The Pharmaceutical Journal Vol 267 No 7168 p470-481
6 October 2001

BPC 2001 summary

Pharmacists can play a central role in a wide range of patient services

Many opportunities exist for pharmacists in primary care, argued Chris Town, chief executive of North Peterborough Primary Care Trust, a trust that has a reputation as one of the most forward-thinking PCTs in England.

Mr Town, speaking on 23 September, pointed out that the National Health Service was going through the biggest period of change in its history and would have only one chance to “get it right”. The problems in primary care are well documented: the quality of care is variable and good practice is not universally adopted; staff have to deal with patients with high expectations who want faster, easy access services and, as a result, staff are suffering from heavy workloads. On top of that there is a shortage of new professionals to cover those retiring. “We are struggling to recruit general practitioners in Peterborough. The average retirement age is 57 or 58 whereas in the past they would have worked until they were 70,” Mr Town said. He also pointed out that staff who used to be prepared to work in nursing homes on night duty, for example, can now earn much more money on a night shift at Tesco. “We need to make better use of what we have got,” he said.

Mr Town suggested that integrated teams of staff could be created to provide complete packages of care that should have common goals, management and assessment criteria, and access to information systems. This would mean that pharmacists, nurses and GPs would have to work more closely together, as well as work more closely with social services. In turn this would require major review of training, job planning and staffing issues so that the integration would not be impeded by old professional rivalries.

One important development to further this integration would be to accelerate the introduction of electronic records for patients. Mr Town gave the example of people’s ability to get money anywhere in the world through electronic banking, and find out the balance on their accounts, to illustrate that a parallel system already exists.

Other developments might include more local testing, for example managing anticoagulant therapy in a primary care setting, while innovations in telecommunications give the opportunity for the electronic transfer of images for consultation or expert reporting. Endoscopy, minor procedures and other investigations and treatments could be carried out on an ambulatory basis. Minor injury services could be developed alongside GP co-operative bases and walk-in centres, to take these functions away from accident and emergency services, and there should be greater access to beds and other support for rehabilitation palliative care and after care in the community.

Pharmacists have a clear role to play in some of these developments. Medicines management services, for example, have to be in place nation-wide by 2004. Mr Town quoted the then health minister responsible for pharmacy services, Lord Hunt, who invited bids for the first 26 pilot sites in 2000 with the promise of £1.9m to support the development of the services and said: “This surely is where pharmacists stand to make the most difference. Medicines management provides a classic win-win, patients get help and better health care, the NHS makes better use of its resources and professionals make better use of their skills. Pharmacists have the opportunity to work closely with the rest of the primary health care team to blaze a trail to improve patient care.”

Medicines management has a broad definition. According to Mr Town, it is structured professional support to optimise prescribing and to provide extra help to those who need it to get the best from medicines and reduce waste. The broad aim of medicines management is to improve and extend a range of services for patients including the identification of individuals’ pharmaceutical needs, the development of partnership in medicines taking and the co-ordination of repeat prescribing and dispensing processes plus targeted treatment review and follow-up. Successful programmes would demonstrate improvements in the health of patients, a reduction in the wastage of medicines and a reduction in unmet evidence-based pharmaceutical need in at least one priority therapeutic area such as coronary heart disease.

There would also be an improvement in medicines-taking through the development of patient partnerships and a reduction in inappropriate clerical and professional time taken up with existing medicines management processes (such as repeat prescribing). And there will also be improved patient satisfaction with the medicines management services provided, in terms of access and convenience and which build on the strengths of pharmacists.

Mr Town explained that North Peterborough PCT has been selected to host one of the medicines management pilots run by the National Prescribing Centre and that after a preliminary meeting he was struck by how the general practitioners involved were “buzzing” about the prospects of re-engineering the service.

Mr Town also spoke about the electronic transfer of prescriptions. His PCT is one of the pilot sites and they have joined a consortium to deliver a “relay” model. The consortium, led by SchlumbegerSema, is supported by Boots The Chemists, Cable & Wireless, Microsoft and National Co-operative Chemists (see p451). Mr Town explained that with this system the GP issues a prescription as normal, and an electronic copy is sent to the relay server. The patient is able to visit any pharmacy working in the system and the pharmacy can download details from the relay or dispense from the paper version.

Mr Town also touched on the development of local pharmaceutical service pilots, which will be similar to the schemes already up and running for GPs and dentists. Whereas pharmacists are currently paid by the number of prescriptions they process, those working under LPS will be contracted to offer additional pharmaceutical services, such as medicines management, prescribing support, health promotion and disease prevention. Most importantly it will be an opportunity for pharmacists to work more flexibly with other health care professionals, to focus on outcomes and the delivery of high quality services.

Mr Town’s vision of the future is rosy: Mr Town would like to see the development on an integrated local pharmaceutical service, where hospital and community pharmacists and prescribing advisers all work in one team of professional advisers. “We just have to get pharmacists in the door for GPs to realise what they are.”

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