The PDA has posed a challenge to NHS England in its response to the NHS Call to Action which has been looking at Community Pharmacy. It asks whether the ‘listening exercise’ that NHS England has embarked upon has gone wide enough by simply seeking ideas about the future of community pharmacy.
Chairman of the PDA Mark Koziol said;
“Undoubtedly, community pharmacy can provide a much greater contribution than is currently the case and the current Call to Action which seeks ideas on how to expand the service is to be welcomed. However, rather than exclusively addressing the possibilities for an enhanced community pharmacy offering through bricks and mortar pharmacies, this Call to Action would have been more productive if it had widened its considerations to the possibility of pharmacy services being offered in the wider community by pharmacists as medicines experts in a way that does not necessarily require them to be the owners or employees of a community pharmacy.”
The PDA argues that exploring the possibilities of pharmacy in the community as opposed to just community pharmacy provides some very exciting options for NHS England as it seeks to meet the increasing healthcare demands with limited resources. Despite the fact that local community pharmacies are accessible to 96% of the population on foot or by public transport, the frail and the elderly are relatively immobile and may not have access. Such patients are increasing in number, they represent a significant cost as far as medicines are concerned and since they are often on long term conditions requiring complex poly pharmacy regimes, they are a high risk group often ending up being hospitalised. Feedback from public consultations have strongly supported the concept of a named pharmacist medicines champion delivering pharmaceutical care and continuity of care as they move from secondary care, into primary care, back to their own home, into a residential home and even follow them into a care home. Such an individually named pharmacist medicines champion would act as the medicines related bridge between the hospital and the GP, the residential home, the local community pharmacy and any other care related agencies.
Said Mark Koziol;
“Pharmacy is a very adaptable and flexible profession, many thousands of pharmacists work on a self-employed basis and this enables them to embrace new models of practice very quickly. This is a great strength of pharmacy which has not been fully appreciated at government level. Additionally, the profession already has more than 2,000 independent pharmacist prescribers within its ranks and currently many of these pharmacists do not use their prescribing qualifications in a way that benefits patients or that delivers solutions to the current capacity problems facing the NHS. All of this represents a tremendous opportunity for the NHS which it must now exploit in a way that benefits patients.”
The PDA argues that the NHS will work at much improved efficiency, if the professionals that work within it can spend more time on delivering the services that they are uniquely trained to deliver. GP’s should diagnose and pharmacists should prescribe. This could work if GP’s would refer caseloads of patients that they have already diagnosed as having long term conditions to pharmacists that would take responsibility for a patient’s medicines regime through the operation of pharmaceutical care clinics. Such a service could be provided from a variety of locations such as residential homes, hospices, the homes of patients, GP surgeries and even in community pharmacies.
“Surveys of PDA members indicate that many of them relish the prospect of developing clinical relationships with patients in this way,”
Continued Mark Koziol,
“However, these pharmacists will need much greater professional autonomy and flexibility than they currently enjoy as predominantly retail employees if they are to achieve this. Under new and more flexible contracting arrangements that enable individual and group practices of pharmacists to deliver a range of pharmaceutical care services in the wider community, they can work in a way in which they are not hampered by a commercial retailing agenda.”
The notion that pharmacists should be able to provide services in the wider community under contractual arrangements that are separate from the current community pharmacy contractual framework is a concept that is gaining a considerable groundswell of support within the profession. Such thinking is embodied in both the recently published Royal Pharmaceutical Society ‘Now or Never’ policy document and also in the Scottish government’s recently launched ten year vision and action plan entitled ‘Prescription for Excellence’.
These issues will be the subject of a PDA conference which will be held in London on April 6th. Speakers will include Professor Linda Strand; an international authority on Pharmaceutical Care and Mike Sobanja the founder of NHS Alliance. Details are available on www.the-pda.org