A powerful plea for the Government to fund the Pharmaceutical Services Negotiating Committee's medicines management trial was made by the PSNC's chairman (Mr Wally Dove) on March 20. In the trial, a sample of community pharmacists will review, with prescribers, the medication and treatment outcomes of patients with coronary heart disease (PJ, January 29, p187). Speaking at the PSNC's annual dinner, Mr Dove pointed out that, at present, there was no co-ordinated way of managing, reviewing and evaluating the medicine regime of someone with a heart condition.
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Wally Dove tells Lord Hunt that medicines management means more efficient use of resources |
No-one currently had the clear responsibility of managing that patient's medication and helping the patient use it efficiently. No-one had the task of evaluating the patient's progress with that drug, to decide whether it was the best treatment for that person's condition and to advise if the dose was correct. And no-one was there to talk to the patient on a regular basis about any problems that they may have in taking the medication.
Mr Dove went on: "We think that amounts to rather a large gap in the service that patients currently get from the NHS. Community pharmacists can fill that gap with a service we have devised called medicines management. Medicines management would offer all of the elements that are currently missing once a treatment has been prescribed. The community pharmacist would, in effect, manage the patient's drug therapy once it had been prescribed by the GP or specialist. That would involve regular discussion with the patient to evaluate the appropriateness and effectiveness of the treatment, with a report and recommendations to the patient's doctor of dosage changes or possibly even a change in treatment.
"It would significantly reduce unnecessary or inappropriate prescribing and result in more efficient use of NHS resources. It would mean that the patient would benefit from a more holistic and focused NHS service.
"Of course, it would require funding, but the benefits to patients and the financial benefits to the NHS would far outweigh the costs. It is not just a pipe dream."
Addressing Lord Hunt of King's Heath (Parliamentary Under-Secretary of State for Health), who was principle guest at the dinner, Mr Dove said: "As you know, Minister, we have recently submitted to your officials a proposal to pilot trial this medicines management service for cardiac patients in 10 different parts of the country over a two-year period. It has the enthusiastic support not only of community pharmacists but also of the Cardiac Patients Association. I hope that you will agree that those pilot trials, funded by your Department, should start as soon as possible. We believe that they will prove that medicines management brings clear benefits to patients and to the NHS and improves team-working between community pharmacists and GPs."
Earlier in his speech, Mr Dove said that two year's had gone by since the former Health Secretary (Mr Frank Dobson) had promised a strategy for community pharmacy. The profession was still waiting. The reason for its impatience was that it was keen to realise the full potential of community pharmacy.
Turning to the issue of waste, Mr Dove said that recent research had shown that 11 per cent of patients (5m people) never even started the course of medication prescribed for them And 34 per cent (15m people) started the course but never finished it. The profession was offended by such waste. The solution, said Mr Dove, was simple - the introduction of a 28-day prescribing maximum. This could be linked to a repeat dispensing initiative under which pharmacists supplied patients with repeat doses of a prescribed medicine when it was appropriate to do so, without the need for the patient to go back to the GP. This would also lay the foundations for medicines management and enable pharmacists to begin assessing the efficacy of a patient's medication regime. The savings that a 28-day rule would bring would far outweigh the costs of paying additional fees to community pharmacists.
On the subject of pharmacist prescribing, Mr Dove said that he believed that the case for full, independent prescribing by community pharmacists was overwhelming. Patients would be able to have quicker access to treatment for common ailments without having to make a doctor's appointment. For GPs, the time currently spent seeing people with minor or common conditions was freed up to spend on more serious cases. Pharmacy prescribing was a key part of the strategy for developing the role of community pharmacy.
In a reference to emergency contraception, Mr Dove said that the Manchester health action zone project, in which pharmacists were supplying emergency contraception under a group protocol arrangement, was proving very successful and pointed the way for the future. There were clear social benefits in allowing supply of emergency contraception through pharmacies, as well as benefits to the NHS in terms of better use of resources.
Mr Dove said that the ideas he had mentioned did not provide a comprehensive strategy for community pharmacy, but they would provide a solid foundation for one.
Present at the dinner were representative of the major health care professions, members and executives of health authorities, and representatives of primary care groups, local health groups, charities, voluntary bodies and patients organisations. Over 150 members of Parliament were also present.