Forum

North and East Devon Health Authority

The development of pharmacy services based on the Pharmacy in the Future plan was discussed at a “Vision day” held by North and East Devon Health Authority on June 14. Clare Bellingham reports

Pharmacy: from vision to reality
Medicines management
Information technology
Remuneration

For further information about the Vision day contact

Karen Acott, pharmaceutical adviser
North Devon Primary Care Group
Tel 01271 327779
email karen.acott@nedevon-ha.swest.nhs.uk

Pharmacy: from vision to reality

General practitioners should establish a diagnosis and determine the class of drugs that a patient should be prescribed, but it should be the pharmacist who should decide on the drug to be given, thus making the most of each professional’s skills.

This was just one of the visions put forward at a workshop in Devon attended by GPs and health authority managers, as well as prescribing advisers and pharmacists, to discuss the development of pharmacy services for the future.

At the moment, pharmacists were a long way from that vision. They were highly skilled and delivered an excellent service but not in the most effective way, according to Dr PATRICIA OAKLEY, director, Practices Made Perfect, a policy research and development organisation that works with the NHS Executive.

Pharmacy in the future should become patient-focused, making use of secure electronic transfer of data, and pharmacists’ role should be enhanced to allow them to help patients manage their medicines more effectively.

The basis of the discussion at the meeting was the Government’s Pharmacy in the Future plan and, according to Dr Oakley, a pharmacist, it was an extremely comprehensive review of the future. It provided six key development areas:

Medicines management
E-prescribing and e-dispensing
Drugs budget strategy
Prescribing controls
Prescribing quality control and audit
Clinical governance

But three key areas needed to be developed before pharmacists could become fully involved. The first was to use a common multidisciplinary assessment tool so that resources were targeted to meet the needs of the patient. The second was to develop medicines management systems and the third was to develop joint training and support. However, the three areas were underpinned by the need for a common patient record to which all health professionals had access.

Medicines management

The principles of developing medicines management and pharmacy services agreed at the meeting were that a development framework had to:

Be patient-focused
Retain patient choices
Adopt a collaborative, multidisciplinary approach
Use technology as a tool
Make best use of skills
Improve access to services
Unhook dispensing from the provision of advice and over-the-counter medicines

Developments in medicines management would fall into three areas — admission and discharge planning, repeat prescribing and monitoring schemes, and intermediate care homes services. The quality control of prescriptions was an important issue, particularly because the categories of professionals who could prescribe was likely to open up in the next few years.

Greater collaboration between the professions was also needed, particularly the integration of pharmacists into the primary care team. Communications needed to be improved, including identifying different professionals’ areas of expertise and sharing good practice. In addition, barriers between primary and secondary care had to be broken down and pharmacists had to stop being competitive and collaborate with each other.

Within clinical governance, the introduction of a near-miss reporting system was imminent. Although the details of the system were not currently known, it was expected that prescribing and dispensing would be a part of it.

Information technology

Dr Oakley reported that there had been two pilot studies in Glasgow in which patient records were held in chips on smart cards that GPs, health centres and community pharmacies could read. A national system was needed so that the records could be accessed if a patient was away from home.

Concerns were raised at the meeting over confidentiality of information in electronic patient records and the hierarchy of access to patient records. It was thought that pharmacists needed access to information in patient’s records in order to carry out medicines management. A fail-safe system was needed whereby central files were updated regularly so that little input was lost. Making sure that viruses could not contaminate the system and that hackers could not get into it were also safety concerns.

Technology used in the United States allowed doctors to have a small, portable machine that allowed patient records to be called up and prescriptions to be electronically transferred to a pharmacy. The machine also had a reference section and a dictaphone that allowed records of the consultation to be made.

A short-term aim for which there was general agreement was that a paper-based system of repeat dispensing could be set up, according to an agreed protocol, that could be moved to electronic repeat dispensing when the technology was available.

The meeting also discussed redefining and emphasising the pharmacist’s advisory role. Pharmacists could provide advisory services for members of the public and for professionals, including NHS Direct, GPs, medical specialists, nurses, therapists, managers and finance specialists. Advisory services might cover:

OTC medicines and well-being
Medication concordance
Effective therapeutics and regimens
Specialist advisory and trial services
Usage patterns and cost-benefit analysis
Research and evidence base

Was one pharmacist capable of providing all of these services? Dr Oakley thought not. Instead she proposed that a raft of specialist advisory pharmacists could be developed, each providing different information that fed into the system in different ways. However, it was important to rank the order in which the services were needed, particularly because there was a national shortage of pharmacists, she said. An immediate aim was to set up a register to identify pharmacists’ specialist interests.

A greater role in advice, support and use of medicines but not necessarily in supply of medicines was seen for pharmacists.

Remuneration

How pharmacists were remunerated was clearly an important issue. On the back of the pharmacy plan there would be major changes to remuneration, said Dr Oakley. There were projects to try new payment schemes, to reward the provision of services, but any local changes had to be within the central Department of Health remuneration rules.

Dr Oakley said that she believed that the Department of Health will set up the equivalent of personal medical services (PMS) pilots (established for GPs) for community pharmacists. This way, pharmacists would be able to protect their income but provide new services via a PMS-type scheme.

She added that the Treasury wanted the global sum to be used differently but that there was additional new money available through the NHS modernisation agency, particularly for medicines management that was tagged in the National Service Framework for Older People, and funding for training. Rather than thinking about a pharmacy agenda, thinking of a pharmacy services agenda allowed resources to be called in from different schemes, Dr Oakley said.