means that one of WCPPE's key responsibilities is the provision of training material to pharmacists with which they can train their own staff. The WCPPE can assess and award National Vocational Qualifications up to level 3 for pharmacy technicians in hospital and community.
Pharmacists in Wales have much to feel good about as they move towards the new millennium. The profession is represented in the various new administrative bodies to a far greater extent than it is in England.
The Society's Welsh Executive is ideally placed to represent the profession, both to colleagues at Lambeth and to the politicians at the National Assembly. As the Assembly settles in to its new role within the British political landscape it can be expected that the Welsh Executive will become more active alongside it. The presence of a pharmacist among the Assembly Members is cause for modest celebration. Clearly Mr Davies's prime responsibility is to his constituents, but, as a practicing pharmacist in such a prominent position within Welsh politics, he will undoubtedly prove to be an asset for the profession in Wales.
In addition, the presence by right of a pharmacist on the board of every local health group is a wonderful advantage for pharmacy in Wales. These factors, when viewed together, give hope that the profession will remain at the forefront of health care decision-making in Wales.
Mr Whitaker is a locum pharmacist. He runs Private-Rx, an internet service for pharmacists