Christine Glover describes “major opportunities” for
British pharmacy
Pharmacy in Britain has major opportunities to further
extend its professional role in relation to the support of self-care,
medicines management and pharmacist prescribing. That was the message
given to pharmacists attending a symposium on prescribing and self-care
organised by the FIP Community Pharmacy Section on 6 September by Christine
Glover, Immediate Past-President of the Royal Pharmaceutical Society.
However, Mrs Glover warned that there were major
challenges still to be overcome, including maintaining medicines supply
under pharmaceutical direction, ensuring patient controlled pharmacist
access to medication and health records, and raising pharmacists’ self-expectations
along with the public’s expectations of pharmacy.
Mrs Glover defined a “new paradigm” of self-care.
Whereas before self-care had been thought of as the informal treatment
of minor illnesses, now it was seen more as an important element in virtually
every form of health care. Concepts like concordance indicated that self-care
involves individual medicine users determining their most important priorities
and goals, deciding which advice and treatment to accept, and actively
making the best of their situation in order to decide on their personal
health outcomes. “Once care models of this sort are accepted then the
strength of the pharmacist’s position as potential facilitator of self-care
in all aspects of health involving the use of medicines becomes much more
apparent,” she said. Old fashioned “I know best; do as I say” professional
paternalism was no longer acceptable.
Mutual dependence
Now there are overlapping fields of public and professional
knowledge and authority. “To achieve the best possible results, professionals
like doctors and pharmacists, together with patients, have to recognise
their mutual dependence and work together on an essentially equal basis,”
Mrs Glover said. Shifts in thinking about public health care offer pharmacists
a unique chance to play a greater role in preventing illness where possible
and treating it effectively where necessary.
Mrs Glover made three additional points about self-care.
First was that some individuals did not want to be closely involved in
decision making about their treatment. For them, instruction remained
preferable to consultation.
Second, even progressive professionals drift into
thinking that patient empowerment was something that they did for patients
by giving the information. This of course, is disguised paternalism, Mrs
Glover said. “Empowerment is something that people ultimately take for
themselves and can be best seen as acquiring a positive mindset and becoming
a critical information seeker.”
Third, she said that supporting self-care is about
improving health outcomes and service quality, not merely about trying
to make savings in the drugs bill by encouraging people to pay for over-the-counter
medicines out of their own pockets. “That sort of simplistic argument
doesn’t help anybody, not least because it undermines trust in what we
are trying to achieve.”
Mrs Glover went on: “My vision for the future of
our profession is one in which we combine our unique scientific knowledge
of medicines and their use with an extended ability to contribute to diagnosis
and treatment in partnership with other health professionals and, most
importantly of all, an increasingly informed and motivated public. I believe
that this will enable us to foster better health and health care for all
sections of the population.”
She also believes that facilitating more effective
self-care is a central task for every modern health care system and that
pharmacists working in both community and hospital settings have a vital
role to play in it. She was confident that pharmacists would be doing
much more in years to come. She told the audience that, over and above
progress in areas such as supplementary prescribing, repeat dispensing
and medicines management, appropriately qualified British pharmacists
are likely to extend their roles to include independent prescribing along
the lines now being pioneered by nurse practitioners in Britain.
But she did not want to finish on an unrealistic
note and ignore the extent of the practical challenges still to be overcome.
“For example, we must not lose sight of the importance of our medicines
supply role. It is important to ensure that this function is maintained
under the appropriate direction of pharmacists.”
There was also the issue of improving community
pharmacists’ access to patients’ health records and their ability to amend
them or add to them. The way forward for pharmacy, she said, must involve
working in ways that are not only sensitive to customers’ desire for convenience
and easy access to effective medicines, but which also ensure that the
care received by patients is properly integrated, safe and efficient.
“This cannot be achieved if we allow treatment patterns and health records
to fragment.”
Availability of medical records
It is vital for the future, Mrs Glover said, that,
with the emergence of ever more sophisticated forms of information technology,
medical records — given the consent and control of patients who are their
true owners — should be made properly available to pharmacists. “Otherwise,”
she warned, “our ability to act as independent prescribers will never
happen. ... If we want to see pharmacists’ roles extended in ways
which benefit the public, we are going to have to fight for constructive
change. If we want a better future we are going to have to actively choose
it and work together in a systematic unified and motivated way to build
it and to demonstrate competence.”
Mrs Glover concluded saying that pharmacists needed
to put thoughts of themselves as victims of circumstance behind them and
move forwards in a confident and determined manner to serve the public’s
interest in health and health care even more effectively. “That’s the
take-home message I leave with you. It is not just the general public’s
and other professionals’ expectation of pharmacy that need to be raised.
The last and most important challenge to overcome relates to our expectations
of ourselves,” she said.
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