From Mrs H. Remington, MRPharmS
SIR,—Agreed (your editorial, PJ, December 11, p929). The future is medicines management and pharmaceutical care, not "supply". Pharmacy in a New Age was ever thus. The profession published this vision of pharmacy five years ago and subsequently the strategy, "Building the Future", to deliver it. Yet The Journal carries articles and letters whose respondents insist on clinging to the old framework which denies the future.
Resistance to change is evident on questions such as technician registration, which is essential as they become ever more responsible in delivering patient care. Denial will not save us from technicians' advancement. They will simply go elsewhere. Also on the question of minimum training standards, these must be in place for all support staff to do just that in a safe manner, unless the tasks we request of them have no risk attached?
In relation to a recurrent theme to protect the old ways of working and organisation of pharmacy services, because we cannot grasp the new, we engage in fights such as those over resale price maintenance, distribution of pharmacies, e-commerce and mail order. We seek patient registration, which will be unnecessary with electronic records. Our energies are focused on the past too often.
Pharmacists will by dint of their practice demonstrate what they can do for patients of primary care groups and trusts - not necessarily on the board, but as practitioners delivering and ensuring quality prescribing. Pharmacists can demonstrate their logical place as "the" NHS Direct by becoming a "supplier" in competition with others. Our value should be evident if it is real.
Perhaps Mr Blair thought establishing something separate and new would be easier than negotiating change with us. Pharmacists can employ group protocols (first Crown report, 1998) already in ways which would expand their pharmaceutical care contribution - others will too. Local initiative on this and NHS Direct is the new way of working.
The three key determinants of the future, apart from our wish to seize it, are: the right to prescribe (Crown 2); full access to patient records (already possible in hospital), which will be fully electronic and accessible to use and add to, by early in the next century; and the manpower to allow us to become engaged in patient care rather than supply.
Pharmacists to deliver this can either come from training more pharmacists or by redeploying and retraining, along with skillmix, the ones we have. I prefer the latter since "supply" in the old ways of working is manifestly not going to survive the next 100 years. One of the main issues we have to recognise is that the "supervision" bulkhead of the past is going to erode. If technicians and dispensing assistants are accurately fulfilling a correct prescription (checked electronically as it is generated electronically) then whither dispensing supervision? Assembly, etc, is not a four-year degree course but an NVQ2. Our value comes from being responsible for that part of the process of medicines management where specialist knowledge is needed. This includes evidence based prescribing (over-the-counter included), and its application to the patient to achieve what you set out to achieve, with their understanding, monitoring the effect of the medicines and modifying accordingly. This is clinical pharmacy in my book - or pharmaceutical care if you prefer.
We are engaged in this to the limit of the legislative framework in hospital pharmacy. Many have pushed beyond the edge. Community pharmacists' clinical practice is far in advance of hospital in respect of their patient contact. Their potential to shape the 90 per cent community proportion of total United Kingdom medicines management is immense. The Government's political drivers must be examined to ensure we understand where to place our efforts resecuring the future. They are interested in cost reduction, clinical governance and patient access. Our programme must sit in parallel if we want their attention and support.
Helen Remington
Chief Pharmacist, Addenbrookes Hospital, Cambridge;
Member of the Royal Pharmaceutical Society's Council