New focus on long-term conditions for NHS Scotland
Pharmacists in Scotland will have a key role to play in the future NHS, as announced last week (PJ, 28 May, p635).
David Kerr’s report — “Building a health service fit
for the future” — was commissioned by the Scottish Executive
as a national framework for service change over the next 15 to 20 years.
It was produced in response to demographic changes: Scotland has an ageing
and, unusually, a declining population. Other challenges are high rates
of cardiovascular disease and cancer, and the fact that one-fifth of
the population lives in a rural area.
In response to these challenges, the report recommends a new model of
care:
· An NHS that is geared towards long-term conditions instead of the
current focus on acute conditions
· A locally responsive NHS, rather than the current hospital-centred
approach
· A move to team-based care from the current doctor-dependent care
· Preventive, integrated care instead of reactive, disjointed care
· A new focus on encouraging self-care
Andy Kerr: patients with long-term conditions need to be identified |
Health minister Andy Kerr said that some of the recommendations would
have to be considered by the Scottish Executive but that other elements
could be implemented straight away. “I want to see health boards
get to work on identifying patients with long-term conditions who are
most at risk of hospitalisation. This will enable them to provide proactive,
co-ordinated care in the community,” he said.
Long-term conditions are an area in which pharmacists will play an expanded
role. The report states: “The new pharmacy contract should reflect
the extended role that pharmacists, and in particular community pharmacists,
could play in the monitoring and review of older people’s medications
and health status.”
It proposes that a generic approach should be taken for managing long-term
conditions, rather than a condition-specific approach. For pharmacists,
this means addressing patients’ pharmaceutical care needs. “Work
in progress has demonstrated a willingness on the part of patients to
engage in more innovative ways of obtaining their medicines and participating
in self-monitoring with help and support from their community pharmacist.”
A new tiered model of unscheduled (out-of-hours) care is proposed. Pharmacy
will have a role in the first level, along with GPs, the ambulance service,
district and community nurses, and NHS 24. “They will act as the
first point of contact to the NHS Scotland Unscheduled Care System,” the
report states. All professionals at this level will have to have the
same core competencies in assessing and referring patients to the most
appropriate part of the service. The report adds that it sees great potential
in applying the forthcoming pharmacy contract “to tackle illness
assessment, chronic disease management and the proactive management of
older patients so that reactive emergency/unscheduled attendances are
reduced”.
A need for new technology is also covered, with a central requirement
for an electronic health record. “We recommend that the electronic
health record should be put in place within three years. It should be
compulsory not optional and should result, over time, in a paper-free
system,” the report states.
Lyndon Braddick, director of the Royal Pharmaceutical Society’s
Scottish Department, said: “We are particularly pleased to see
reference to the role of community pharmacies as walk-in centres with
other health care professionals offering outreach services from pharmacy
premises and the potential to offer direct access to self-care, chronic
disease management and minor injury care in the communities where people
both live and work.” |
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