Two local pharmaceutical committees - Barking and Havering and Redbridge and Waltham Forest - have told the working groups developing the NHS national plan (PJ, April 1, p502) that the whole community pharmacy system needs fundamental review".
They say that community pharmacists are subject to restrictions that impede the improvement of service and express hope that the plan will provide a framework for the promotion and implementation of the potential of pharmaceutical services. In a joint submission, the two LPCs call for root and branch change to the infrastructure of pharmacy services, saying that the current contract for community pharmacy provides few incentives for high quality professional services. Instead, it rewards dispensing at the expense of other professional services.
"This ignores the very significant development of new concepts of pharmaceutical care that place emphasis on responsibility (with others) for the effects of the therapeutic process," the two LPCs say.
They call for economies of scale by encouraging relocations or reductions in pharmacy numbers through planned and locally negotiated processes and a shift in the balance of remuneration towards extended professional services.
"The contract should resource local pharmacies to provide pharmaceutical care to the community and to actively collaborate with health and social care colleagues," they say. This could be used to focus pharmacy services on a range of quality standards.
On partnership, the first of the five headings to be used for the development of the national plan, the LPCs recommend formal referral systems between pharmacists, doctors, nurses and other health and social care professionals.
They point out that although the concept of partnership is highly relevant to the planning and commissioning of health services, community pharmacists have had little involvement in the work of PCGs.
On performance, they say that there is great scope for improved efficiency and that a substantial proportion of repeat prescribing by general medical practitioners is wasteful. They say that the benefits of pharmacist-led medication review are clear and quote a study in Glasgow which showed savings of £35.62 per patient in direct costs and a further £21 in indirect savings, coupled with significant health gains.
They recognise, too, that community pharmacists' performance can be improved. They recommend a resourced and supported system of personal development planning for all community pharmacists.
Under the heading "professions", the two LPCs argue that community pharmacists can carry out a clinically extended role. In particular, they say that pharmacists have a valuable part to play in identifying and managing patients with chronic disease and managing common ailments. They recommend dependent prescriber powers for pharmacists for prescription medicines. Pharmacists should also be able to prescribe over-the-counter medicines for common ailments on the NHS.
Concerning access to patient care, the submission points out that community pharmacists provide highly accessible services without appointment. It recommends that pharmacists be resourced to extend their services to include domiciliary medication review and advice for the elderly and housebound, and a broader range of services in nursing and residential homes, such as dose adjustments and diagnostic testing.
Considering patient care and empowerment, the two committees say that the provision of accurate information in a way that is easily understood is a role for which pharmacists are well suited. They suggest that concordance, in which patients are included as partners in the therapeutic process, is a key strategy to promote long-term compliance with treatment. They recommend piloting written contracts between pharmacists and patients that set out an agreed pattern of dispensing and compliance, as has been tried in the United States of America.