The President of the Royal Pharmaceutical Society, Mrs Christine Glover, calls on pharmacists to focus their energies on ensuring that the profession makes an effective contribution to the modernised NHS
We have the mixed blessing of living in interesting times. The imminent publication of the national plan for the National Health Service in England and the parallel exercises being undertaken in Wales and Scotland will undoubtedly bring challenges for many pharmacists alongside opportunities for the profession as a whole.
The plan for England will be based on the reports of the modernisation action teams, and it is clear that they will envisage new ways of working throughout primary and secondary care. Pharmacists in both community and hospital settings will have to adapt and extend their roles in order to meet fresh demands from service users ("expert patients and carers"), service managers and professional colleagues alike.
Over the five years in which we have been engaged with Pharmacy in a New Age and the associated initiatives, the Society has already anticipated much of the change needed and has worked to help prepare the profession for what may come. But the architects of the "new NHS" may yet make unwelcome demands in certain areas. One such area that has been flagged for restructuring is the pattern of remuneration for community pharmacy services. Although it is acknowledged that the traditional fee structures have underpinned a socially valuable public/private partnership between the NHS and community pharmacy, the Government is now looking for extra added value in all health services.
Old demarcations will go and settings will change as the Government pursues its goals for improved access and patient care. More pharmacists may be expected to work in general medical practices and other community clinical settings as well as in the high street. Pharmacists will be increasingly called on to support professionals such as nurses as they play a progressively wider and more varied role, not only in care but also in medicines provision.
We obviously do not want to see pharmacy marginalised in the new wave of reform - but will need to recognise that doctors and nurses continue to be the main focus of attention. Earlier this month, Health Minister Alan Milburn said: "I hope the national plan will forge a national alliance of doctors, nurses, patients and others behind a modernised and extended NHS." The Society is working to see that pharmacists are not lost among the unnamed "others", but are recognised as significant, central players in the creation of more accessible and effective services for the prevention and treatment of illness and the care of people.
To do this, we need to understand policy makers' motivations and goals, and the types of changes both they and many members of the public want to see.
National politicians - and especially members of the Government - suffer from an insatiable need for "big ideas". Electorates do not forgive those who fail to deliver promises or those whose programmes lack "news value".
Prime Minister Tony Blair's administration has gambled much of its future on investing new money in the NHS, with 6 per cent real yearly growth expected for the next four years. Six modernisation action teams (MATs) were set up to help ensure that the new money is spent effectively. The MATs were also designed to involve a wide range of NHS stakeholders and get their buy-in to the agenda already being developed by the civil service and Alan Milburn's new health strategy unit. The MATs have now reported to ministers on areas ranging from performance improvement and service access to patient empowerment and prevention. The specifics they addressed include:
Leaks from these reports - presumably engineered to prepare and test public opinion - have already provided clues to the direction that ministers are likely to take at the end of July.
Such moves will have significant implications for pharmacy and its practice, although to date the main national plan concept directly relating to the profession appears to be that of extending NHS-funded provision of pharmacy medicines via community pharmacies for conditions such as winter colds. There has been relatively little more detailed public discussion, at least in the context of the national plan, of more comprehensive pharmaceutical care or the wider implications of an independent prescribing role for pharmacists. However, the Prime Minister himself has spoken of the potential for pharmacists to manage the supply of repeat medication, a clear signal that this is on the modernisation agenda.
The initial announcement of the national plan is likely to be broad brush, with the detailed strategy for pharmacy following in later stages. So there is a danger that, when the national plan is first published, pharmacists may feel sidelined because all the attention may appear to be focused on doctors and nurses. We need to look beyond this and focus our energies on how we as a profession can play a positive part in achieving genuine improvements in patient care and treatment outcomes throughout the years to come.
I recognise that these are challenging, and even worrying, times for many in our profession. The Society is committed to progressing the work that it began with Pharmacy in a New Age, which foresaw the direction in which the health service - and the profession - would need to travel.
We want to ensure that pharmacists are a key part of the modernised health service, using their expertise to achieve better health outcomes and higher standards of patient care. If all members of the profession can stand together in the pursuit of this end and make an effective contribution to the emergence of an improved, modern NHS, then the profession will achieve its ambitions to be and remain a key player in health care, as identified back in 1997 (Declaration of strategic intent by the Council, "Building the future", September, 1997): "The pharmacy profession will work for a future in which it can make the greatest possible contribution to the health of the people of Britain, in ways that are efficient, sustainable and that meet people's needs."