The Pharmaceutical Journal
Vol 274 No 7347 p525-526
30 April 2005

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Institute of Pharmacy Management International

Focus on teenagers to secure a healthy future

Teenagers are the future. And community pharmacists should foster relationships with teenagers if they want a greater share of the health market in the future.

That was the message delivered to the conference by Al Thompson, GP and clinical director, Wigan Borough, and his three 15-year-old assistants — Natalie Firth, Mitchell Lloyd and Jordan Oldbury — from a local school.

Institute members were told that pharmacists should supplement Government health care information in teenage-friendly ways. Perhaps they could provide a website — teenagers spend a lot of time on the internet — where health information messages would be placed and teenagers could access them in privacy. Another development could be the provision of self-help computers for teenagers to use in community pharmacies. And pharmacists must be able to point teenagers in the direction of other agencies that can help them, like GPs or particular health information websites.

Communication skills with teenagers are hugely important, said the speakers. Teenagers do not respond to text-heavy leaflets so these need to be designed specially. Also teenagers do not want to be spoken to in their own jargon; pharmacists should talk to them in the same way they talk to adults. Pharmacists already cater for a wide range of people and this has to be extended to include a teenage focus. This would benefit pharmacists because adults would be unlikely to go to pharmacies in later life if they had not felt welcome there when they were teenagers.

The speakers outlined the possible consequences for community pharmacy if teenagers were not included in the services pharmacy provides. Teenagers would end up listening to old wives’ tales rather than sensible health advice and this could result in increased health problems, including unwanted pregnancies, and rises in smoking and obesity among teenagers. Community pharmacists need to create a system based on the future, ie, based round teenagers, otherwise their customer base will eventually fall away and this could lead to bankruptcy, the speakers suggested. But if pharmacists were to provide the kind of information that teenagers wanted and needed, teenage health would improve, there would be fewer unwanted pregnancies and as a result there would be fewer social problems.

The result of that would be that community pharmacists would be valued and respected members of their local communities and, who knows, might even become millionaires, the teenagers told the conference. The main positive income, however, would be that community pharmacists would have a greater share of the health care market in the future.

Multidisciplinary teams provide the best care

Nurses, doctors and pharmacists have failed to work together to achieve better care for patients. If they did, they would make a “lethal combination” which would make ministers shake, said Lyn Young, of the Royal College of Nursing. Perhaps there is a need for the three professions to have a shared manifesto, especially at this general election time. But could they ever agree? “It is time we all started to lobby from the same place.”

She told the meeting that nurses had learnt that whenever a group is lobbying the Government it needs to move away from self-interest and towards patients’ interests and keep the public on their side. It is not in patients’ interest for health professional groups to have what she termed “tribal” knowledge. Knowledge needs to be shared among the different health professional groups and those who assist them, such as pharmacy assistants and health care assistants. Modern health care needs team thinking. Successful teams lead to “cracking health care”, she said, and everyone in the team needs to “do for one another” when it is safe to do so. It is about trust.

“Let’s share our obsession with improved patient care,” she said. “There will be mistakes along they way but that is fine so long as we learn as we go.” Pharmacists and nurses are getting on, but are not yet where they want to be although they are making fantastic progress. They are no longer working “in boxes”. Teams provide the best of care, she concluded.

CPD is not optional

Continuing professional development is not optional, said Alison Ewing, member of the Royal Pharmaceutical Society’s Council. Speaking at the conference dinner, she said that the Society specifically aims to support pharmacists and their staff so that they can achieve excellence across the profession. Part of this support has been to introduce a new CPD programme. “This has not been seen universally as an improvement, which is apparent if you read the letters pages of The Journal recently . Indeed, it was a major issue in the recent Council election,” she told IPMI members and their guests. “However, there is one thing that is without doubt — it is not optional,” she insisted.

Provide advanced services as soon as possible

In order to make the new contract successful financially, pharmacists should aim to provide advanced services as soon as possible, said Dan Attry, superintendent pharmacist at Murray & Son Ltd, Stourbridge, West Midlands. They will need to make some initial investments to enable provision of these services. For example, some pharmacies will need to be redesigned and consultation areas constructed. Pharmacists will also need to look at the skill mix of the staff in their pharmacies. Only by providing advanced services are pharmacists likely to be better off, because the new contract is moving away from prescription volume-based payments towards provision of services for example, medicines use review, for which pharmacist are to be paid £23 each.

“Pharmacists will need to plan and put in place all necessary mechanisms and training to be able to qualify for payments under the new contract,” he said. They will have to prove that they can provide services and the proof of that lies in accreditation.

