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Letters to the Editor
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Community pharmacy
Increased professional role means more risk
From Miss C. C. McCreedy, MRPharmS
Your correspondent, Nsanyu
Kometa (PJ, 17 February, p187) made some
interesting points about the potential benefits to patient care if pharmacists
were to have access to medical records and asked that pharmacy organisations,
including the National Pharmacy Association, to make such a recommendation
to the Department of Health and other appropriate bodies.
The NPA has recently issued a position statement that made the case for
pharmacists to have access to clinical information through the electronic
NHS care record and is submitting a response to the Parliamentary Select
Committee on Health’s inquiry into the electronic patient record.
However, such access has considerable implications for pharmacy practice.
It is not the panacea for all ills and brings with it other risks and
responsibilities.
As the professional role expands there will be a corresponding increase
in risk. Pharmacists will be expected to exercise professional discretion
by factoring in all available information in the treatment of patients.
In court pharmacists will be judged against what a reasonably competent
pharmacist would have done in the same circumstances with the same information.
The NPA is looking at the liability implications of a changing role including
increased access to patient information by asking questions such as:
• What should a pharmacist take into account when examining a patient
record?
• How does a pharmacist respond to areas where a query may be in order?
• What happens where a dispensing pharmacist and prescriber reach an
impasse on what is best for the patient?
• In essence what are the legal implications associated with pharmacist
access to patient records?
Pharmacists need guidance here and, as part of this, help with assessing
what is an acceptable risk to avoid every single issue or interaction
being queried.
At what point does a pharmacist override what a doctor says and refuse,
for example, to dispense a prescription?
The NPA will be making sure that any potential risks, new or existing,
are dealt with in a way that is conducive to a busy pharmacy environment.
And we will be seeking to do this before rather than after care record
access becomes a reality.
As an indemnity insurer we will need to underwrite the associated risk
but as a defence organisation we will also need to assess on an ongoing
basis the implications for risk and therefore costs of indemnity cover.
As costs increase, which they inevitably will, we would be looking to
get these costs built in to the cost of service model
using the so-called “fair funding” model.
Colette McCreedy
Director of Practice
National Pharmacy Association
St Albans, Hertfordshire
Most innovation derives from the independent sector
From Mr N. Baumber, FRPharmS
Your editorial “Hopes
for the high street” (PJ, 17 February,
p176) is worthy of further debate. Essentially it poses two fundamental
questions:
1. Does community pharmacy have a brighter future providing clinical
services from within a retail environment or must the environment itself
change to become more purely clinical?
2. Are there inherent scale advantages of larger, more general retailers
like Boots in the current NHS climate of patient choice?
In answer to the first of these the Independent Pharmacy Federation
would suggest that “it depends”. The whole point about the
choice agenda is exactly that: choice. The current configuration of community
pharmacy services allows consumers to access pharmacy in whatever way
is most relevant, and this will vary throughout consumers’ own
lifecycles. This is a key strength of community pharmacy and, far from
decrying it, we should applaud it.
Clinical services demand the right environment — privacy, space,
ambience and time for the pharmacist’s interaction with patient.
But more than anything else, we submit, it depends on the will of pharmacists
themselves. Some contractors may wish to specialise, but the move towards
providing counselling rooms and the growing numbers of medicines use
reviews is evidence enough of contractors’ commitment. This strategy
is especially crucial for those who are seeing a reduction in prescription
volume to unrewarding levels of income
and see cognitive services as the future.
In terms of becoming a more clinical environment we disagree with your
thesis that this is years away: there is no need to wait, it is happening
already for both independents and multiples.
With regard to the second question, we are far from convinced that your
perceived advantages of scale and location are truly that. Boots operates
from large locations, generally remote from residential areas and with
the concomitant town-centre overheads. To make ends meet Boots has no
option other than to sell general merchandise.
The average independent meanwhile now relies on the NHS for 90 per cent
of its revenue, with the vast majority of its non-NHS (over-the-counter)
income being for health-related products. Boots could never survive on
this basis.
In order to avoid “postcode pharmacy” the Pharmaceutical
Services Negotiating Committee should be pushing both for national extensions
to valuable enhanced services through the advanced (and therefore ring-fenced)
element of the contract, and for a ring-fenced sum (akin to GPs’ Quality
and Outcomes Framework) for the purchase of locally sensitive enhanced
pharmacy services.
While the income that can be derived from the provision of additional
services should be available to all, we submit that it will benefit smaller,
local contractors to a greater degree due to their lower operating costs.
As we have suggested before, it is the independent sector from which
most innovation derives. Such practice innovation (the so-called leading
edge) must feed into the enhanced and advanced services under the pharmacy
contract to benefit all contractors and therefore all pharmacy consumers.
The Independent Pharmacy Federation will continue to work to guarantee
a future for the independent sector and thus for the innovation that
will drive forward the entire profession.
Noel Baumber
Board Member
Independent Pharmacy Federation
Lack of funding for community pharmacy services
From Mr K. Patel, MRPharmS
I was disappointed and angered by Sue Sharpe’s dismissive reply
to David Kent’s letter with regard to low volume prescription pharmacies
(PJ, 17 February, p187).
I have today received a letter from my primary care trust informing me
that it is unable to offer any funding because of financial constraints
for my low volume prescription pharmacy although it had granted a contract
in June 2006 on the basis of it being necessary and desirable under the
current regulations of entry. I believe this is the same PCT to which Sue
Sharpe refers in her reply.
I noticed today on the Pharmaceutical Services Negotiating Committee website
that its motto is “Speaking for the community pharmacy”. I
agree with Mr Kent and sincerely believe that the PSNC is not listening
to community pharmacists. It has been brought to its attention many times
in the past two years that funding outside the community pharmacy contractual
framework cannot be achieved and will not happen.
I am flabbergasted that, even after all this time since the introduction
of the new contract, the PSNC is still negotiating with the Department
of Health with the view to PCTs funding the services. We all know that
most PCTs are under considerable financial constraints and pharmacy services
unfortunately are way down on their list of priorities.
I signed up with the new contract hoping to provide all these wonderful
enhanced services that we were promised. However, because they were negotiated
by the PSNC to be funded outside the community pharmacy framework, I am
unable to provide any of these apart from medicines use reviews, which
is part of the contract framework.
My PCT has good intentions. There are a few pilot services funded but not
rolled out to everyone — because of lack of funds. I completed a
six-month diabetes care certificate at Warwick University, but am unable
to make use of it since the pilot scheme has not been rolled out — because
of lack of funds. I cannot offer an emergency hormonal contraception service
under a patient group direction to students on this university campus — because
of lack of funds. We still do not have “smart cards”, so what
hope is there of ever providing these enhanced services that I was so excited
about two years ago?
The PSNC has to start listening and the “off the shelf LPS for low
volume pharmacies contract” must be included in the community pharmacy
framework. Unfortunately, it does not help being a forward thinking pharmacist
because two years on, it is still prescription numbers that make a community
pharmacy viable.
Kishore Patel
Brunel Pharmacy
Brunel University
Uxbridge, Middlesex |
The
Pharmaceutical Journal