The Pharmaceutical Journal
Vol 268 No 7184 p168-169
9 February 2002

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Pharmacy strategy launched in Scotland

This week saw the launch of "The right medicine: a strategy for pharmaceutical care in Scotland". It aims to make better use of pharmacists' skills and expertise to improve patient care. Clare Bellingham finds out what the strategy says

Related websites
A strategy for Pharmaceutical care in Scotland [more]
Scottish Executive (www.scotland.gov.uk)

Scotland's strategy for pharmaceutical care gives pharmacists in Scotland a vision for the future. It outlines how the Scottish Executive plans to modernise pharmacy services over the next four years. "The right medicine" identifies a more prominent role for pharmacists in the delivery of health care, through the introduction of initiatives such as repeat dispensing, pharmacist prescribing and use of pharmacy premises as walk-in centres.

The strategy comprises five chapters:

• Improving health
• Improving access
• Helping patients make better use of their medicines
• Service redesign
• Partnership with staff

Actions to be taken in each year between now and 2005 are included in the strategy (see Panel). Bill Scott, chief pharmaceutical officer, Scottish Executive, will be responsible for delivery of these developments and will establish implementation groups to ensure this happens.

Improving health

The strategy highlights the fact that community pharmacists are often patients' first, and sometimes only, point of contact with a health care professional. "This creates a unique opportunity to improve the gateways for signposting, accessing and providing services and information on health and health issues to a broad spectrum of the population," it says. In the future, pharmacies will be more widely included in campaigns, activities and initiatives as part of a multidisciplinary approach to health promotion. All NHS boards and local health care co-operatives (LHCCs) will have to ensure that they have access to pharmaceutical public health advice in order to develop pharmacy's contribution in this area.

Two new organisations will be set up to optimise the use of medicines: a Medicines Utilisation Unit, which will provide NHS bodies in Scotland with information about how medicines are used, and a Scottish Centre for Drug Reactions Reporting, which aims to strengthen the yellow card scheme. The strategy says that there is a need for a centre in Scotland to provide feedback on adverse reaction reporting.

A public awareness campaign about the safe storage and use of medicines is also planned.

Improving access

Pharmacist prescribing is to be introduced in Scotland by 2003. Speaking at the launch of the strategy, Malcolm Chisholm MSP, the Minister for Health and Community Care, said: "In conjunction with the Department of Health, we plan to introduce pharmacist prescribing to allow pharmacists to adjust doses on repeat prescriptions." He added that this would help to prevent medicine-related hospital admissions, bring greater convenience for patients and reduce GP workloads.

The strategy also suggests that pharmacists might be able to prescribe independently: "Pharmacists may be able to prescribe prescription-only medicines privately, for example in travel clinics."

Developing closer working with the medical profession is also highlighted as a way of encouraging prescribing partnerships. "Hospital pharmacists, as part of the health care team, have for many years been closely advising on the prescribing of medicines to meet the needs of individual patients. We want to see this extended," the strategy says.

Among other issues in improving access, the strategy notes that a problem faced by community pharmacy is that the public does not always recognise pharmacies as either part of NHS Scotland or providers of NHS services because they straddle the private and public sectors. In order to tackle this, all pharmacies will be encouraged to carry the NHS Scotland logo to emphasise the importance of community pharmacy as part of the wider team within the NHS.

The strategy highlights the need for greater privacy in community pharmacies so that pharmacists can deliver extended roles. The allocation of funding as part of the Primary and Community Care Premises Modernisation programme to 10 pharmacies was also announced at the pharmacy strategy's launch (see p161).

Mr Chisholm said that the potential within community pharmacies to offer a wider range of joined-up services had to be unlocked. "I am pleased to announce £500,000 of funding to enable 10 pharmacies to create model, 21st century premises," he said.

Walk-in centres

According to the strategy, community pharmacies should be developed as "walk-in healthy living centres". It says: "This will be enhanced by the development of a standardised pharmacy patient record and decision support system to ensure continuity of care throughout NHS Scotland."

Frank Owens, chairman, Scottish Pharmaceutical General Council, commented: "In a reconfigured Scottish primary care service, there is no need for expensive NHS walk-in centres such as we have in other parts of the United Kingdom. There is potential to redesign some of our pharmacies to allow a shared use: other disciplines such as nurses, physiotherapists and social work staff could use community pharmacies as additional outreach premises from which to contact patients and clients. I am delighted that the value of this message has been formally recognised within the strategy."

