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Our coverage of the British Pharmaceutical
Conference 2004 starts with a report from Clare Bellingham of
a discussion of the part pharmacists
can play in enabling patients to make informed decisions about their
medicines. She also covers remarks made by the President of the Royal
Pharmaceutical Society (p479),
supplementary prescribing (p482 and p483)
and the views of the four chief pharmacists (p484). Olivia
Timbs reports
on the address given by Sir Nigel Crisp (p479). Photographs from the
conference start on p480. Our coverage will continue next week
Pharmacists are essential in making change happen in the NHS, said
Harry Cayton, director for patients and the public, Department of Health,
during
his presentation on patient choice.
“There are five to six million visits to pharmacies every day.
That compares with fewer than one million in primary care and 125,000
outpatient visits,” he
explained. “So if you want to tranform the relationship between
patients and the NHS, and to engage patients with the NHS and health
care in a different way, then pharmacists are absolutely essential to
making that change happen.”
Mr Cayton added that pharmacists have been at the forefront of innovation
in patient choice in recent years, with their involvement in developments
such as repeat dispensing, supplementary prescribing, minor ailment schemes
and local pharmaceutical services. These pilots are symbols of change
in the modernisation of the NHS and will be of great importance to the
five million people visiting a pharmacy each day. “The flexibility
and creativity you have shown as a profession and your commitment to
partnership with patients is an important part of a modernised NHS,” he
commented.
Approximately 110,000 people contributed to last year’s consultation
on patient choice, “Building on the best”, he said. “It
established that patients want choice. Not only about when and where
they are treated, but choices about how, why and in what way they are
treated.” How patient choice works
PERSONAL HEALTH
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Personal choices
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Treatment choices
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Access choices
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Primary care choices |
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Electronic NHS |
Self-management |
Relationships |
Health information framework |
FAIR ACCESS |
Mr Cayton has produced a diagram to illustrate how patient choice should
work (see Figure). He explained that the four building blocks at the
bottom are the enablers of choice. “The most important of these
is good information. Without good information, none of us can make
good choices,” he commented.
“Patients told us constantly that they needed the expertise of professionals
to give them that information.” At the moment, patients get information
from all sorts of places, many of which are unofficial so the health
information framework must take all this into account, he added.
The second enabler, relationships, is about establishing good relationships
between professionals and service users. Self-management is about enabling
people with long-term conditions to make decisions for their health care,
he explained. “The community pharmacy in particular is a place
where most people go to do their self-management,” he commented.
Without an electronic NHS, the fourth enabler, there will not be mobility
around the system, he said.
The top four building blocks of the diagram are the four kinds of choice
that people want: choice in primary care, choice in access, choice in
treatment and personal choice. Patients prioritise choices in decisions
made about their treatment over choice about which hospital they attend,
he said.
Mr Cayton stressed the effectiveness of the Expert Patient Programme
in supporting self-care. “I would like to hear from you about how
to use pharmacists to promote the EPP,” he said. He also commented
that the Medicines Partnership is an important part of the Department’s
engagement with patients and the professions in this area and had been
important in promoting patient choice.
The electronic care record will play a major contribution in helping
to develop choice in the system, Mr Cayton said. A new National Care
Record Development Board has been established at the Department of Health.
He has been appointed to chair the board, which will be looking at the
users of national care records rather than the technology side (which
will be addressed by the National Programme for IT). The members of the
board will be announced shortly, and Mr Cayton said that there are some
pharmacists on the shortlist. “But the real way for most people
to get involved is through the stakeholder network,” he said. Discussion
John D’Arcy, chief executive of the National Pharmaceutical Association,
commented that community pharmacists could contribute on a number of
levels to choice and access. From Mr Cayton’s diagram, he said
there were three areas to focus on: providing access to quality services
(which included freeing capacity by reducing the burden on GPs), providing
usable and authoritative information and giving patients personal empowerment.
From a secondary care perspective, Helen Howe, chief pharmacist at Addenbrooke’s
Hospital in Cambridge, commented that there is a need for hospital pharmacists
to
address a couple of issues. First, self-administration of medicines in
hospitals and, second, patients’ access to medicines other than
those that have been prescribed (eg, over-the-counter medicines for minor
ailments).
Joanne Shaw, director of the Medicines Partnership, pointed out that
people have always exercised a choice over whether or not to take their
medicines. “Our role is to provide them with the best information
we can.”
Mr Cayton added, during the discussion, that no one in Government has
said that there should be unlimited choice. It has to be considered whether
one patient’s choice is fair to the rest of the community. “So
I think the debate about MMR is not a debate about choice at all. It
is a debate about whether or not the vaccine is efficacious and safe.” He
added that all the evidence is clear that MMR is safe and that it is
a public health issue. Choosing not to have MMR puts other people’s
children at risk of these diseases, and pregnant women at risk of rubella
and therefore delivering deaf-blind babies. “The MMR debate has
become a political knock-about; it is not about health any more.”
Mr Cayton also said that he expected some changes to the way the Medicines
and Healthcare products Regulatory Agency and Committee on Safety of
Medicines work will be announced soon. “We need to help these organisations
to become more publicly accountable over the way in which they make decisions,” he
said. Although he did not think there is anything wrong with the decision-making
processes, he thought the organisations were secretive and inward looking. |
The
Pharmaceutical Journal