The Pharmaceutical Journal
Vol 270 No 7235 p197-198
8 February 2003

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One year on: has it been the right medicine for Scotland? summary

Strategy makes steady progress

Individual parts of the strategy are progressing well. The challenge will be to make these into a greater whole

In its introduction, the Scottish pharmaceutical care strategy — "The right medicine" — says that it sets out an achievable vision for modernising pharmacy services. This phrase appears to sum up the strategy's key strengths to date: the projects undertaken have been modest but achievable and contribute towards the larger vision of a modern pharmacy service. The biggest challenges will come as the strategy nears its completion date of 2005 and the individual parts have to be melded into the whole of a new contract for community pharmacy in Scotland.

Bill Scott, chief pharmaceutical officer at the Scottish Executive Health Department (SEHD), says that seven of the key action points identified in the strategy for delivery in the first year have been achieved and the remainder are near to achievement.

"'The right medicine' has 60 action points in total," says Mr Scott. "These are all interrelated to deliver three key objectives for pharmacy in Scotland, which are health improvement, the treatment of minor illnesses within the NHS and contributing to chronic disease management."

Among the action points completed so far are trials of electronic transmission of prescriptions (including the connection of community pharmacies to the NHSnet), which are under way in Ayrshire and Arran, and starting pharmacist prescribing, which is being extended across Tayside in the form of the direct supply of non-prescription medicines to patients exempt from prescription charges (see p198). In addition, repeat dispensing is rolling out in north-east Fife (see p200). All of these appear to be, individually, successful so far. The SEHD has also supported some "quick win" schemes, such as encouraging community pharmacies to display the NHS Scotland logo (PJ, 11 January, p40).

A programme for modernising some community pharmacy premises, supported by over £500,000 of funding, has also been implemented (see Panel).

David Thomson, chairman of the Scottish Executiveof the Royal Pharmaceutical Society, says that a one-year report card for the Scottish pharmaceutical care strategy should read "Good work in progress — more to follow".

"It hardly seems 12 months since the launch of 'The right medicine'," says Mr Thomson. "This reflects the pace of activity that has been evident in this time. Clearly the promise that the strategy would herald a period of unprecedented change for pharmacy in Scotland has been extremely accurate. This pace will continue to gather momentum as the support networks become established."

Frank Owens, chairman of the Scottish Pharmaceutical General Council, is also pleased with the progress being achieved to date with the strategy.

"The strategy may well be bold and ambitious, but we need to be aware that it is only one part of a much bigger and bolder plan for the modernisation of the entire Scottish primary care service."

He adds that the modernisation process offers opportunities for pharmacy that it declines at its peril.

"Of course, delivering the vision will necessarily require considerable resource. Realising that resource will be the responsibility of the SPGC in negotiating a new pharmacy contract."

Discussions have already begun on the principles of this contract. The pharmaceutical care strategy covers the period until 2005 and the new contract may well take effect from then. The key principles identified mirror those in the strategy, namely health improvement, access to pharmacy services and chronic disease management. Access will cover areas such as direct supply, repeat dispensing and out-of-hours services.

In terms of chronic disease management, Mr Owens says that while good progress has been made to date through some of the pharmaceutical care model schemes, there is still a long way to go in developing the necessary infrastructure, changing practice and applying suitable support and finances. "That said, I firmly believe that the effort involved, monumental as it may be, will be well rewarded, securing a viable future for the next generation of pharmacists."

Compliance needs

One sign of this future role can be seen in the compliance needs assessment initiative launched within the past three months. Under this initiative, vulnerable patients living at home who are experiencing difficulties managing their medicines can be referred by a range of health and social care professionals. Pharmacists then carry out assessments either in a pharmacy or at the patient's own home. If appropriate, monitored dosage systems can be supplied.

"In essence, there are two aspects to this scheme," Mr Owens says. "There is the mechanical filling of the boxes, but of far more importance is the fact that it provides pharmacists with an opportunity to develop consultation skills for when medication review becomes part of normal practice."

The pharmaceutical care strategy has been supported by a review of pharmaceutical public health carried out by the Public Health Institute of Scotland (PJ, 18 January, p70). "Pharmacy for health" makes 23 recommendations in four key areas of health improvement, support networks, skills development and evidence-based practice. Among its suggestions are the use of "spotter pharmacies" to monitor public health and disease spread through patterns in the sales of non-prescription medicines and consultations with pharmacists. The report has been sent to pharmacists and senior public health figures in Scotland.

Viewed from afar, it is clear that good progress is being made in several separate areas of the pharmaceutical care strategy. This progress will be given a hard test this year as pilots are extended to larger areas. After that comes the hardest part of all — making a coherent and sustainable future role out of the individual successes.