A vision of the future of community pharmacy from the point of view of both
the Royal College of General Practitioners and the Royal Pharmaceutical Society
was presented on September 10. The President of the Society, Mrs Christine Glover,
chaired the session
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Mr Peter Curphey (left) and Professor Mike Pringle (right)
discussed the future of community pharmacy from the point of view of the
Royal Pharmaceutical Society and the Royal College of General Practitioners,
respectively
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Pharmacists’ skills have traditionally been under-utilised but now general
practitioners want and need access to the profession’s knowledge in order
to provide a patient-centred National Health Service and integrated, high quality
health care, said Professor MIKE PRINGLE (Royal College of General Practitioners).
This was the view of the Royal College of General Practitioners (RCGP). The
college had no mandate over pharmacists but was interested in developing primary
care with the help of all allied health care professions.
The NHS national plan had encouraged the development of a patient-centred health
service but there was a long was to go to achieve this. For example, if a patient
went to a pharmacist, a practice nurse and a GP, they would probably be given
three different sets of advice. How did that look to the patient? Did it give
the patient confidence in the health service? If a patient ran out of tablets,
they had to go through a complicated, lengthy and inconvenient process to get
a new supply. The whole thing was a “shambles” and not in the least
bit patient-centred.
So, what would health care professionals want from the health service if they
were patients? They would want the pharmacist, doctor and nurse to be in touch
with each other and to be able to provide consistent advice relevant to the
individual patient. Once there was co-ordinated information for patients, they
would begin to have a better view of the system, Professor Pringle said.
Underuse of skills
At present, pharmacists underwent four years of training and were asked to spend
most of their time sticking labels on bottles. Was this really a good use of
a valuable resource?
GPs needed access to the knowledge of pharmacists in order to improve patient
care. They needed to know when patients were not complying with their medicines
or were having problems either taking them or affording them. Pharmacists had
to be involved in prescribing decisions and practice pharmacists had begun to
make a huge difference.
Traditional community pharmacists did a great job and had a role that had to
be preserved, Professor Pringle said. It was important not to lose the services
and virtues of the traditional community pharmacist but they were not currently
able to make full use of their skills.
Pharmaceutical advisers were useful in providing prescribing information but
“practice-attached” pharmacists were the innovation that the RCGP
wanted to explore. This type of pharmacist could offer a front-line consultation
service and be the first port of call for patients visiting the practice, in
much the same way that community pharmacists were the first port of call in
the high street.
By working in a practice, pharmacists could make immediate referrals to general
practitioners and would be able to follow the progress of patients more easily.
In addition, patients could choose whom they wanted to see — a pharmacist,
nurse or doctor — and could do so in appropriate surroundings rather than
standing in the middle of a shop. By working in a practice, pharmacists could
and should be involved in directly implementing national service frameworks,
guidelines and other strategies, such as long-term medication review.
Why did pharmacists not have prescribing rights? Surely, as experts about medicines,
they should have? It was up to pharmacists to define the areas where pharmacist
prescribing was appropriate.
Pharmacists should be partners in practices rather than employees and this should
be encouraged in those who wished to take up the partnership option.
Types of practice pharmacist
Professor Pringle envisaged three possible types of practice-attached pharmacists:
The important thing was that doctors and pharmacists should work together. It was vital that the current regulations governing remuneration and supervision were changed to allow this to happen.