Devolution – an opportunity to increase demand for pharmacists

It is universally accepted that pharmacists' skills are underutilised in the healthcare system. The devolution of healthcare policy has created opportunities for pharmacists

Thu 6th December 2012 The PDA

The PDA has argued through its Road Map for Pharmacy proposals that not only are they underutilised but that we need them doing more of what they are trained to do if the NHS is to meet its health outcome targets.

In this way the demand for pharmacists will increase in line with the increase in supply. The PDA’s policy in this regard is described on page 16, but as well as having a vision, the PDA must also have a plan to turn it into reality.

Ever since the PDA’s Road Map proposals were launched in 2011, the PDA, through various means, has progressed this agenda. However, it is apparent that the devolution of healthcare policy to the four countries is now offering some unique and powerful pretexts to do this.

Why is it that pharmacy in Scotland always seems to be ahead of England? This is a question often asked in pharmacy circles. This seems to occur because Scotland can determine its own operational policies and, increasingly Northern Ireland and Wales are also taking their own routes. In an informal meeting with government officials, PDA representatives were told that devolution meant that a ‘practice laboratory’ approach could now be taken in each country. Added to this,
an element of constructive competition could allow the countries to seek out the most beneficial solutions for its people. In this way, new models of practice can be piloted, creases ironed out and if successful, then new services could be replicated in any of the other countries.

This philosophy places Scotland, Wales and Northern Ireland into key strategic positions in terms of future pharmacy development and this is why on top of work being done in England, the PDA is working to actively influence the developmental agenda in these countries.

Northern Ireland

Because of pharmacy numbers, Northern Ireland policy can be nimble and move quickly, in theory at least. Pharmacy here has its own unique issues – some are very positive but some are distinctly problematic.  Northern Ireland community pharmacy is currently facing a significant financial crisis which is absorbing much of the energy of the pharmacy bodies – morale is low. The current conditions mean that something must be done at strategic level and to that end in December 2011, the NI Government published a policy document called ‘Transforming Your Care’.

Several of the themes are relevant to the PDA’s Road Map proposals:

  • Re-designing primary and secondary care
  • Reducing hospital admissions
  • A stronger role for pharmacists for patients with long term conditions
  • Greater integration and creation of care partnerships.

The good news is that discussions have now commenced on delivering the detail, and the PDA has been invited to join a steering group to deliver the changes. This will provide an excellent opportunity to embed some of its Road Map principles. A PDA policy manager for Northern Ireland, Harry Harron, was appointed in March 2012 (News page 4), and already meetings with government and pharmacy organisation representatives have been held. The Northern Ireland Road Map proposals are currently being honed to ensure that they resonate with this exercise.

Scotland

The Scottish pharmacy system has been diverging from the rest of the UK for some time and it has arguably the most advanced models of practice anywhere in the UK. The good news for members is that in October 2011 the Scottish Government launched ‘A review of Pharmaceutical Care in the
community’. This review has unashamedly signposted the fact that there is to be radical reform of pharmacy practice for the benefit of the people of Scotland. This is an excellent context through which to launch the PDA Road Map initiative in Scotland. To that end a PDA policy manager for Scotland, Chris Naldrett, was appointed at the end of 2011.

Members in Scotland have been surveyed, focus group meetings held, and a PDA Conference to consider the review was held in March. A number of stakeholder meetings have been attended and in July the PDA made its final oral submission to the review team. The finalised Road Map proposal for Scotland, with all of its ambitions, visions, financial calculations and supporting arguments has been published: www.the-pda.org/scottishroadmap

We expect the review findings will be announced by winter of this year and we hope that important elements of our proposals will find their way into this report.

Wales

Historically, negotiations on pharmacy development in both England and Wales have always been led by the PSNC and some have argued that they have been dominated by a more English approach. As an example Wales, like England, has had MUR’s and more recently, the New Medicines Service. However, all that is now set to change. From April 2012, Welsh pharmacy has split off from central negotiations and will undertake its own contractual negotiations with the Welsh government. Furthermore, in May 2012, the Welsh Government published a policy document entitled ‘The contribution of community pharmacy to health services in Wales’. Within it are found a number of useful ideas:

  • A radical change to the remuneration systems to include patient registration
  • Greater integration of services provides by GPs and pharmacists
  • A greater involvement of pharmacists in public health.

All of which are to be found in the PDA Road Map approach. This exciting development means that, just like Northern Ireland and Scotland, the Welsh government has a proactive developmental policy that provides the PDA with an excellent pretext to engage it with its Road Map initiative.
Demonstrably, the divergence of pharmacy policy can have a major impact.

This new opportunity has allowed the PDA to engage in much more policy developmental activity in Wales than was the case previously. A PDA conference was held in Wales in June 2012 and PDA officials have presented the case for PDA members at an increasing number of meetings and national events in Wales. The PDA is currently drafting its Welsh Road Map proposals, which it will use to engage with the Welsh government on behalf of PDA members.

England

In numerical terms, England is the largest UK pharmacy administration and is therefore prone to inertia, making it more difficult to rapidly develop the pharmacy agenda. In England, the large multiples have, in the PDA’s view, enjoyed significant sway over pharmacy policy and this is problematic. As well as creating an organised lobbying group, some of them have also enjoyed direct access to Downing Street.

It is therefore unsurprising that the English community pharmacy agenda has been dominated by models of practice that arguably lend themselves to production line style operations. What the PDA has called the commoditisation of pharmacy services in England (and for historical reasons also currently in Wales) has The PDA will continue to press for the creation of new pharmacist roles across all of the four UK countries, enabling them to make the most of their unique skills and enabling them to enjoy professional satisfaction and reward from delivering genuine pharmaceutical care to patients.

It is apparent, that some rich and powerful pre-texts for radical review are currently available in Scotland, Northern Ireland and Wales in a way that they are currently not in England. If these reviews lead to successful outcomes in the short term, then this will be a powerful lever for the reform of the English system. produced models of practice such as MURs that are relentlessly targeted by employers to increase their incomes.

Probably because of this, these services are unpopular with many of the pharmacists who are expected to deliver them. If pharmaceutical care is to take root in England, then it can only do so with the support of pharmacists and we argue that powerful vested interests must step back and allow a ‘back to the drawing board’ approach to be taken.

Conclusion

The PDA will continue to press for the creation of new pharmacist roles across all of the four UK countries, enabling them to make the most of their unique skills and enabling them to enjoy professional satisfaction and reward from delivering genuine pharmaceutical care to patients. It
is apparent, that some rich and powerful pre-texts for radical review are currently available in Scotland, Northern Ireland and Wales in a way that they are currently not in England. If these reviews lead to successful outcomes in the short term, then this will be a powerful lever for the reform of the English system.

 

Article published in Insight Autumn 2012

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