New services

In terms of developing services in community pharmacy, the following roles for pharmacists will be introduced by 2005:

1. Repeat dispensing as part of agreed shared care packages between general practitioners, pharmacists and patients so that patients can have repeat prescriptions dispensed for 18 months without the need to go to their GP
2. Monitoring of diseases or therapies to identify poor symptom control or inappropriate therapy; pharmacists will be able to adjust dosages of medicines within agreed limits without the patient having to visit their GP
3. Pharmacist prescribing for common illnesses to improve patient access to health care

Alison Strath, chairman of the Royal Pharmaceutical Society in Scotland said: "The introduction of a repeat dispensing model, allowing certain patients to receive repeats of their prescription from their pharmacy for up to 18 months without having to go back to their GP is, for me, the most exciting prospect. It offers patients a much more convenient service, frees doctors to spend more time with patients who have the most immediate needs and allows pharmacists an enhanced role in providing direct patient care."

Mr Owens said that up to 35 per cent of all GP consultations are for minor, self-limiting conditions and that in some parts of Scotland, patients have to wait three or more days for a non-urgent appointment. " Community pharmacists counter prescribe every day of their working lives. Why not allow pharmacists to prescribe, within agreed protocols, on the NHS, and make the entire process easier for patients and at the same time ease the burden on GPs and practice nurses — a simple philosophy, but one that's deliverable."

Mr Chisholm also mentioned Scotland's pilot for electronic transmission of prescriptions in Ayrshire and Arran which is scheduled to go live later this month. It is hoped that all community pharmacies in the area will be connected to the NHSnet by this summer. The strategy aims to roll out ETP across Scotland by 2005.

Also by 2005, regular medication reviews by pharmacists will be introduced. "As part of a new national contract, the Scottish Executive Health Department will put in place ways to develop the clinical skills of community pharmacists allowing certain patients to have their medicines reviewed at least once a year," the strategy says. Pharmacy services in hospitals will also be redesigned so that all patients will have their medication reviewed before discharge. The strategy calls for dispensing of patient packs whenever possible in primary, secondary and tertiary care.

Remuneration

In community pharmacy, the strategy recognises problems faced by the current system of remuneration. "The Scottish Executive Health Department will work with the profession to develop a new system of remuneration which provides incentives to deliver quality services. To support this process, it will seek the necessary powers to introduce local pharmaceutical services which will enable NHS boards to contract directly with community pharmacy contractors for the provision of additional services," it states.

Mr Scott said that the issue of remuneration was one of the factors that underpinned the strategy. "We have to look at remuneration models and find a more effective model based on quality for our community colleagues," he commented.

Partnership with staff

The strategy highlights the need to ensure all staff are fully trained for the new roles it outlines. The Scottish Executive plans to review the skill mix to examine how to use the skills of pharmacists, technicians, dispensers and assistants fully. In addition, it will work to support early implementation of a compulsory obligation for pharmacists to undertake and document continuing professional development as a requirement for registration to practice.

The strategy also aims to improve pharmacists' training. Mr Scott said: "By 2004, pharmacists' preregistration training will be split between hospital and community pharmacies enabling new graduates to gain experience in both fields."

Similarities

Many aspects of this week's Scottish strategy are similar to those in England's pharmacy strategy (Pharmacy in the Future). Both include the introduction of pharmacist prescribing, repeat dispensing and electronic transfer of prescriptions.

In Scotland, the recognition of pharmacies as walk-in centres is not mirrored in England, where walk-in centres have been developed separately, although some include space for pharmacists. England also does not have the concept of model pharmacies which are being introduced in Scotland to act as test beds for some of the initiatives described in the strategy.

Overall, Scotland's strategy for pharmaceutical care should be seen as a positive step forward for pharmacy. Mr Owens said: "Clearly the Scottish Executive sees significant potential for community pharmacy to extend its role, both as a gateway to and provider of NHS primary care services. I welcome that recognition."

Now that the recognition has arrived, and the health minister has assured pharmacists in Scotland that their voice has been heard, it is time to start work on realising the opportunities.