The Pharmaceutical Journal
Vol 269 No 72xx pxx
13 July 2002

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Northern Regional Pharmacy Conference

Dr Jim Smith, chief pharmaceutical officer for England, explained that this was a time of great change for pharmacists, the national Health Service and for himself. A stream of Department of Health publications had followed the NHS plan, which was now two years old; progress was being made quite steadily with implementing the various directives. The Government was looking most seriously at public private partnerships (PPP) to help deliver the plan and Dr Smith cited community pharmacy as a perfect example of a PPP, which delivered successfully. However, there were many milestones that had to be passed by community pharmacy and among the DoH's medium-term aims, Dr Smith listed:

• The introduction of electronic transfer of prescriptions

• The development of a new contract for community pharmacy (the DoH is awaiting the outcome of the Office of Fair Trading's investigation into the restriction of NHS contracts before taking forward any new contract details)

• The development and implementation of clinical governance

• More POM to P shifts

• NHS Direct's involvement with the community pharmacist and the referral of patients to their local pharmacist

• The furtherance of medicines management

Another burning issue that Dr Smith addressed was skill mix and making the best use of staff. The idea of rigid demarcation lines within the NHS was no longer part of DoH thinking. Pharmacists were going to be allowed, and encouraged, to begin prescribing and as a result they were going to have to delegate certain tasks to staff. This process, Dr Smith was at pains to explain, should not be regarded as "deskilling", but as empowerment. Support staff will have to be regulated, although no mention was made of when, how and by whom; training would also be part of the package with standards to be set. Dr Smith realised that this would increase community pharmacy's costs.

He also mentioned pharmacist prescribing and told participants that all pharmacists will be considered to be potential prescribers; none is to be excluded. There were to be no restrictions on where or on what drugs, except Controlled Drugs, that may be ordered.

In conclusion, he asked primary care pharmacists to stop competing in the way they currently do and begin collaborating to help ensure the huge challenges that face the profession can be overcome. Then we as a profession can make the system work for the benefit of all.

John D'Arcy, chief executive, National Pharmaceutical Association, said that pharmacists are self-deprecating and regularly undersell themselves. They are by their training and practice reactive; they are not proactive. This means that they expect to be told what to do and how to do it, to their own detriment. They have now been recognised by the NHS as part of the primary care team and uniquely had a document, "Pharmacy in the future", dedicated to them.

They were facing some big issues that must be addressed, not least of which was the desire to undertake new roles and do more while declining to delegate any of their existing roles. As prescription numbers increase and more patients more questions, the time pharmacists have available for existing roles, let alone new ones, is being squeezed. "Something has to give," he said.

The advantages of delegating were cost efficiency (but only if tasks were delegated to competent people), increased job satisfaction for all employed in the pharmacy and maximum use of limited human resources.

On the subject of supervision, Mr D'Arcy stressed the importance of not going too far too quickly. He pointed out that there is no legal definition of supervision and that there is no mention of a "final check" within any official document. Supervision is really about ensuring safe and appropriate use of medicines; there is no need to supervise every prescription and perhaps the pharmacist need only supervise one prescription for a chronically sick patient every six months. There needed to be a practical manifestation of supervision. He added that the pharmacist must be accountable and that pharmacies must not be run without pharmacists.

Mr D'Arcy then turned his attention to local pharmaceutical services (LPS). He stated that £3bn is being wasted annually because medicines are not being taken by patients. Any project that could help alleviate this waste, or some of it, would be candidate for an LPS scheme. There was much fear of the unknown among community pharmacists regarding LPS and their reluctance to be proactive or to become involved was one reason for this. LPS would have to fit with local health improvement programmes. Mr D'Arcy's view was that LPS could be a test bed for the new contract.

Speaking of the new contract, he suggested that when it arrived it would be more modern than the current one; it would embody the right obligations and incentives for community pharmacists, which were missing at the moment. It would need to reward quality not quantity as at present, with "best" gaining at the expense of "bare minimum". However much that the profession delivers currently is good and must not be rejected simply for the sake of change.

