The Pharmaceutical Journal Vol 267 No 7168 p458
6 October 2001

This article
Reprint
Photocopy

Pharmacy in the future — one year on

One year has passed since the launch of the programme for pharmacy in the National Health Service in England. Michael Thompson finds that views on progress vary according to the standpoint of the observer

At last year’s British Pharmaceutical Conference, the then Minister with responsibility for pharmacy at the Department of Health (Lord Hunt) announced an ambitious programme for the development of National Health Service hospital and community pharmaceutical services (PJ, 16 September 2000, p397).

A year has now passed, so it is legitimate to ask what has changed since the paper was launched and what, if any, of its targets have been met. To the outside observer the answers might seem to be “little” and “none”, but there is optimism for the future provided that key obstacles — there are just not enough pharmacists and insufficient resources — can be surmounted.

Certainly the lack of a sufficient number of pharmacists is seen as a key problem to implementation of the programme by Helen Remington, president of the Guild of Healthcare Pharmacists, chief pharmacist Addenbrooke’s NHS Trust and a Royal Pharmaceutical Society Council member.

“There is some progress and huge potential,” she says. “The hospital sector is welcoming the opportunities that are offered to pharmacists.”

But her positive response is tinged with disappointment that more has not been achieved due to staffing problems.

The principal change set out in the programme for the hospital sector entails restructuring services to make them more efficient, safe, patient focused and delivered at the point of need when they are needed.

Changes envisaged by Mrs Remington include 28-day medicines supplies, re-use of patients’ own medicines, discharge prescribing by pharmacists, automation of dispensing and the handling of medication needs on admission by pharmacists.

All of these are already happening in various hospitals, although others would like to start, or expand, them but are being held up by finance or staff considerations.

It is not only the shortage of pharmacists that is holding things up. Some of the changes require pharmacists’ time to be released, by training technicians to take on basic tasks that pharmacists should not be doing, but there are not enough technicians either. At least this suggests that the lead time to improvement could be less than the five years that it takes to train a pharmacist — technicians can be trained in two years.

“Opportunities are being missed because we can’t get the staff to deliver,” concludes Mrs Remington.

Similar frustration, but for different reasons, is felt by the representatives of community pharmacy.

Pharmaceutical Services Negotiating Committee chief executive Sue Sharpe says: “The opportunities heralded in the pharmacy plan still seem some way off. Community pharmacists are going through a very difficult time and would really like to see soon some more targeted evidence of commitment to using their resources and network.”

There is particular disappointment that discussions on the new contract, announced by Lord Hunt in December 2000, have not begun.

“We are very disappointed that the new contract will not now be discussed for another year,” Mrs Sharpe says. “Community pharmacists waited a long time for the programme.There is an enormous amount of change signalled in the plan and our concern is to make sure that as these changes develop they make the best use of community pharmacies and help us do our best for patients and the NHS.”

Areas in which there has been progress towards change include pharmacist prescribing, electronic prescribing, medicines management and local pharmaceutical services. However, in all these cases nothing has actually started to change. Framework legislation for prescribing is in place, but there are no signs of implementation; indeed, a Royal Pharmaceutical Society task force is not expected to produce a report until late next year. Electronic prescribing pilots have been approved, but none have actually started. Medicines management pilots have been approved, but no-one has started managing medication yet under the scheme. Local pharmaceutical services are expected to start next year, but there are, as yet, no detailed rules for how they will operate and bids have not been invited.

Hertfordshire community pharmacist Graham Phillips takes the view that the fact that Lord Hunt’s document was launched as a programme for pharmacy, rather than a plan for pharmacy, offers a clue to what is going on.

“The fact that they didn’t call it a plan suggests that it is only a discussion document. It is as though somebody had a dream for the future of pharmacy, but never sat down and said ‘here is the plan; here is the map’.”

For support, he points to the introduction of NHS Direct and primary care trusts, which were announced and had resources directed at them.

“To achieve strategic change you have got to provide resources,” Mr Phillips says. “We are serious about this. If the Government is serious then we cannot deliver on the basis of existing resources.”

Not surprisingly, the view from the Department of Health is a more optimistic one, reinforced by a belief that the essential foundations for change have been well laid and that building will soon commence.

Dr Jim Smith, the chief pharmaceutical officer for England, says: “I am content with what we have achieved in the first year.”

He says that some 20 per cent of the Health and Social Care Act 2001 concerns community pharmacy. “This was achieved despite a crowded Parliamentary timetable and a lot of competition for inclusion in the Act. The groundwork has been laid for pharmacist prescribing, for local pharmaceutical services and for regulatory change.”

“We are only in the first year of a four-year programme,” Dr Smith goes on. “In the second year we will start to implement changes. We hope to consult on pharmacist prescribing very soon — there will be a first, informal, consultation before the end of the year. I hope to see the first cohort of pharmacists prescribing by the middle of 2003, but there is an enormous amount of work to do before this. There will have to be formal consultation on the principles and framework of pharmacist prescribing, followed by consultation on changes to the POM Order.

So what has been achieved? The answer seems to be most of what has to be done before any real change can be implemented. Pharmacists should look forward to change but should not expect any change to the maxim that the wheels of Government turn slowly.

Back to Top

Michael Thompson is on the staff of The Pharmaceutical Journal