Paul Gimson |
Paul Gimson
Paul Gimson studied pharmacy at Cardiff University and worked as
a community pharmacist in Wales for eight years.
He undertook
a wide range of roles and moved into providing prescribing
support
and advice.
That led to work with local health boards and a
brief secondment into the Welsh Assembly Government before he
joined the Royal Pharmaceutical Society, leaving his role as lead
pharmacist
for long-term conditions at the Society to take over the
position
of chief executive of Community Pharmacy Wales from Peter
Haydn Jones, who stepped down in September 2007.
Mr Gimson works
alongside CPW chairman Phil Parry. |
Last week, the Welsh Assembly Government demonstrated its determination
that community pharmacy should play a key
role in chronic conditions management (PJ, 23 February 2008, p203). That did not come about
by chance, Paul Gimson, chief executive of Community Pharmacy Wales,
pointed out
to The Journal. It was, he said, a result of a lot of hard work by pharmacists
in Wales to persuade the WAG of the role that pharmacy can play.
New role
An appreciation of that hard work has come quickly for Mr Gimson. Speaking
ahead of the WAG’s announcement, he said that the size of the
task that lies ahead for him has become clear in the weeks since he
took up his new role in January 2008.
“There is a huge agenda
for pharmacy in Wales,” he says. “I knew it was big, but
I am still coming to terms with just how big it is. Everyone has an
idea
of what needs to be done and how it should be done which you have to
take on board.”
Nonetheless, Mr Gimson is keen to pay tribute to the work others have
done for community pharmacy in Wales and to the dedication and commitment
of CPW’s staff. But he also acknowledges that political life in
Wales does sometimes make his job easier.
“It is good because it is a small political environment,” he says. “That
enables you to make contact easily with policy makers and means you can
have a working relationship with them. The difficult part is turning
this improved accessibility into results, something we are working very
hard on.”
CPW is also able to work closely with other healthcare organisations,
and he hopes this will improve with time, as working relationships develop
and devolution moves forward.
In a number of areas of health policy Wales has moved away from England
and, to some extent, Scotland. Prescription charges were removed in April
2007, having been steadily phased out since the WAG announced its intention
to abolish them in 2003. Smoking in public places was banned in Wales
three months before the ban in England.
And nationally agreed enhanced
service specifications and indicative rates have so far been developed
for five services (care home support, minor ailments, pharmaceutical
rota, syringe and needle exchange, and supervised administration of medicines).
Mr Gimson says it is still too early to tell what impact the removal
of charges has had on prescription volume or pharmacy workload. But the
change has had benefits for the public’s perception of pharmacy,
he believes. “From the point of view of the public, they felt they
were paying the pharmacist for the medicine,” he says. “The
fact that patients now do not have to pay means they can appreciate the
service pharmacists provide more clearly. That can only be a good thing
for patients and for pharmacy.”
He adds: “Pharmacists also appreciate not having to collect a fee.
That has benefits in terms of improved relationships with patients and
in terms of the time saved — and it is also making the introduction
of electronic prescribing that little bit easier.”
The introduction of the five nationally agreed enhanced service frameworks
has allowed pharmacy-based clinical services to be introduced consistently
across Wales. Frameworks for more services are in development and the
next one to be issued will be for emergency hormonal contraception. Commissioning
Having nationally agreed frameworks should make it easier for local
health boards to commission enhanced services. “It allows LHBs
to know what services might be available and what pharmacies can offer,
and
it makes it easier to negotiate funding and for LHBs in terms of knowing
how much they should expect to pay for a particular service,” Mr
Gimson says.
CPW is also working on a Welsh system of national accreditation,
similar to the North West of England Harmonisation of Accreditation
Group scheme.
However, the enhanced tier of the community pharmacy contract has not
been as successful as CPW had hoped. “There are three tiers to
the new contract and the third tier is just not being taken up as we
hoped it would be,” Mr Gimson says. “LHBs have not been taking
advantage of the possibilities offered.”
There have, nonetheless, been benefits to having nationally agreed enhanced
frameworks, he stresses. Smoking cessation is now provided to a national
enhanced service template in well over half of LHBs. That has benefits
for how pharmacy is perceived in the wider world of public health and
could be used as a lever to try to get the service funded at a national
level.