The problem of control of entry which was the subject of an OFT inquiry was another vexation that pharmacy could well do without. The present system of control of entry underpinned the pharmacy network, which provided a near national distribution of community pharmacies.

Quality and its development in community pharmacy, as clinical governance, was also considered by Mr D'Arcy. Bearing in mind the number of prescriptions that were dispensed, quality within community pharmacy was high. Where the profession was not so good was in reassuring patients and communicating with them. Record keeping was poor with much being supplied over the counter and little, if anything, being recorded.

Continuing professional development is an essential part of developing and maintaining quality and there was no doubt in Mr D'Arcy's mind that it would eventually become mandatory. This would lead, however, to a two-tier register of practising and non-practising members.

Mr D'Arcy stated that all the professions are under pressure: on margin, on workload and on regulation. But if we are to deliver in the future then several issues would need to be addressed:

• We must be patient-focused because of competition on the high street

• We must make available the services that patients want at a time and place of their choosing

• We need to become proactive, becoming more collaborative and interacting with other professions

• Patients must be convinced that their pharmacist is "up to speed"

• We must "do our bit" but the DoH must be supportive

Nick Lowen, a pharmacist and trading strategy manager for GlaxoSmithKline, said that GSK had undergone much change but not as much as that undergone by community pharmacy, which he likened to changing an engine on an aeroplane while it was still flying. He explained that GSK had engaged in a widespread consultation process developing a community pharmacy advisory board of practising pharmacists.

GSK was aware of the pressures and problems facing community pharmacists and was anxious to collaborate with them in projects such as asthma, diabetes and smoking cessation. The company had produced three initiatives involving community pharmacy. These were a pharmacy asthma care pack, a diabetic-glycaemic review and a pharmacist-to-patient counselling protocol for use in depression. These initiatives, apart from helping patients, are intended to help the pharmacist to develop relationships with patients, enhance professional satisfaction, move toward medicines management with its new income streams, drive footfall through pharmacies and create loyalty to pharmacy.

It was GSK's intention to help the community pharmacist successfully navigate the changes which are facing the whole of the pharmacy profession.

In his presentation, Joe Asghar, from the Directorate of Social Health Care (North), outlined what he believed were the changes, challenges and expectations for the profession.

Among the changes to pharmacy that will have to be tackled if the profession is to survive are modernisation of the Royal Pharmaceutical Society, clinical governance, medicines management initiatives, professional demands (workforce/skill mix), automation and e-commerce, local pharmaceutical services, pharmacist prescribing, accreditation and reaccreditation (competency) and public health involvement. This was a formidable list that needed to be prioritised, if possible.

The challenges are multifaceted and include seamless care (social, law enforcement, public health, primary and secondary care), workforce organisation, providing resources where they are needed, leadership and addressing all the medicines issues in the NHS plan.

Mr Asghar went on to say that opportunities do exist if we work together, and that our professional culture will need to be flexible in order to maximise them. Concluding, he said that pharmacists can meet the needs of a modern health service.

A brief question and answer session followed. The first questioner wondered what were the implications of not having pharmacists sitting on PCT boards. The answer was that while the DoH thought it was a good idea, there was no way it would dictate to a PCT and insist that pharmacists be given a seat. If a pharmacist was not appointed to the board then other methods should be found to influence the behaviour of the PCT. Good contacts were vital.

A second questioner wanted to know how it was that the DoH had directed that GPs and nurses should be included but not pharmacists? The answers from the speakers suggested that it was difficult for pharmacists to find the time needed to make such a commitment; pharmacists found it hard enough to make time to attend training sessions. The questioner had also suggested that the DoH undervalued the supply function of pharmacists. Dr Smith replied that the DoH had not undervalued this aspect and what was needed was pharmacists to undertake an extended role while delegating the dispensing process.