One of the most important trials of a new practice model for community pharmacy is about to take place in England and, possibly, Wales. It is on a form of medicines management that has been developed by the principal professional bodies and organisations with an interest in community pharmacy. Pharmacists in 10 geographical areas will apply the model to patients with coronary heart disease. As an interview with the chairman of the profession's leadership group on medicines management makes clear (see p187), the importance of this development should not be underestimated.
The term "medicines management" is being used to describe the process on trial, but it might as well have been "pharmaceutical care", because the essential components of classic pharmaceutical care will all be present in the model under test. That is, participating pharmacists will assess the treatment that a patient is on, discuss with the patient what to expect from the treatment, follow up to see if the treatment is working and take action if it is not.
In overall terms, the trial will test the hypothesis that the addition of pharmacists in the primary care team in collaboration with doctors is able to deliver measurable differences in patient care, in patient outcomes and in the economics of prescribing. Here there might be a distinction from classical pharmaceutical care in that the pharmacist does not seem to be assuming responsibility, as Cipolle, Strand and Morley (developers of the Minnesota model) would require, for a patient's drug-related needs (Pharmaceutical Care Practice. New York: McGraw-Hill, 1998). Rather, the English trialists seem to favour a more collaborative approach. But having said that, Cipolle et al recognise the need for co-operation with other health care providers. Pharmaceutical care does not take place in a vacuum, they point out.
The fact that the trial is to take place in England provides clear evidence that there is recognition at the highest level that pharmacy practice is in urgent need of reform. The current, supply-orientated style of pharmaceutical service is outmoded, increasingly poorly remunerated and in urgent need of replacement. Cipolle, Strand and Morley put this succinctly in their seminal work: "We believe that traditional dispensing roles as the raison d'être of pharmacy practice are moving towards extinction."
In the old days, pharmacists used their skills to prepare medicines extemporaneously from ingredients held in the pharmacy. But, with virtually all medicines being made elsewhere, pharmacists, if they are to retain any professional credibility, have to find a new way of adding value in a distinctive manner to the medicines supply and usage process. Many pharmacists believe that this will be through pharmaceutical care or medicines management. But it is clear from experience on a world-wide basis that purchasers, from individuals to governments, have to be persuaded that this is so. That is why trials such as the one that we report this week are taking place and that is why it is essential that the trials are enthusiastically supported by the profession and that they are successful. The future of pharmacy depends on it.