Hospital Pharmacist
Vol 9 No 2 p28
February 2002

An opportunity for pharmacy in Scotland

By Norman Lannigan, PhD, MRPharmS

Cancer in Scotland: action for change¹ was produced recently by the Scottish Executive in partnership with NHS Scotland. This cancer plan for Scotland had input from the multidisciplinary Scottish Cancer Group which was set up by the health minister to develop and implement the plan. The Scottish Cancer Group approached those involved at a grass roots level and as a result, cancer services and patients had a strong voice in deciding where best to target an additional £40m of investment over the next three years to make cancer services more effective.

Explicit mention is made throughout the plan of the importance of pharmacy and pharmacists for the delivery of care to cancer patients. Currently, an implementation plan is under development led by a Scottish Cancer Group now enhanced by including patients, voluntary organisations and greater regional representation, and on which pharmacy is represented. The first year's investment of £10m includes specific plans to fund equipment to the value of £1.1m to facilitate the safe preparation of chemotherapy.

A capacity planning exercise is under way for pharmacy across Scotland to determine the additional resources required to deliver safe and effective chemotherapy for a predicted doubling of demand over the next 10 years.² This exercise is designed to support investment planning decisions made by regional cancer advisory groups in the north, west and south-east of Scotland.

Cancer is the leading cause of premature death among Scots. In 1999, 14,740 Scots died of cancer. There are variations in incidence and outcome linked to deprivation and where patients live. There is, therefore, much to be done.

The cancer plan sets out intentions for investment and change in the following areas:

• Preventing cancer
• Rapid access to diagnoses and treatment
• Improving cancer treatment and care
• Palliative care
• Investing in staff and technology
• Supporting research and development

Pharmacy has a role to play in all these areas and the cancer plan offers a real opportunity for pharmacy in Scotland to secure its position within the multidisciplinary team and to gain due recognition for its unique contribution to the care of patients with cancer.

Smoking is by far the largest preventable cause of cancer and the benefit of any reduction in smoking would soon make an impact. Smoking cessation schemes operated by community pharmacy have been shown to be effective in supporting patients who desire to stop smoking.

Within the "improving cancer treatment and care" section of the plan, due recognition is given to the fact that safe delivery of chemotherapy is highly specialised and wherever it is delivered the service must be of the highest standard. Evidence-based guidelines for the use of cytotoxic chemotherapy in the clinical environment were commissioned by the Association of Scottish Trust Chief Pharmacists and developed by the Scottish Cancer Care Pharmacy Group.

The guidelines were published in an NHS circular³ following enthusiastic endorsement by the Scottish Cancer Group. An audit tool is currently being developed by the Scottish Cancer Care Pharmacy Group to assist trust chief pharmacists with assessing compliance with the standards locally. A clear lead role has been identified by the multidisciplinary team in assuring the safe use of cytoxics, from dispensing to prescribing and administration.

The cancer plan recognises that side effects of chemotherapy can be minimised by good supportive care and standardised protocols. The Scottish Cancer Care Pharmacy Group is developing a model template for a chemotherapy protocol. This template is designed to ensure that the important elements, which need to be considered when drafting a protocol, are present. It is hoped that the Scottish Cancer Group will endorse this template and that it is used by regional cancer networks to ensure that protocols achieve a minimum standard of content and quality.

The misuse of oral chemotherapy has resulted in serious errors with drastic consequences for patients. Most of these errors have been the result of poor communication across the interface between primary and secondary care and were entirely preventable. Many new oral chemotherapy treatments are currently under development and in the future these therapies, which will extend into the community, will become more common. There is, therefore, a need to develop standards for the safe use of oral chemotherapy. It will be vital that there are good communication systems between specialist cancer pharmacists and their community colleagues who will play an increasingly important role in ensuring patients receive the correct therapy and are appropriately monitored.

The Scottish Cancer Care Pharmacy group has developed pharmaceutical care planning for patients receiving chemotherapy as a pilot project across Scotland. A commitment to the further development of this has been made in the cancer plan. This process is designed as a quality assurance tool to aid the clinical team and the pharmacist in particular, in ensuring that the patient receives the appropriate chemotherapy and other supporting medicines such as antiemetics. The tool can be used to facilitate the transfer of pharmaceutical care between cancer centres and units and between secondary and primary care supporting the patient throughout their chemotherapy treatment journey.

Data from the care planning process is not collected by other processes and could be pooled to facilitate research and clinical audit, and to aid planning of service redesign. An electronic version, which will link with other national clinical information technology initiatives, is currently being planned. This initiative should also support the efficient communication of care plans.

The Scottish cancer plan provides a real opportunity for pharmacy in Scotland to secure the required resources to ensure that the profession plays a leading role in the care of patients with cancer. The important role that pharmacy plays is recognised by the multidisciplinary team and by the Scottish Executive who have publicly declared confidence in the profession. The challenge for pharmacy is to deliver!

Dr Lannigan is trust chief pharmacist of Lothian University Hospitals NHS Trust and a member of the Scottish Cancer Group