Practice symposium: Tomorrow’s world
Chronic disease management, patient choice and special interest practitioners
were among the topics discussed at a practice symposium on delivering care
for, and with, patients. Harriet Adcock (on the staff of The
Journal) reports Government director of primary care says pharmacy should make use of “localness”
David Colin-Thomé: influence PCTs by helping them meet their
clinical care agendas |
Primary care health professionals, such as those working within pharmacies
and general practices, need to combine their “localness” with
having professionally managed organisations able to provide systematic
care for chronic conditions, Dr David Colin-Thomé, national clinical
director for primary care, Department of Health, told conference participants. “Chronic
disease is the big issue that we in the health service have got to address,” he
said.
More resources need to be devoted to this area, which means challenging
some of the inappropriateness of the acute-care models currently in place.
In addition, the way services are commissioned needs to be looked at
differently. “In
the past this meant spending a lot of time pouring over figures, but the
quality of care of patients didn’t seem to change very much.” He
proposed that services should be redesigned at a local level rather than
concentrating on national contracts.
One aspect of health care that is changing rapidly is that patients are
getting more involved with their own care. “The dominant professional-knows-best
model has pervaded the health service for too long,” Dr Colin-Thomé said.
He went on to suggest ways in which the influence of professionals within
the National Health Service could be challenged. “One way is to increase
the choices of patients,” he said, adding that there was to be
a big push from the Department of Health towards self-care.
In terms of patient choice, Dr Colin-Thomé warned that small primary
care organisations should not throw away their heritage of personal care. “Evidence
shows us that patients value small practices because they get better
continuity and personal care.”
He went on to say that there are now opportunities for commissioning
within primary care and there have been big injections of cash into the
health
service. However, Dr Colin-Thomé warned that health professions
must start to think differently. “If we follow the same patterns
... that money won’t seem to be going anywhere.”
One way of thinking differently is the concept of practitioners with
a special interest. This will provide primary care trusts with a broader
pool of talent — people who can challenge the way things are done.
Responding to a question about developing pharmacists with special interests,
Dr Colin-Thomé said it was up to pharmacists to identify the skills
needed by PCTs. “If there is an unmet need, a PCT might help to train
people,” he added.
However, he warned that such ventures would need proper accreditation
and systematic audits. “It is much more about the quality of the
individual.”
He acknowledged that pharmacy is an untapped resource, not sufficiently
incorporated into the main stream of clinical activity. Furthermore,
pharmacists have not been afforded the same advantages as general practitioners
within
PCTs. “Some people say — and this could include pharmacy — it’s
not fair that there aren’t enough of us on the board.” But
Dr Colin-Thomé pointed out that pharmacists would be better off
sorting out what care is required locally and then offering a service that
meets that need. “The way to influence a PCT is to help them meet
their agendas in clinical care. Instead of bemoaning our lot, we need to
ask ‘what can we do’,” he said.
In the debate that followed Dr Colin-Thomé’s address, Professor
Bob Michell, a Privy Council nominee member of the Royal Pharmaceutical
Society’s Council, asked what the NHS was doing to confront the need
for an information technology infrastructure within community pharmacy.
He pointed out that patients now have access to primary research literature
via the internet. “Unless pharmacists have the infrastructure to
access primary databases for evidence-based medicine, they will be scientifically
illiterate against some of the enquiries that they will receive.”
Dr Colin-Thomé agreed that there was a need to extend the IT infrastructure
of the NHS to health professionals working in primary care. However, he
pointed out that this was only just being developed for general practice
(where most clinical decision making is currently made). “The plan
will be to roll this out to other professionals,” he said.
Pharmacists can provide holistic view to patient care
Gill Dorer: patients want to take part in an interactive consultation |
Pharmacists can provide “joined-up thinking” when it comes
to the care of patients with multiple chronic conditions, Gill Dorer,
director of services, Arthritis Care, suggested to conference participants.
As a patient with several long-term conditions she admitted to fantasising
about chairing a case conference at which all the health care professionals
involved in her care take part.
“
I recognise that that is highly unlikely but think it is up to pharmacists
to provide the joined-up thinking and to provide a holistic overview of
a patient and a patient’s medication when they are prescribed from
a number of different sources.” Another thing that is important to
patients is being seen as equal. “What patients most want is to
be listened to. They want to be respected and they want to be valued.
They
want to take part in an interactive consultation, in which their own
expertise is recognised and made use of.”
She added that there should be a balance of power between the patient
and the health professional. Ms Dorer recalled an instance where her
place
in the hospital pharmacy queue was secured by a numbered ticket from
a dispenser identical to the ones used at supermarkets. “It does not
feel good to be a numbered patient,” she said. “I’d
like to encourage you to think about the equality of patients. Remember
it is
both what you do and how you do it that gets the best results.” |
