From Mr H. H. Ghalamkari, MRPharmS
SIR,— The National Health Service plan for England places the development of medicines management as the major priority of the pharmaceutical profession. However, is medicines management going to become a specialist service delivered in a non-pharmacy setting by pharmacists holding special contracts, or is it going to become a core service delivered by all pharmacists?
The term medicines management will mean different things to different people. In my view there are different levels of medicines management, some of which can be delivered by a community pharmacist like me; other levels will require specialisation.
From the clinical model, I can become more proactive in making treatment interventions on prescriptions, justifying the interventions using clinical governance and national service frameworks, documenting these interventions and following up the interventions made.
Drawing on the concept of concordance, I can provide an opportunity for patients to discuss their medicines — in particular, what each medicine is for, how they work, the signs for their side effects, precautions, etc.
There is also a level of medicines management, which draws on a social model of care that involves helping people navigate through the systems of repeat prescription ordering, issuing of prescriptions, obtaining dispensed medicines and subsequent reordering of repeat prescriptions.
The levels of medicines management that I have listed above, are not a million miles away from what community pharmacists currently do on an informal basis. For medicines management to become part of daily practice, these services need to be formalised, for example, by being written into our terms of service and job descriptions. Once medicines management is given priority in these terms, then working practices will have to be developed to support and facilitate the importance attached to the service.
Medicines remain the main treatment option in the NHS, thus solutions to problems associated with their use have huge implications. Pharmacists can potentially provide solutions through the development of different levels of medicines management services. Our professional organisations should now concentrate on how all pharmacists, regardless of their work setting, can put medicines management into practice.
Hooman Ghalamkari Worcester