The Pharmaceutical Journal Vol 268 No 7183 p146 2 February 2002	This article Reprint Photocopy
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Articles

Medicines management and change management — the PSNC pilot trials

By Allen Tweedie, FRPharmS, FRSH

To those who regularly read The Pharmaceutical Journal, it will have been apparent for some time that medicines management is at the top of the agenda for both the Department of Health and the profession. This article some of the implications for the profession

Medicines management services will be a major driver for changes to the delivery of primary health care that revolve around medicine-based therapy. More especially, these new services will require change in both facilities and operational procedures within the pharmacy itself. These changes are imminent. The medicines management pilot trials — led by the Pharmaceutical Services Negotiating Committee — will soon start to run, and medicines management packages are shortly to be released by the PSNC for immediate application in primary care. These packages will be disease-focused, dealing with one group of patients or one area of illness at a time, eg, care of the elderly and diabetes. The appropriate patient organisations have been consulted and the national service frameworks used as templates for service design. Targeting specific groups makes the introduction of medicines management more manageable and ensures that the benefits can be quickly identified and recognised by all concerned. Medicines management can be defined as "the systematic provision of medicines therapy, through a partnership of effort between patients and professionals, to deliver best patient outcome at minimised cost". This definition indicates two new relationship constructs: one with the patient and one with the doctor. Although pharmacists already have good general relationships with both, the new "medicines management relationship" requires both "structure" and "system". The structure is the tripartite partnership of effort between patient, doctor and pharmacist, together with the specific contribution formally recognised and made by each. This is a new regular routine, not a sporadic intervention. The system is the employment of the selected range of elements of medicines management for which each partner is responsible and the order in which they are addressed. Patients' areas of concern include their clinical response, their needs and wants and their motivation to stick with the prescribed medication. Medical areas of concern include clinical effectiveness, drug economics, budget control and disease prioritisation. Pharmacists are the bridge between the two. The PSNC medicines management packages cover all these aspects and will enable contractors to offer new services under the guidance and support of the local pharmaceutical committees as well as the PSNC itself. Funding, via the primary care trusts and groups will pay for the new service, but other considerations are now also rising to the top of the agenda. These include the wider employment of pharmacy support staff to release pharmacist time (under the umbrella of skill mix issues) and the need to improve premises in order to deliver the new services. The skill mix debate is already gathering momentum under the banner of "supervision". Supervision will remain the responsibility of the pharmacist, but the meaning of supervision will be updated and strengthened, in line with quality assurance and audit principles. It is not, as it is sometimes suggested, a weakening of the pharmacist's position. More responsibility for the mechanical tasks will go to the trained technician. Indeed, the concept has already been revised by the advent of Lord Hunt's paper, "Pharmacy in the future", which states: "The Government believes the law permits the distance sale and supply of medicines, provided that normal safeguards are met. This means for example, that sales of pharmacy-only (P) medicines by electronic means are acceptable provided they are made under the supervision of a registered pharmacist and from a registered pharmacy." It is now officially recognised that it is possible to supervise the sale of a medicine, for example, without the patient or patient's representative being present. A dedicated area for consultation in pharmacy premises is also crucial to our ability to deliver the new services. Conversational approaches across the counter are not acceptable for this new dimension to the service. Confidentiality, comfort and confidence are vital. The patient must be able to recognise an entirely new order of service, appreciate and be confident in the discussion and feel the benefit. The doctor must have confidence in what we are doing and the way in which we do it. Various models of how premises can be adapted to accommodate the new services have already been devised for the medicines management pilots, and these will be deployed to customise each pharmacy so that it is ready to provide the service. Design options will be included in the service packages, to be released over the next few months. So, although these are strong indications that pharmacy is at last entering a new phase and becoming a more integrated part of the provision of primary health care, other changes still need to be made. Medicines management will be a major consideration in the new contract for pharmacy, as will the other new services we will be developing over the coming months. A heavy investment of effort has been made in bringing us this far, but the greater achievement will be from our colleagues in the front line of health care, picking up the challenge of change by providing new services. In the future, the PSNC will chart out, in detail, the route into the new services and the crucial importance of partnership building with our colleagues in the medical and associated professions. Both local pharmaceutical committees and local medical committees will have a vital role to play. Far from being a threatening time for community pharmacy, great opportunities now present themselves. The way we manage the changes and equip ourselves for the future will be crucial to success, both in terms of professional fulfilment and how we are rewarded for providing new services. We are at last moving into a new era of service and we must engage it with confidence and excellence. Let it be said, however, that none of this can take place without equitable address of remuneration. Proper reward must be ensured for these quality-driven, value-adding services, which will deliver massive benefits to patients, politicians and health professionals alike.

Allen Tweedie is chairman of the Leadership Group on Medicines Management (e-mail Consultweed@aol.com)

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