A warning against going too far with integrating community pharmacy into primary care has been issued by Boots the Chemists.
Speaking at a King's Fund seminar on "New models of consumer sovereignty in health care", Boots's superintendent pharmacist (Mr Digby Emson) said: "I would warn against undermining the basic economics of the existing network of community pharmacies. . . . This would certainly be the result if attempts were made to relocate, wholesale, the core National Health Service medicines supply process into primary care practice or other NHS trust settings."
Mr Emson said that the one-off cost of moving dispensing into medical practice settings would be high. After that, recurrent day to day costs could well exceed the current figure. As things stood, both capital and revenue elements of these costs were met, in part, by a contribution from over-the-counter sales.
"In time new models of NHS medicines supply may emerge," Mr Emson said, "but we should be careful of imposing potentially destructive changes without adequate consultation or clear consideration of what we are ultimately aiming to build."
Mr Emson told his audience that constructive development might, in time, lead to a transformation in the working relationships between the professions involved in primary care. Functional boundaries would blur and, perhaps, go altogether. A challenge for the 21st century would be for all the health professions to achieve greater unity in regulation and to define acceptable practices, not as separate groups accountable only to themselves, but together, accountable to the community and to patients.
"I believe that most people now accept that health care ‘tribalism' must be tackled, and that rigid demarcation boundaries and the ‘silo' budgets and mentalities which tend to go with them in the NHS need to be broken down," Mr Emson said. "This should allow competent people from a range of backgrounds to deliver NHS, and other complementary, services in the ways which individual consumers find most relevant and convenient. . . .
"That is why I believe we should move towards greater use of systems of personal accreditation and individual skill validation. The generic community pharmacist, doctor or nurse is increasingly going to be complemented by individuals with a pharmacy, medical or nursing background who have special skills in particular areas. . . .
Forming new, positive, partnerships which exploit the complementary skills of nursing and pharmacy will be a crucial test. Community pharmacy as a whole will also need to accept greater plurality in its professional role, and, with this, a range of new work settings."
Referring to an as yet unpublished report by the Royal College of General Practitioners, which the Royal Pharmaceutical Society's Council has seen (PJ, April 22, p612), Mr Emson added: "Much of what they have said makes good sense. I am certain that closer working between pharmacists, primary care nurses and general medical practitioners will bring valuable clinical and other patient benefits."