The Pharmaceutical Journal Vol 267 No 7170 p564-565
20 October 2001

This article
Reprint
Photocopy

National Association of Co-operative Executive Pharmacists summary

Challenges in community pharmacy

Scotland is in its third year of developing pharmaceutical care programmes and has a number of pilots in other areas, according to FRANK OWENS, chairman of the Scottish Pharmaceutical General Council. Three model schemes of pharmaceutical care are operating in Scotland. They are in palliative care, patients suffering severe and enduring mental illness, and the frail elderly.

In the palliative care model, the objective is to ensure that patients requiring palliative care are guaranteed a supply of essential medicines at a time of need. “It is unacceptable for a profession like pharmacy to not have drugs in stock that can make a big difference in the last few hours of life. This is an extremely simple and achievable aim,” he said. It had also involved the creation of a network of specialist community pharmacies to provide information and advice on palliative care to patients, their relatives and other health care professionals.

The objectives of the other models are to improve medicines concordance and to encourage integration between the community pharmacist and other care providers.

“When the schemes were launched in 1999, the intention was to develop a bottom-up approach. There was a realisation that we were embarking on an unknown journey. The idea was to allow different models to establish themselves, let them develop, evaluate best practice and roll this out nationally,” he said. A pharmaceutical care facilitation unit is to be set up to facilitate translation of successful pilot schemes into best practice (see Society news).

A pilot scheme allowing the direct supply of over-the-counter medicines free of charge was launched in April this year in Arbroath and Ayrshire. The pharmacist can prescribe from a limited protocol and supply medicines free of charge to patients who are exempt from paying prescription charges. Patients who use the service register with the pharmacy. Initially, there was some hesitation and people waited until they were ill before registering, but now, six months into the pilot, the number of people registered is on an exponential curve, he said. He pointed out that pharmacists counter-prescribe every day and allowing pharmacists to prescribe on the NHS in this way eases the burden on general practitioners and nurses. Mr Owens said that he was hopeful that the project would be successful. “We see this as perhaps the first real step towards establishing pharmacist prescribing in Scotland,” he added.

Repeat dispensing is also under consideration. The preferred option consisted of a “master” prescription, authorising up to six months supply in instalments, with “slave” prescriptions which means that they act as a trigger for reimbursement each time an instalment is dispensed. By using the same pharmacy for six months, the pharmacist has the opportunity to build up an accurate patient medication record and monitor compliance. “It potentially allows the pharmacist to provide a far greater degree of pharmaceutical care than might previously have been possible,” he said.

However, Mr Owens cautioned: “If we are genuinely serious about pharmaceutical care then it is essential that our pharmacy premises are suitable for the task.” Funding had been secured to allow pharmacists to develop quiet areas in the pharmacies. “I believe that in five years’ time it will become unusual for a community pharmacy not to have a discrete consultation area. In 10 years’ time, it will probably not be possible to practice pharmacy unless you have a consultation area,” he said. In Glasgow, the Scottish Executive is funding the development of a model pharmacy that has two consultation areas and a treatment room that can be used by other health professionals such as nurses, physiotherapists and social services. Through other health professionals practising in the pharmacy, this could provide a step forward in getting people to see pharmacy as key to NHS services, he added.

Back to Top