Turning to enhanced services under the new contract, Mr Attry said that one of these, a minor ailments service, is fast becoming a “must have” for primary care trusts, especially since GP surgeries are no longer opening on Saturdays. He said that the specification and value of enhanced services is being agreed nationally so there will be a standard across England. Furthermore, the Pharmaceutical Services Negotiating Committee is in the process of producing specifications and benchmark prices which would be published soon. These should help pharmacists negotiate with PCTs, he said.

PCTs are responsible for commissioning enhanced services locally, he explained. And they would only be interested in services that fulfilled local needs. Since money for enhanced services is not available from the global sum, funding for additional pharmaceutical services has to come from local funds. “Apart from the new global sum, no PCT money is pharmacy-badged,” said Mr Attry. But there are a number of sources of funding that may not at first sight appear relevant to pharmacy. For example, PCTs have a prescribing budget which, if not closely monitored, can spiral out of control. Many PCTs have taken on practice pharmacists and pharmacy prescribing advisers to drive down the spend. The money saved by pharmacists could therefore be available for investing in other pharmacy services.

Money might be available from local drug action team budgets — for those pharmacists willing to provide supervised methadone consumption and needle exchange services — to build consultation areas. Another source of funding might be Sure Start, providing the pharmacy is developing services specifically directed at children.

As far as PCTs are concerned, key planning documents will determine the success of funding requests. Pharmacists need to ask themselves if the services they want to provide will help meet PCTs’ targets. Also, timing of requests is crucial: for example, PCTs have a rolling three-year local delivery plan covering local health improvements.

Mr Attry said that networking and team building are essential for success. Pharmacist should get to know the chairman and members of their local PCT. They need to find a champion among the key decision makers and influencers within the PCT. A seat on the professional executive committee always helps.

What makes the difference between a PCT deciding to invest in a service or not? It boils down to local relationships, the ability of stakeholders to lobby effectively, obtaining help from key influences in the PCT and being able to sell the benefits of the new service, said Mr Attry. Negotiating skills are important.However, contractors would want to be sure that any funding for services delivers a fair return for their investment. That is the key to finding out whether the new contract will be successful or not.

Use support staff effectively — don’t be hung up on traditional roles!

Instead of asking what support staff can do, perhaps pharmacists should be asking what roles they cannot carry out, said Helen Dalrymple, of the UK Association of Pharmacy Technicians. Skill mix is the key, she said. Lots of skills in pharmacies are unused because people are “hung up” on traditional roles. It is time to build on strengths and move forward.

Pharmacy technicians have several skills that could be put to better use. They are accurate and pay attention to detail, they are used to working in teams, they are used to communicating with professional colleagues and with patients and, like other groups, they have a professional attitude. They see their role as being there to help patients.

But there are challenges, Ms Dalrymple said. More suitable training and development programmes are needed so that technicians can be promoted to their level of competence rather than their level of incompetence. And the public need to be made more aware of technicians’ roles and responsibilities.

She told the meeting that what are considered new developments in technicians’ extended roles will become the norm.

For instance, in hospitals there are already accredited checking technicians and clinical technicians. There are medicines management technicians who help to speed discharge processes and manage patients’ own drugs. There are technicians in medicines information departments and some have taken on dispensary management roles and even medicines administration roles on wards. Ms Dalrymple explained that she is responsible for pharmacy training and development at her workplace. There, she oversees training and development for all staff, and this includes preregistration training and continuing professional development.

In the community sector there are roles for technicians in checking dispensed prescriptions, patient and customer support, assisting in medication reviews and management roles. There is also a role for them in patient counselling and concordance reviews. In fact, said Ms Dalrymple, this is an important role because technicians may be able to obtain information from patients about lack of adherence to medication regimens that the patient might not want to divulge to the pharmacist.

In primary care, technicians could collect data, carry out audits, give advice on generic switches and carry out medication reviews.

All of this requires a little vision and quality training, either through distance learning or attendance at courses. But there is a need, too, for workplace assessors, she said.

Now that the Royal Pharmaceutical Society is registering technicians, they will also have to engage in CPD, said Ms Dalrymple. CPD, she said, is good employment practice and will be mandatory for registered staff. It helps them maintain their skills and knowledge base and safeguards patients and the public.

Finally, Ms Dalrymple said that there is a 10.5 per cent shortfall in the number of technicians required so there is a need to think about training for the future. The public needs to understand the difference between pharmacists and pharmacy technicians and realise that being a technician is a viable career option for both men and women. The new community pharmacy contract will certainly present new opportunities for technicians, she said.