The Royal Pharmaceutical Society has told the Prime Minister (Mr Tony Blair) how it believes pharmacists can help meet his challenge to modernise the National Health Service (PJ, April 1, p502).
A paper sent to Mr Blair on April 13 sets out to show how current work at the Society can contribute to the five areas identified in the modernisation challenge (partnership, performance, professions, patient care and prevention).
Partnership The paper suggests the creation of a system for providing pharmaceutical advice on drug use for prescribers at all levels of the NHS in order to reduce iatrogenic illness. It makes the point that up to 7 per cent of hospital beds are occupied as a result of adverse drug reactions. In particular, it says that a focused approach to medicines management, particularly for the elderly, ought to be developed.
A second point made in the context of partnership is that seamless discharge of patients from hospital to home is important to their recovery. Hospital pharmacists have a key role in discharge planning, it says, and can also provide specialised outreach services. However, their career structure has led to a workforce shortage and needs to be addressed. There should also be links between pharmacists working in primary and secondary care in order to make discharge a smooth process.
Performance The paper calls for resources to be made available to pharmacists in support of clinical governance. It says that local pharmaceutical committees have been refused funds by health authorities because the money is held by primary care groups, while PCGs have suggested that they are not responsible for community pharmacy.
"Fuller involvement by community pharmacists in arrangements for clinical governance will improve and strengthen performance across the NHS and provide an additional multidisciplinary approach to service delivery," it says.
On clinical guidelines and audit, the Society says that it will extend its role in guideline development, which is funded by the National Institute for Clinical Excellence, by working through PCG prescribing support pharmacists and trust chief pharmacists to deliver consistent uptake and implementation of NICE clinical guidelines. It suggests that the Government should consider contributing resources to the Pharmacy Practice Research Trust.
The final point made in this section is that the NHS remuneration system for community pharmacy does not encourage excellence.
Professions Prescribing and repeat dispensing are addressed in a section on the challenge to the professions. The Society says that it wants to discuss with the Government ways of promoting the pharmacist's role in treating minor self-treatable illnesses, including NHS prescribing. Pharmacists also want to take greater responsibility for managing and monitoring repeat dispensing as a way of enhancing patient services, the paper says. It adds that if the new NHS modernisation drive means the expected pharmacy strategy is no longer appropriate then the Government should make this clear and start discussions on ways forward in the five challenge areas. The Society also suggests that procedures it is developing for auditing prescribing should be developed into longer term quality improvement tools.
Patient care The key issue considered here is concordance. The Society says that partnership between patients and health professionals is likely to lead to better health outcomes as people make informed decisions about their medicines. It draws attention to the www.concordance.org website. Concordance should be included in the education and practice of health professionals. The Society says that it would welcome the opportunity to work with the groups producing national service frameworks.
Prevention "Pharmacists are high street public health promoters," the Society says. Despite this, they have not always been given information on health alerts early enough. Pharmacists should be better integrated into the NHS early warning system for medical emergency information. Support for pharmacists' involvement in smoking cessation should also be developed and there should be a an improved role in public health promotion.
The Society concludes: "Our profession welcomes the Government's initiative as a great opportunity to tackle these barriers and effect positive change," the Society tells Mr Blair. "We look forward to contributing our knowledge and perspective to the process of creating solutions for a better, modernised, NHS."