The chairman of the Royal Pharmaceutical Society in Scotland, Ms Alison Strath, replies to the Scottish Health Minister’s plan for the National Health Service in Scotland (see p904) and its endorsement of the principles of pharmaceutical care
The publication of "Our National Health: a plan for action, a plan for change"by Susan Deacon, Minister for Health and Community Care, gives pharmacy in Scotland an opportunity to realise its full potential.
In Scotland, the profession has worked hard to embrace the new political environment since devolution. We have sought opportunities to promote pharmacy and engage with the modernisation programme, which began in 1999, with considerable success.
In our discussions with the Minister and her officials before publication of "Our National Health", we stressed the importance of a strong role for pharmacy in improving the patient’s journey through the National Health Service in Scotland (NHSiS), from repeat dispensing to medication review and therapeutic drug monitoring.
We agreed that the 1,140 community pharmacies in Scotland were already acting as walk-in healthy living centres. Each has the potential to provide a wider range of health promotion advice to its community, as well as treating minor ailments, providing a convenient service to patients and relieving general medical practitioners of some of their workload.
Pilot projects due to commence in spring, 2001, in Arbroath and Patna build on this principle, allowing community pharmacists to prescribe over-the-counter medicines on the NHS to patients normally exempt from prescription charges. We further discussed the extension of the pharmaceutical care model schemes to include national priority areas such as cardiovascular disease and diabetes.
We called for a wider role for hospital pharmacists in admission and discharge procedures, as well as clinical activity at ward level, to improve the efficiency of the system. We also discussed a strengthening of the pharmacist’s role in the provision of care from local health care co-operatives.
These were our priorities for immediate action and I am delighted that they are reflected in the plan announced by the Minister.
"Our National Health"focuses on promoting health in an NHS in its broadest context: from empowering communities and other agencies, through the whole cycle to rebuilding a national health service and underpinning patient-centred health care. These areas are core values for pharmacy.
There are many opportunities for pharmacy within "Our National Health". It states that better access to the NHSiS can be promoted by making better use of Scotland’s pharmacists and pharmacies. Specifically:
• The model schemes for pharmaceutical care in the community that are already in place for palliative care, older people and people with mental health problems will be extended to include chronic conditions. Also, arrangements to allow pharmacists to prescribe a broader range of medicines, conduct medication reviews and monitor certain treatments will be supported
• The provision of repeat medication will be improved and this will be supported by electronic transmission of prescriptions and better information exchange
The plan expresses a commendable intention to work with and invest in staff. In particular, the Scottish Executive will "work with the pharmaceutical professions in Scotland to address manpower and develop a strategy for pharmacy".
"Our National Health"must not be viewed as a static statement of principle. It sets out a direction of travel, but not a destination. The Minister is determined to work with the NHSiS, other providers and the public to guide the implementation of the plan. We must use it, build on it and work with it to drive the debate within our profession and with others on how to best deliver services to the public, especially in public health and tackling inequalities.
Pharmacists work in widely disparate communities, from urban Easterhouse to rural Easter Ross, giving us a breadth of experience in addressing inequalities in health, be they created by urban deprivation or by geographical remoteness.
Removing health inequalities will be top of the agenda for the Ministers for Health and Community Care and for Social Justice over the coming years. It is in these areas that pharmacy and pharmacists will need to deliver a sharper and more coherent message to the Scottish Parliament and its Executive, the NHSiS, other health care professionals and voluntary agency staff.
In 1999 there was a marginal improvement in the overall health of Scots, but there remain chronic problems in terms of diet, smoking, depression (especially in younger people), sexual health and drug misuse. These problems are most acute in Scotland’s all too many areas of high deprivation.
We must ensure that we build on the recognition that has been given to pharmacy and widen our contacts to reach those working in our local communities, such as the voluntary sector, patient groups and residents’ associations. As a profession we should be proud of our relationship with the public — our patients, our customers. We must ensure that the public become our advocates and mobilise their support.
As pharmacists we need to improve the channels of communication to disseminate best practice throughout Scotland. As a profession we must improve how we engage with the public and other health care professionals to deliver combined services to improve patient care.
How many times have we heard GPs say that they can improve the quality of their consultations if they had more time with patients but fail to see the value of pharmacists in bringing this about? Too often we have heard health managers call for greater efficiencies in discharge planning but not involve hospital and community pharmacists in planning procedures.
The Scottish Executive has set out its stall in "Our National Health". It is about putting patients first. This will involve removing rigid professional demarcations of responsibilities and raises issues regarding the nature of the professions, their roles and how they work together in the NHSiS.
Since devolution there has been an increasing number of calls from the Scottish Parliament for greater accountability of the health professions in Scotland. We need to assure the Scottish Parliament that our profession is not remote from it and that the people of Scotland, our patients, can have confidence in the skills and knowledge of pharmacists and their staff.
We must also be confident that our structures give Scotland’s pharmacists confidence that they are properly represented and resourced in both Edinburgh and London.
The Minister’s officials who drafted the plan were instructed to be radical and build on the proposals for England, but to come up with Scottish solutions to Scottish problems. Therefore, the Society needs to be equipped to move ahead in Scotland, at times in a direction different from that in England and Wales, and at times at a different pace. How the Society functions internally, and how it expresses itself publicly must also be equal to that task: Scottish solutions for Scottish problems, when required. These are also issues for the Society in England and Wales.
Constitutionally we are travelling on an exciting journey and any journey must begin with a single step. The direction we choose matters more than ever before. Pharmacists have been offered significant opportunities in "Our National Health"and we must embrace them. This will require strong leadership, fresh thinking on the structure of our Society, a strategic vision of where we need to be and an action plan for implementation.
The Minister has indicated her commitment to genuine partnership. The time is long overdue for us to take up our rightful place at the table alongside our colleagues and to make our contribution to the debate on the new health and social care strategy and its subsequent delivery.