It was important to think laterally and to align ambitions for the profession
with those for a patient-centred NHS in order to take pharmacy forward, said
Mr
PETER CURPHEY (Council member, Royal Pharmaceutical Society).
Medicines supply might not be the province of the pharmacist for ever but pharmaceutical
care would be. Whatever the obstacles, standing still was not an option, although
there were still pharmacists who believed it was.
Change could be uncomfortable but pharmacy needed to move its focus to patients,
medicines management, pharmaceutical care and patients (again). The NHS plan
held clues as to where the profession should be concentrating its efforts in
the future. It was important to deliver quality services, and registration fees
might have to be increased significantly to fund the additional competence assessment
needed to support this.
One of the most exciting possibilities was the chance of payment for the new
roles being undertaken by pharmacists. Perhaps there should be a campaign to
pay pharmacists for overall service provision rather than by the number of prescriptions
they dispensed, he said.
There were a number of questions that the profession should be asking itself
— Could the profession deliver these services? What were the obstacles?
One obstacle might be that the profession tended to undervalue itself. For example,
locum fees were small compared with those charged by tradesmen, such as plumbers
and builders, so why did pharmacists agree to them?
Was the profession only happy when rules and regulations surrounded it? Was
it "rooted in the past" and "mesmerised" by supervision
and personal control of medicines sales? Personal control was not possible when
the pharmacist was on a domiciliary visit or conducting a consultation but technical
staff could be trained to cover. Checking technicians had existed in hospital
pharmacies for years. Surely regularisation and registration of technicians
was now more urgent?
The Society wanted pharmacists to increase their contact with patients and be
involved with formulary development, prescribing advice and other work in primary
care trusts. There was a need to concentrate on skills and knowledge rather
than location and pharmacists could even co-
operate to provide services to patients.
Self-care was the real 21st century revolution. Members of the public were better
able to deal with their problems because they had increased access to information.
The NHS plan had finally recognised that community pharmacists and over-the-counter
sales were part of primary care and could help self-care greatly.
Round-the-clock service
There was reluctance within the profession to provide a 24-hour service and
this, together with pharmacy’s remoteness from other health care professions,
had meant that the profession had largely been omitted from walk-in centres
and similar services. Those that had pioneered late opening had been pilloried
as rota breakers. Now was the time for pharmacists to get involved; the profession
had to be seen as a team player that was anxious to be part of the provision
of patient care. There was the potential for primary care trusts to fund on-call
services and for pharmacists to be involved in helping emergency centres.
Community pharmacists could become involved in the prevention of admission to
hospital, with monitoring of discharge back into primary care. This was a real
opportunity for teamwork to succeed.
Other pioneers had explored technology-based services in the form of "e-pharmacies",
websites and telephone help lines. The pioneers were few and the rest of the
profession had to catch up with them quickly.
Deregulation of medicines
The NHS plan had mentioned the wider availability of medicines and it was up
to the profession to fill in the blanks here.
Did patients really deserve to be "nannied" by the pharmacy profession
who insisted that the public could not even touch the packaging of pharmacy-only
medicines, let alone make up their own mind whether to take the drug after appropriate
advice from the pharmacist? Perhaps the profession should stop whingeing about
the deregulation of medicines to the general sales category in the case of products
that clearly did not leave patients at risk. Who, in this case, were pharmacists
trying to protect? This did not mean that the profession should be thoughtless
or cavalier but that it should be careful of "knee-jerk self-protection".
Community pharmacy would be put under strain from threats, such as product supply
via e-commerce and primary care centres and the ability of the profession to
rise to the challenge in the patient’s interest would be of major importance.
Pharmacy on television?
Digital television would provide internet access to huge numbers of people and
would have enormous information implications for the profession. At the very
least, there should be a pharmacy programme on all health channels providing
advice and discussing medicines management. This could be fronted by a media-friendly
pharmacist with an upbeat, patient-focused approach. The pharmaceutical industry
could be approached for funding if advertising restrictions were removed. It
was better to embrace the technology and manage it than to disapprove.
New challenges facing pharmacy
Developments that would affect pharmacy included: