The Pharmaceutical Journal Vol 267 No 7159 p147
4 August 2001

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Benefits of a pharmacist at board level

Pharmacists have reserved seats on Welsh local health groups, and some have won places in their own right on boards of primary care trusts in England and local health care co-operatives in Scotland. What benefits are there if pharmacists are members of these organisations? Clare Bellingham investigates

Pharmacist members of boards of local health groups (LHGs) in Wales, primary care trusts (PCTs) in England and local health care co-operatives (LHCCs) in Scotland are clear about one thing: if pharmacists are not involved in these organisations, decisions will be made without their input. And if pharmacists are unhappy with a decision, they should remember that it is a lot harder to change once it has been made. In order to influence decisions, pharmacists need to get involved at the board level.

Another advantage of involvement on LHG, PCT and LHCC boards is that it helps to break down barriers between the health professions, something that pharmacy in general would benefit from. Yet there are always downsides and shortage of time, it seems, is the major one for board members irrespective of which professional group the member belongs to.

Pharmacists cannot justify a role purely on the basis of being able to provide pharmaceutical input. After all, pharmaceutical advisers are employed to do just that. Rather, board members need to be able to address wider public health issues, which begs the question: are pharmacists the right people to do this? In addition, other health professionals, such as opticians and dentists, may argue that if pharmacists have a reserved seat on boards then they should, too. Maidstone and Malling PCT has offered a co-opted place to be shared by a pharmacist, a dentist and an optician. But the strength of pharmacy is in its unique position of being an accessible source of health information for a large number of people who do not consult other health professionals. In order to guarantee a seat on boards, it is this strength that should be emphasised.

Delivering public health care

Sailesh Dawda is a pharmacist who has been a board member of Epping Forest PCT since its inception in 1999. “As a board member, your role is to deliver the best possible health care to the local population while considering budgetary constraints,” he says. “You have to implement things like the national service frameworks and juggle where the priorities are. If I had not been on the board from the beginning then pharmacy would not have had a say in investment planning but, because I have been there to provide pharmacy input, money has been set aside for improving pharmaceutical services,” he explains. “In many cases, pharmacy would have been sidelined. The first reaction of the board is always towards GPs and nurses, and pharmacists are forgotten.”

Mr Dawda gives two examples of schemes that had been set up by the PCT as a result of his involvement. The first is a domiciliary visiting service in which pharmacists provide complete pharmaceutical care for patients for two months after the patient is referred into the scheme, eg, by general practitioners, nurses or social workers. Pharmacists visit patients twice and the scheme is open to every community pharmacist in Epping Forest PCT. The scheme has received £48,000 of allocated funding. The second example is a similar service but is pharmacy-based: pharmacists take on pharmaceutical care of patients for a six-month period. Funding is allocated at £150 per patient for the six months (plus additional payment for delivery etc) which allows pharmacists to spend dedicated time to review patients medication needs.

Mr Dawda adds that the PCT had recently been approached by a generics company and the potential outcome of its suggestion would have a huge negative impact on remuneration, particularly for independent pharmacists. Without a pharmacist on the board, the first community pharmacists would have known about this was when a change was made, he says.

Alison Strath, chairman of the Royal Pharmaceutical Society’s Scottish Executive, was a board member of Dundee LHCC until three months ago. “There is a tremendous potential for the profession in working at a local level in LHCCs and their equivalents,” she says. “The value of a multidisciplinary board is that people bring different perspectives and values to the table.” Pharmacists can make a contribution about use of medicines, particularly new drugs, but also on a general public health perspective, she adds.

In Scotland, another opportunity for pharmacists to become involved is in area clinical forums which are being formed as a result of changes being made to unify health boards. “There are areas where pharmacists can provide input and influence: it’s all about being there and participating,” she says.

Stephen Newbury is a pharmacist who has been a board member of Swansea LHG since 1999. He is chairman of the prescribing group of the LHG and a member of the clinical governance subgroup. An example of a project that he has been involved with in the clinical governance area is in use of methotrexate for treatment of rheumatoid arthritis. In the project, community pharmacists are focussing on improving patients’ understanding of the medication, eg, dosing schedules. One of the issues arising from the project is that not all preparations of methotrexate are licensed for treating rheumatoid arthritis, he says. In addition, the scheme examines whether patients are having the correct monitoring, eg, blood tests, and patients are now issued with booklets to record test results and parameters for each test that can be taken to any health professional. Of 63 pharmacies in the Swansea LHG area, 45 pharmacists are involved in the project. Another example of something that had occurred partly as a result of his involvement on the LHG board is the inclusion of pharmacists in local action teams for drug and alcohol abuse — a new role for pharmacists. Mr Newbury is also involved in a project examining funding for protected learning time for general practitioners. It is envisaged that this will also include other health professionals, including pharmacists, he says.

The downsides

A disadvantage of the role is lack of time. Mr Dawda is provided with locum cover for three days a month in order to spend time on PCT work. However, he has to dedicate some of his own time to the role.

“The job is as big as you make it and the more involved you become, the more time you have to spend away from your practice. But this is the same for all practitioners,” Ms Strath says. However, the advantage of continuing to practise is that it allows board members to bring day-to-day practice to decision making, she adds.

Mr Dawda says that another downside to the job is frustration that some community pharmacists do not support the initiatives put forward by the PCT because they do not want to change the way they work. For example, when the domiciliary scheme was started, only three pharmacists wanted to become involved. “I had to answer to the PCT, which said that this money would be better spent elsewhere,” he says. Mr Dawda has held meetings with local pharmacists and has had support from the LPCs and things have improved this year.

The Royal Pharmaceutical Society may also be able to provide information to pharmacists on boards (contact Anne Adams on tel 0115 939 6465 for further details).

John Bannister points out this week that pharmacists have had to fight for seats on boards. The benefits gained from pharmacists being there suggest that the fight is worthwhile.

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Clare Bellingham is on the staff of The Pharmaceutical Journal