The Pharmaceutical Journal
Vol 268 No 7196 p627-628
4 May 2002

Society summary

Wales is "squandering" pharmacy's potential contribution to health care

The unique contribution that pharmacy can make to improving the health of the people of Wales is being squandered, the chairman of the Royal Pharmaceutical Society's Welsh Executive, Andrea Robinson, told guests at the executive's annual dinner on 23 April.

Mrs Robinson suggested that the National Assembly for Wales, the National Health Service in Wales and other health care partners should "think pharmacy" more often and be more imaginative when addressing medication and related health care issues.

Mrs Robinson said that among pharmacists' great strengths is that patients like them. The pharmacy is a welcoming venue, with much less of what sociologists call "social distance" between people and their pharmacists than between patients and doctors. A second strength is that pharmacists are found in virtually every community in Wales, in supermarkets and high streets and in every hospital ward and outpatient department. A third strength is pharmacists' unique expertise in the use of medicines. Patient increasingly demand expert advice on medicines, and no one is better able to meet that need than pharmacists.

So patients, carers and taxpayers all like pharmacists. And an estimated 100,000 of them visit community pharmacies in Wales every day for the purposes of "health gain". But despite that, the pharmacy resource is being squandered because pharmacists could do so much more.

NHS challenges

Mrs Robinson said that among the challenges facing the NHS are that half of all patients with chronic conditions use their medicines ineffectively, 6–10 per cent of hospital admissions are caused by problems with medicines, and medicines worth nearly £6m are returned unused to Welsh pharmacies every year. In addition, care workers feel vulnerable when supervising clients' medication, thousands of people wait every day to see a GP for something that others could deal with satisfactorily, and many more are suffering the health consequences of smoking, drug misuse or unwanted pregnancy, when proven help is available.

In every case, pharmacists can help. They can help people understand, use and adjust their medication. They can offer advice and support to care workers. They can offer medicines-related services in the pharmacy. But despite countless examples of the proven benefits of such approaches, far too many remain as isolated pilots, either unknown or unadopted in the wider NHS.

Nowhere is this more the case than in services for older people, Mrs Robinson said. "All the issues — monitored and adjusted prescriptions, appropriate use of complex medication, proper hospital discharge arrangements, general health promotion and advice, support for carers — all apply in spades with older people. The single assessment process, for example, should involve pharmacists, and so should health promotion campaigns for older people."

Local projects

Mrs Robinson went on to give examples of local pharmacy projects in England and Wales that offer "simple, effective, practical solutions to common problems" and said that there are plenty of tried-and-tested service models, delivering high quality, cost-effective services. The paradox, she said, is why these services are not commonplace in every part of Wales.

One problem, said Mrs Robinson, is the relative invisibility of pharmacy within the NHS. It is too easily forgotten, even though pharmacists serve on local health groups (LHGs) and local health boards (LHBs). There is a need to "think pharmacy" a bit more.

Money

A second problem is money. Community pharmacy is already exceptional value for money for the NHS in Wales, but new services need specific resourcing. The old approach to contracting stifled innovation but the NHS and social services can now share funds, LHGs and LHBs can contract for local services, and the national contractual framework for community pharmacy is about to be overhauled. National and local managers and policy-makers in Wales should use the flexibilities open to them, Mrs Robinson suggested. She concluded: "With all the extra money now starting to flow in, we have no excuses if we fail to deliver."

A response to the chairman's speech was given by Ann Lloyd, director of NHS Wales, who was the chief guest at the dinner.