In addition, evidence of the success of pharmacy-based smoking cessation
schemes could be used to support proposals for other services. For instance,
when commissioners are looking at how primary care can take on a greater
role in the management of chronic conditions — as they will be
required to under the WAG’s new service improvement plan — examples
of services that have worked can be used to support the idea that pharmacy
can offer a tailor-made solution.
With regard to other tiers of the contract, pharmacies in Wales have
had similar experiences to those in England. One of the major issues
relating to medicines use reviews has been how people are commissioning
across services, Mr Gimson believes.
“MURs have a lot more potential to be used in a positive way to integrate
care,” he says. “For instance, one of the actions that case
managers of chronic conditions management services can undertake is to
refer patients to a pharmacist for an MUR. Where that has been tried
it has been a real success. Pharmacists do not just have patients coming
in cold for an MUR. They have information from the case manager and so
the MUR can form part of the patients’ integrated care across services.”
Pharmacy services in Wales are also likely to benefit in future from
proposals set out in “One Wales”, the manifesto published
by the Labour and Plaid Cymru coalition in June last year (2007).
The “One Wales” document makes reference to pharmacy-led
NHS drop-in centres and CPW is in discussions around these. “We
have been involved in a variety of formal talks and informal meetings
with politicians and civil servants,” Mr Gimson says. “Discussions
have been positive around pharmacy-led drop-in centres, as well as around
a minor ailments scheme, a wider public health role and a role in the
management of chronic conditions.” Other issues
In addition, talks are ongoing around supporting the provision of monitored
dosage systems from pharmacies. These discussions have led the WAG
to realise that MDSs are used to tackle problems that are part of far
broader difficulties with medicines management. So the WAG is now looking
at forming a group to look at how to improve medicines management in
vulnerable and older people who need help with taking their medicines
appropriately.
The WAG has also announced that it is establishing a group to advise
it on the development of rural health services. “The WAG is in
the process of establishing the group,” Mr Gimson explains.
“At previous meetings we have been assured that pharmacy would play a
part and we have no reason to think that would have changed,” he
says. “The group will need to consider how the pharmacy network
in rural areas can be maintained and how pharmacy can help to solve problems
of access to healthcare in rural areas.”
As well as issues particular to Wales, CPW also has to work on developments
that affect pharmacy across Great Britain, such as the
establishment of a professional body for
pharmacy.
“We want to see a body that has good professional representation and that
drives, develops and supports the profession,” Mr Gimson says. “Our
view is that a professional body needs to reflect the fact that health
policies differ across the devolved administrations and so the professional
body needs to have strongly devolved functions.
“We think a federal structure
would help achieve this, by allowing autonomy in each of the devolved
administrations but, at the same time, allowing the benefit of a united
organisation when the national bodies come together to work on shared
issues.”
The one GB-wide change that has had the biggest immediate impact on community
pharmacy in Wales has, however, been the changes
in reimbursement prices (PJ, 6 October 2007, p371). “Category M is a huge concern for contractors,” Mr
Gimson says. “It is the number one thing that people have come
to me about. The changes are really affecting contractors’ cash
flow. At the moment the variations and unpredictability are making it
difficult for them to have the ability to plan and the confidence to
invest in their businesses and so something needs to be done, in the
context of Category M prices across the whole year.”
Mr Gimson also believes the upcoming
White Paper on pharmaceutical services (PJ, 4 August 2007, p118) may have a huge impact on pharmacy in Wales.
The White Paper will only apply to England, but the changes are likely
to have a considerable knock-on effect in Wales, he argues. “The
White Paper could really help to enable new services to be developed
if appropriate incentives are put in place,” he says.
However, he adds: “I hope that whatever is recommended does not
result in a destabilisation of the community pharmacy network. Contractors
can only invest in service development in a stable network. At the moment
the White Paper is hanging over everyone and everything seems to be in
the balance — it is in no one’s interest to see a situation
in which a lack of confidence and stability means people cannot develop
new services to benefit patients.” |
The
Pharmaceutical Journal