The Pharmaceutical Journal Vol 266 No 7154 p888-891
June 30, 2001

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Primary care pharmacy

Call for national patient group directions

From Mr P. G. W. Jones, MRPharmS

The call by Martin Shakespeare (PJ, June 23, p840) for national patient group directions and a national service framework for primary care pharmacy certainly provides food for thought.

Although I agree that the major components of a PGD should be common throughout the country, there are aspects which do vary locally. Arrangements for referral to another health professional or the action to be adopted if a patient is excluded from treatment, or declines treatment under a PGD vary from place to place. My own experience in dealing with many colleagues from several professions is that it is difficult to gain a consensus in just one locality. It can be argued that this is the very reason a national PGD should be produced, but if it fails to work in practice then we have failed patients.

Local health professionals may not be prepared to accept responsibility for the use of a nationally produced PGD. Locum pharmacists may prove to be the most experienced pharmacists in the use of PGDs because they gain knowledge by practising widely. However they do need to be able to respond appropriately in each local health environment, a point worthy of consideration by those of us producing PGDs for use in community pharmacy. I think that it would be unwise to try to introduce a nationally produced PGD without consulting microbiologists and public health doctors locally.

The concept of an NSF for primary care pharmacy is novel and the underlying principle of having national guidance recommending the improvement of services to patients by improving the contribution of community pharmacists seems attractive. We are already experiencing the response to the publication of the National Plan for Pharmacy and also Health Service Circular 2000/026 recommending the adoption of PGDs, yet we continue to be critical of the rate of improvement in developing our services for the benefit of patients.

A further point for consideration is the need to compete for funds. Absence of funding is the single most important reason for variations in the adoption of PGDs in community pharmacy or any other proposal for developing services. Inequalities in the provision of service to patients currently exist nationally despite the efforts of the National Institute for Clinical Excellence and the production of several NSFs, simply because there is either inadequate funding to implement the guidance or differences of opinion on how scarce resources should be prioritised and allocated locally. The production of an NSF for primary care pharmacy, while reinforcing the role and contribution of the pharmacist and raising awareness, would not guarantee the adoption of specified PGDs, based upon experience to date. Nevertheless I applaud Mr Shakespeare for speaking out. We do seem to have adopted an ad hoc, piecemeal and inconsistent approach.

Peter G. W. Jones
Prescribing Adviser and PGD Website Manager
Salford West Primary Care Group

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