Left to right: Jim Smith, Norman Morrow, Carwen Wynne Howells and Bill Scott |
Despite being billed as “question time with the chief pharmacists”,
most of the session was taken up by presentations given by the four chief
pharmacists, leaving time for only three questions.
Bill Scott, chief pharmaceutical officer for Scotland, spoke first. “Pharmacy’s
time has come. It is the most exciting time to be a pharmacist,” he
said. “There are numerous opportunities unfolding, kick-started
by the new pharmacy contracts.”
Mr Scott’s vision is for pharmacists to be full members of the
health care team delivering pharmaceutical care for patients. “We
have to evolve from being pharmacies on the high street to becoming health
care centres on the high street,” he said. He had recently seen
a surgeon undertake minor surgery in a pharmacy. “But we need premises
that are fit for purpose,” he commented. The Scottish Executive
has been investing in pharmacy premises improvement and now 65 per cent
of community pharmacies in Scotland have consultation areas.
On supplementary prescribing, Mr Scott commented: “I see, eventually,
that all pharmacists will have these prescribing powers. But we must
also press for independent prescribing. I cannot see how pharmacists
can fully play a part in the NHS if they are denied an independent prescribing
role.”
Community pharmacists are the front line troops of the profession, said
Mr Scott. Most of the public and patients judge pharmacy by their experience
with community pharmacists. “We have to consider, with a new clinical
contract, is it still appropriate to allow any pharmacist to become a
community pharmacist without further qualifications,” he said. “In
Scotland we have established a working group to scope and plan for a
voluntary vocational training scheme.”
Norman Morrow, chief pharmaceutical officer for Northern Ireland, described
his vision of pharmacy’s future. “The key challenges are
to improve the quality of patient care, to utilise networks and skill
mix, to improve patient safety and to improve continuity of care. From
a pharmaceutical point of view, we need to target the areas where we
can have the most impact,” he said.
An integrated medicines management system has been developed over the
past three years. It improves efficacy and efficiency of the hospital
service, he said. In particular, it reduces readmission rates. “As
a result of this work, the Department of Health has given us permanent
funding for this and additional money to develop it in the future,” reported
Dr Morrow.
The second approach was the establishment of medicines governance teams
in hospitals in Northern Ireland. A ninefold increase in reporting adverse
drug reactions and near misses has been achieved over the two to three
years since their introduction.
Continuity of care has been addressed through the establishment of specialist
medicines teams. In accident and emergency departments, pharmacists are
being used to triage patients, an approach that has been shown to prevent
10 to 15 per cent of unnecessary admissions, he said. Technology and risk management
Carwen Wynne Howells, chief pharmaceutical officer for Wales, discussed
the use of technology in pharmacy. “Technology — a catalyst
for change” was the title of the BPC in 1999, she reported. “At
the time, we were too busy millennium-proofing our systems to worry
about implementing IT strategies. This was probably just as well since
many of the initial plans were somewhat over-optimistic in terms of
time-frames and deliverability.”
“It is easy to put in systems that reflect the here and now but forget
to build in the capacity to reflect changing needs in the future,” she
said. “The public is used to having banking, shopping, travel and
a whole range of other services available online. What is wrong with
medicines and pharmaceutical services? It may well be the public, not
the professionals, that determine the direction of travel when it comes
to investing in IT services,” she commented.
Miss Wynne Howells said that, compared with other business sectors, the
health service had been relatively slow in realising the potential of
automation. It is being piloted in Wales. “Benefits realised include
increased capacity and an ability to re-engineer processes but, more
importantly, an ability to redeploy staff to more patient-focused areas,” she
said.
This fed into the presentation by Jim Smith, chief pharmaceutical officer
for England, who talked about risk management. He said that there has
been a huge Government drive to tackle quality and risk management in
the health service. “Clinical governance has been described as
by far the most high profile vehicle for achieving culture change in
the NHS,” he said. “I am pleased that clinical governance
will be in the new contractual framework in England. It is essential
and is a first. Pharmacists in all sectors have done good work around
service quality but it should not be an optional extra and that is why
it needs to be in the contractual framework,” he commented.
“
We are strongly committed to taking forward independent prescribing,” said
Dr Smith. “We have already started the scoping discussions and
will be moving towards a public consultation quite soon. My hope is that
by the end of 2005 we will have the necessary legislation in place to
empower independent prescribing.” He said that in five years’ time,
it would be possible to look back and see how pharmacist prescribing
had transformed the way the pharmacy service operates. Three questions
The first question was whether developments in IT should be approached
on a UK basis rather than in each individual country. Miss Wynne-Howells
suggested that IT should be looked at on an even wider basis, perhaps
in a global way, to stop reinventing the wheel. However, Dr Smith said: “In
an ideal world, we would have a UK strategy but in practical and financial
terms it would be difficult to implement.”
The second question was about barriers to incident reporting by pharmacists.
Dr Smith said that it was important to collect as much data on errors
and near misses as possible. Reporting to the National Patient Safety
Agency is anonymous, he stressed. “We are aware of the barriers
and hope we can overcome them,” he said.
The final question was regarding patient pack dispensing. “We are
not going to legislate to compel patient pack dispensing,” said
Dr Smith. However, he added that the Government intends to legislate
to facilitate it through some degree of rounding of quantities. Miss
Wynne Howells said that a circular had been issued in Wales recently
to encourage dispensing of original packs but there was no intention
of introducing legislation on this issue. |
The
Pharmaceutical Journal