Ian Mullen: change in the way the pharmacy is regarded |
Few people would dispute that pharmacists can provide fantastic services
which benefit both patients and the NHS. Yet pharmacists often grumble
that the NHS does not exploit pharmacy’s full potential. Evidence
from the implementation of the new community pharmacy contract in England
shows that commissioning of enhanced services from pharmacies is, at
best, modest (PJ, 19 August 2006, p224).
So why are pharmacists
so poor at getting their services commissioned by NHS organisations?
One person who can shed light on the subject is Ian Mullen. Mr Mullen
is chairman of NHS Forth Valley and a pharmacist, giving him insight
into the issue from both an NHS and a pharmacy perspective. He believes
some of pharmacy’s problems are historical.
“In the past,
pharmacy was seen as an adjunct to the main clinical business; boards
didn’t involve pharmacists until they talked about medicines,” explains
Mr Mullen. “It has taken some time for people within the NHS to
see that pharmacy is about more than managing the drugs bill and is a
core service in itself.”
Community pharmacy fared worse, being viewed as entirely separate from
the NHS. “The NHS saw community pharmacy as very much about retail
pharmacy, and not as part of the mainstream NHS primary care service.
But that has now changed dramatically,” he says.
Part of the reason
for this change is the influence of hospital pharmacy. “Within
the managed service, the medical and nursing professions have seen the
significant role that pharmacists have to play in the delivery of the
acute service. This has led to a considerable change in the way the pharmacy
is regarded,” he says.
Also, structural changes within NHS organisations mean pharmacists are
becoming more influential in Scotland, in particular. “The recent
advent of the directors of pharmacy posts at NHS boards has meant that
pharmacists are able to take a more strategic role in NHS development,” Mr
Mullen comments.
“The medical profession is already heavily involved
in NHS strategic work and, to an increasing extent, so is the nursing
profession. Now pharmacy needs to become part of core service meetings.”
Mr Mullen’s key message is that pharmacists need to get more involved
with NHS organisations: “Pharmacists need to take an active part.
This means getting involved with NHS organisations, such as community
health partnerships.” He comments that pharmacy organisations within
the NHS (such as area pharmaceutical committees) have tended to sit on
the periphery, only taking interest in pharmacy issues as they crop up.
Understanding
NHS priorities is crucial. “NHS organisations are
all involved in service redesign. We are moving from an era of financial
largesse to one of tighter funding, so boards are looking to improve
efficiency and to redesign services. Pharmacists need to understand the
priorities of the local NHS organisation and come forward with suggestions
of how pharmacy can tackle them.”
Mr Mullen highlights current priorities as funding issues, redesigning
and improving the quality of services, and shifting the balance of care.
He suggests pharmacists should examine NHS organisation’s local
delivery plan. In Scotland, these plans reflect the Government’s
HEAT (health improvement, efficiency, access and treatment) targets. “Community
pharmacy has to tap into those in order to be able to be seen as an effective
health care resource for boards,” he says.
“The way to achieve greater involvement is not to sit and complain that
commissioners are ignoring pharmacy, but to go to the NHS with solutions,” he
stresses. “This is one of the reasons that the new community pharmacy
contract in Scotland has been successful thus far: it has provided solutions
for the NHS.”
So if pharmacists do manage to get themselves around the NHS negotiating
table, what approach should they take? “The worst thing any contractor
profession can do is be entirely defensive, see things as a threat, and
be constantly focused on what they have, rather than on opportunities
to deliver care,” says Mr Mullen. “The best thing is to recognise
these opportunities and provide boards with a solution.”
“I attend regular strategic meetings between NHS board chairmen and Scottish
Government ministers, and it is clear that there is a serious interest
in developing pharmacy,” he says. “Government ministers see
accessibility as one of pharmacy’s many benefits.”
One of the big issues that Mr Mullen would like to see resolved is how
pharmacy in its entirety can become more integrated. “Pharmacy
has a strong base in both primary and secondary care: there is a real
opportunity to integrate pharmaceutical care to improve quality,” he
says.
“Certainly the future for community pharmacy, in my view,
lies in that integration: getting closer to the NHS, not operating in
isolation”. He points out that this closer co-operation was part
of the ethos of “The right medicine” (Scotland’s pharmacy
strategy).
Another challenge is pharmacy’s need to increase its profile. “Pharmacy’s
new professional body has to be able to promote the profession to the
NHS. It has to be as effective as the British Medical Association is
in promoting the medical profession to the public, media, Government
and the NHS. But it also has to be relevant to day-to-day clinical practice,” Mr
Mullen says.
However, he warns: “If there is not a sufficient number
of pharmacists signed up, then the professional body will lose its credibility
in the eyes of the NHS and the Government.”
Pharmacists are frequently suspicious that funding for local NHS services
goes straight to GPs. Mr Mullen agrees that GPs are effective at negotiating
enhanced services, but says pharmacists can tap into this funding. “The
GMS [general medical services] contract involved the NHS paying considerable
additional funds to GPs and these are tied to the delivery of enhanced
services. It was a successful negotiation for GPs, so it has been interesting
to watch how the Government has behaved since,” he says.
“Recent
moves have been hugely advantageous for pharmacists. The advent of the
changes in GP hours has meant that the NHS and Government see that, in
order to provide a seamless service for patients, they have to involve
other primary care professionals.”
For example, NHS Forth Valley has recently set up a service for patients
with chronic obstructive pulmonary disease in which pharmacists can prescribe
antibiotics and steroids under a patient group direction (PJ, 12 April,
2008 p426). “The funding for this comes for the GMS enhanced services
money,” says Mr Mullen.
Was this not controversial? “We had
transparent negotiations so that GPs and pharmacists could see that the
service was about improving quality for patients. This service redesign
makes better use of both pharmacists’ and GPs’ time, and
it is difficult to argue against that” he says.
On the whole, Mr Mullen is optimistic about the future. “There
is an element of pushing at an open door,” he says. “But
pharmacy has to be more innovative. Pharmacy has to come forward and
instigate things.” |
The
Pharmaceutical Journal