Primary Care Pharmacy November 2001 Vol 2 No 3 p60

Leading article

Moving towards a quality focused health agenda

Over the summer months developments in the primary care environment have continued to accelerate. Pilots for medicines management schemes have been established, model schemes for pharmaceutical care are being evaluated, nurse prescribing and its implications for patients and the health care team as a whole is under discussion, the College of Pharmacy Practice faculty of prescribing and medicines management has been launched, and the end of resale price maintenance are but some of the issues that will all have an effect on pharmacy practice during the coming months and years. Add to this increased patient expectations and the need to improve the quality of health care through implementation of National Service Frameworks, SIGN guidelines and NICE recommendations from within existing budgets, and the agenda for primary care becomes diverse, time consuming and challenging.

How can primary care pharmacists support, deliver and contribute to this agenda? Many of us have spent several years promoting cost-effective prescribing, encouraging prescribers to eliminate "waste" and address budget overspends. With quality moving up the health care agenda, the role of primary care pharmacists is beginning to change. The move towards a quality focus in prescribing means waste elimination is even more essential in order to target funds towards evidence-based interventions and this edition looks at two methods of minimising waste. First by optimising doses thereby simplifying the treatment regimen for the patient and reducing the cost to the practice prescribing budget. Secondly by perhaps a more radical and controversial, but none the less cost-effective approach, to purchasing medicines at a practice level.

The proposals of the Adam Smith Institute (PJ 2001;267:199-201) would radically change the pharmacist's role and provide a framework for an extended and enhanced role for community and practice pharmacists. The concept of doctors diagnosing and pharmacists deciding on the most appropriate medicine to treat the condition, providing appropriate follow up, dosage adjustment and monitoring have been discussed frequently over the last decade as a solution to better medicines management, reduced hospital admissions and reduction in the wastage of medicines. However implementation has been limited to a few innovative GP practices and in pilot project schemes. In this issue we hear how the role is changing for prescribing advisers working with PCGs and PCTs and also for community pharmacists participating in model schemes. Will these initiatives found the basis for a more radical change in the way pharmacists practice in primary care during the next decade?

Whatever our current primary care roles, they are changing and being open to the need to adapt our pharmaceutical and clinical skills and experiences to enhance multidisciplinary working will be an essential component to effective health care for patients in the future.

Sheena Macgregor
Editor