The Pharmaceutical Journal
Vol 268 No 7190 p385-391
23 March 2002

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Pharmacists are "disenfranchised" by medical domination of LHCCs

Community pharmacists in Scotland are currently disenfranchised because of the medical domination of local health care co-operatives (LHCCs), according to Scotland's chief pharmaceutical officer, Bill Scott. But Mr Scott believes that pharmacists will come into their own by 2006 with the implementation of the 37 action points in the pharmaceutical care strategy for Scotland, "The right medicine".

Speaking to a meeting of Scottish LHCC pharmacists held at Dunblane, Perthshire, on 16 and 17 March, Mr Scott said that new NHS Scotland initiatives centred around GP surgeries, and so practice pharmacists were being controlled by practice managers.

New money was being channelled into nurse-led initiatives in an effort to reduce the drugs bill, but pharmacists were seen as the problem rather than a solution. Money saved was not being ploughed back into the service. The net result was that the NHS was failing the Scottish public.

Mr Scott highlighted the lack of strategic planning for pharmaceutical services in the past and said that it was "a perverse incentive for therapeutic practice" for pharmacists' remuneration system to reward volume rather than quality. The increasing number of prescribers meant an increasing volume of prescriptions, longer hours and a need for more pharmacists.

Commenting on manpower shortages, Mr Scott said that most of the pharmacy workforce is engaged in mechanical tasks when their skills could be employed far more effectively in health care delivery. He added that he believes the shortages are exacerbated by there being too many pharmacists working in GP surgeries.

On pharmaceutical care, Mr Scott said that more than 8 per cent of hospital admissions relate to medication problems. Medicines appear to be poorly understood in the community and also among some prescribers. He suggested that there had never been a greater need for pharmaceutical care programmes, but a wide variation in pharmacy practice in Scotland meant that such services were not available everywhere. There was a need for better access to health care delivery, which should include pharmacy prescribing within agreed protocols.

Looking to the future, Mr Scott suggested that from 2006 LHCCs would be an important building block at the heart of the NHS organisation, truly multidisciplinary and firmly focused on improving Scotland's health as a whole, rather than on a product in isolation. He envisaged a concept of standardised pharmaceutical care not just based on the GP surgery or the pharmacy but operating from many premises. Pharmacists would be responsible for monitoring chronic disease and running clinics, and domiciliary visits would be more frequent than today. Pharmacy locality groups would hold the pharmacy budget and be responsible for strategic development.

An important development would be the integration of community and hospital pharmacy. Most of the pharmaceutical workforce would be engaged in providing clinical care, ensuring the best use of skill mix and technology. An exciting prospect was the possibility of pharmacy integrating with other agencies to form walk-in pharmaceutical care centres.

Mr Scott's vision for 2006 includes:

• delivery of standardised pharmaceutical care throughout Scotland
• a change in the design and function of community pharmacy
• walk-in centres in pharmacies
• pharmacist-run clinics
• integrated information technology throughout the NHS in Scotland with common patient records

Achieving this vision, he suggested, would require commitment by pharmacists, support from patients, buy-in from others in the health care team, funding and a robust infrastructure — but it was all possible.
— From Dr Steven Kayne

Meeting report, p413