BPC 2001 summary

What do you think?

Primary care pharmacists: are they pixies or pixels?

Having pharmacists working in primary care is not the way forward, the chief pharmacist for Scotland, Bill Scott, believes. These pharmacists would be better employed working in community pharmacies.

Mr Scott said that pharmacists could be pixies or pixels — either doctors’ little helpers or part of the big picture: “Primary care pharmacists are the pixies. Primary care is dragging our best pharmacists away from community to help doctors with their formularies. The best way to care for patients is on an individual basis, as happens in community pharmacy where they see all the patients.

“Primary care pharmacy is not the way to go. These people have to be engaged working in community pharmacy.”

Mr Scott was speaking during a question time session with the three chief pharmacists for Scotland, England and Wales. Questioned about Mr Scott’s comments, Dr Jim Smith, chief pharmacist, Department of Health, said: “I do not agree with Bill’s pessimism. We do need a balance, a mixed economy. The growth of primary care pharmacy has been a huge success and a good thing. The bedrock has to be an accessible community pharmacy service but I do not think that primary care pharmacists should be corralled back into the community.”

Carwen Wynne Howells, chief pharmacist, National Assembly for Wales, said that the pharmacy workforce was not all in the right places. However, workforce issues were not going to be solved until they were looked at across the profession as a whole.

Short-term strategy

Mr Scott defended his views, saying: “I believe primary care pharmacy is a short-term strategy. Pharmacy is about caring for people on a one-to-one basis.” He added that if community pharmacy could not offer pharmacy graduates an environment that they wanted to work in then they would go into primary care. The community pharmacy contract needed to be renegotiated to address this problem.

Mr Scott said that the gateway to developing community pharmacy was repeat dispensing. Pilot projects for this were already under way in Fife. Mr Scott said that repeat dispensing would do for community pharmacy what the development of clinical pharmacy services had done for hospital pharmacy. It would get pharmacists and prescribers talking about patients’ clinical needs.

Representation

In an introductory talk about developments in primary care, Mr Scott said that pharmacy needs to be represented at every level of the National Health Service structure. In Scotland this meant health boards, primary care trusts and local health care co-operatives.

“If you are not round the table how can you make your views known or get hold of some of the money?” he asked.

Questioned about representation of pharmacists on the new strategic health authorities in England, Dr Smith said that he was arguing hard for it. “It is vital that pharmacy should be represented in the public health function of the new special health authorities.”

Carwen Wynne Howells, in her introductory talk about developments in secondary and tertiary care, said that the whole structure of hospital pharmacy in Wales was going to be re-examined “lock, stock and barrel”. She said that it had, at last, been recognised that medicines were a central component of hospital care and that hospital pharmacists had a central role to play in medicines management.

Unfortunately, hospital pharmacists were in short supply, as were technicians. A survey in Wales had shown that 120 pharmacists were needed for every 100 whole time equivalent pharmacy posts and 130 technicians for every 100 posts. The current drift from secondary to primary care was not sustainable, she said.

Ms Wynne Howells said that a commitment had been made to pharmacist prescribing in Wales. The current deputy chief pharmacist was moving into a new role to develop this. However, if pharmacist prescribing was to come about then there would have to be a re-evaluation of how pharmacy technicians could take on clinical roles.

Asked about pharmacist prescribing in Scotland, Bill Scott said that it was perverse that pharmacists were not prescribing. However, there were other groups which also wanted prescribing rights. “We support pharmacist prescribing,” he said, “but nature will take its course.”

Dr Smith was more optimistic. He expects pharmacists in both community and hospital pharmacy to be able to prescribe as dependent prescribers — amending treatments which other prescribers have initiated — within two years. There is strong support for this from the Department, the profession and the All-Party Parliamentary Pharmacy Group.

Medication errors are rare but still too frequent, Dr Smith believes. They undermine public confidence in the NHS.

The current handling of medication errors in primary care is driven mainly by complaints or litigation. Dr Smith said that around a quarter of all litigation involving GPs centred around medication errors. He could find no public domain information about errors in pharmacy, although individual companies held their own records.

Model pharmacy

Bill Scott said that a model pharmacy, incorporating a walk-in centre, will be opened in Glasgow shortly. The pharmacy would be used by social workers and community nurses as well as pharmacists. It would incorporate some of the services provided by NHS walk-in centres in England.

“Pharmacies are our walk-in centres,” Mr Scott said. The focus of the pharmacy will be on care not products.

What do you think?

Back to Top