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Beth Taylor, member of the NHS modernisation board
and primary care task group that consulted on choice, responsiveness
and equity
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Some are predicting that 2004 may mark a step change for the better
for pharmacists. One of the good reasons for this optimism, perhaps not
yet
widely recognised, is the report of the Department of Health’s
latest consultation on choice, responsiveness and equity, which was published
in early December 2003. The report, “Building on the best” (available
here), makes encouraging
reading for those who would like to see a more radical, patient-centred
approach to managing medicines
in the future. It quotes a PJ editorial on concordance, and has been
welcomed by pharmacy organisations (PJ 13 December 2003, p802).
This is not mainly about choice of hospital for elective care. “Building
on the best” is about a far wider interpretation of what choice
can mean for health care, and both primary care and medicines are central
in this vision. Many responses from patient organisations featured medication
as an issue, and pharmacy organisations were well represented. As a member
of the primary care task group, I had the opportunity to listen to patients’ views
and contribute directly to the debate, and it has been both a refreshing
and encouraging experience.
So how did this report arise, and what were major themes to emerge from
the consultation, from which the profession can learn? The new Secretary
of State, John Reid, highlighted early on his ambition to put patient
voices at the centre of policy making, and move away from a “one
size fits all” culture in the NHS. Modernisers were also debating
the need for cultural change in the NHS. The result was the choice, responsiveness
and equity consultation, which ran from August until November last year.
There were four strands: a public consultation involving patient and
health care organisations, local consultations with patient representatives
and the NHS, eight national task groups on major themes, and direct contributions
from individuals. The eight themes for national task groups were primary
care, maternity services, planned care, older people, children’s
services, mental health, emergency care, and people with long-term conditions.
The key questions posed were concerned with patient choice, information
and support needed and changes in the system required.
At the start, I was aware of a great deal of scepticism from within the
NHS generally about choice in primary care. Comments along the lines
of “It’s not relevant because we have a GP system in place” and “It’s
bound to be more expensive if we duplicate services” were common.
It has been heartening to see how quickly these views have turned around
in a short time, and the final report places great emphasis on offering
wider options to patients about how, when and where they can access primary
care services in future. The major reason for this, in my view, has been
the enlightening responses from the public and their representatives
on what choices they would like to see in a modern NHS. People wanted:
more opportunity to share in decisions about health and health care and
to make choices about that care where appropriate; more information in
order to make decisions and choices about their treatment or care; and
services to be shaped around their needs instead of being expected to
fit the system.
All these points are highly relevant in primary care. The primary care
task group advocated more flexibility and choice in how people access
medicines, and direct access to a wider range of primary care practitioners,
including pharmacists, where appropriate. Another interesting theme was
the need for a possibly non-clinical “navigator” role in
primary care, to help people make informed and personal choices about
services available, and to avoid unnecessary referrals and treatments.
What does all this mean for the NHS and for pharmacists? This report
does not contain a list of targets for NHS managers to be measured against
but, instead, marks the start of an important change in culture and direction
for the NHS. John Reid has made it clear that the themes of the report
will impact on all future national policy developments, and must also
be taken into account more locally. It is clear from modernisation board
meetings that the leaders of national patient organisations are becoming
much more influential in many ways, as signalled by Harry Cayton’s
role as director of patients and the public within the Department of
Health. I believe this is hugely welcome, and that such people are some
of the most effective advocates we as a profession could wish for.
They can be vocal about making greater use of pharmacists and pharmacies,
reflecting views from their members. As a result, medicines feature prominently
in the final report, which includes the following priorities for action:
Increased choice of access to a wider range of services in primary
care, helping people get access to health care on their own terms.
This will include not only developing traditional primary care services
but also
encouraging innovative new providers, particularly in deprived areas
where primary care has traditionally been weak. It will also mean extending
the ways in which people can
get advice in other ways and new arrangements to help people access care
away from home.
Increase choice of where, when and how to get medicines. The Department
will continue to ease the bureaucracy around repeat prescribing, free
restrictions on the location of new pharmacies, expand the range of medicines
pharmacies can provide without a prescription, promote minor ailments
schemes where pharmacies can help patients manage conditions like coughs,
hay fever and stomach upsets without involving their GP and increase
the range of health care professionals who can prescribe.
Cynics may point out that some actions within the Department’s
response are ones that were in progress already, and do not represent
new thinking. This may be partly true, but what is new is the emphasis
on personally relevant choices, convenient and timely access to wider
service options in primary care, and a shift in the type of information
required to support this.
So how should we be responding? There is specific mention of the valuable
role of pharmacists in monitoring chronic diseases, and clear support
for pharmacy-based minor ailment services. There is mention of mail order
and internet pharmacies, but we must accept that this accurately reflects
the public’s views. What we have to ensure is that such views are
not allowed to close down choices for other groups of patients such as
those who wish to use local pharmacy services, because this would go
against the key principle of equity and could impact disproportionately
on disadvantaged groups.
The themes will support those developing many different community pharmacy
services that people can directly access without visiting a GP first.
GPs are sometimes divided on this issue, but my perception is that provided
information is fed back to them appropriately, many are supportive of
direction of travel, particularly if IT developments can help. Certainly,
patients are fed up with wasting GPs’ time on visits made solely
in order to get referrals elsewhere.
So 2004 has started with a national policy development in which medicines
and pharmacy are centre stage, patient-focused and fit well with the
profession’s aspirations. Let us make sure that as a profession
we can build on the best I know we can offer.
Feedback on local examples of good practice is welcome and can be e-mailed
to beth.taylor@southwarkpct.nhs.uk. |
The Pharmaceutical Journal