Primary Care Pharmacy March 2001 Vol 2 No 1 p2

Leading article

New challenges for primary care

This year started with a new series of challenges for primary care organisations and the pharmacists that work within them. Primary care groups (PCGs) are moving towards trust status. Three very different health plans for the three countries of Great Britain, with associated strategies for pharmacy, have now been published. National service frameworks and the National Institute for Clinical Excellence (or in Scotland, the Scottish Intercollegiate Guidelines Network, Clinical Standards Board for Scotland and the Health Technology Board for Scotland) are well established.

There is a move towards the implementation of evidence-based medicine in a population of patients with increased knowledge and expectations, who have been promised that post-code prescribing will end. These are all very positive moves but the recent Department of Health publication on strategies for prescribing and budget setting reports that all of this must be paid for from within existing unified budgets, using prescribing indicators and incentive schemes for practices. So begins the pharmacist's challenge.

Most of us have already supported and facilitated practices to increase generic prescribing, to eliminate waste and to switch to more cost-effective alternatives. Most practices have already maximised generic prescribing, substituted more cost-effective alternatives and eliminated prescribing of limited value. There is little scope to make savings to accommodate the expected increases and budget setting is likely to become an even more complicated process in years to come. This new challenge will be considerable.

Within all of this there is a challenge for the pharmacy profession itself. A personal concern of my own is that there is a growing divergence in practice across the United Kingdom. The development of local health care co-operatives, PCGs and local health groups created fundamental differences between Scotland, England and Wales. Will changes in the health strategies of each of the home countries mean that pharmacy has to deliver different training programmes to address fundamentally different working practices?

Pharmacists working in one part of the country may gain prescribing rights before those working in another. Individual health plans in each country will undoubtedly create an even wider variance in professional practice and education needs. Does this concern you? How can we ensure that what is a relatively small profession already, can continue to develop while maintaining the right focus, the appropriate representation and the provision of the educational needs of all pharmacists in the UK? Primary Care Pharmacy would like your views.

Sheena Macgregor
Editor