Pharmacy is the third largest health profession and can help solve the problems facing the health service. It deserves a voice in NHS policymaking, says Judith Smith.
The NHS is looking for fresh ideas. It needs to improve productivity in a sector in which this is notoriously hard to achieve − and to do so while improving quality of care.
‘Pharmacists can play an important role improving the use of medicines by prescribers and hospitals, which is all too often wasteful, inefficient or even dangerous’
Specifically, the NHS must find ways to support people with long term conditions to manage their symptoms, improve access to care for people in the most deprived areas and increase its capacity to treat patients out of hours and in the community.
As chair of the Royal Pharmaceutical Society’s commission on new models of care involving pharmacy, I came across new and exciting services with a real chance of helping the NHS achieve these aims. Innovative pharmacists across England are redefining their role from the dispensing and supply of medicines towards delivering direct care to patients.
Broaden the role of pharmacists
Pharmacists are experts in medicines but have broader clinical training, which means they can do much more. They can provide much of the monitoring and expert guidance crucial to supporting people with long term conditions.
For example, in Brighton, people taking anti-coagulation drugs can have a blood test at a local pharmacy with any adjustments to medication made immediately by the pharmacist. The service was previously provided through a much longer and less convenient process in hospital.
‘There is a window of opportunity for pharmacists to help solve the wider problems faced by the health and social care service, most particularly urgent care’
Pharmacists can also play an important role improving the use of medicines by prescribers and hospitals, which is all too often wasteful, inefficient or even dangerous.
At Hartland Way Surgery in London, a pharmacist is partner in the GP practice, working within the practice team to provide prescribing advice, promote optimum use of medicines and support patients in using their medication.
Other schemes have used the long opening hours of community pharmacies − and their status as the NHS funded service most visited by the population − to deliver public health services like immunisation, smoking cessation and emergency contraception.
Pharmacists are also qualified to diagnose and treat many common illnesses and conditions that pose no serious threat to long term health.
Easing general practice pressures
Where commissioners, as part of wider primary care plans, support these services, there is evidence they can help alleviate pressure on general practice.
‘NHS England should be using its position to shift funding from the dispensing and supply of medicines to paying for pharmacists providing care’
Pharmacists face their own challenges, inextricably linked to the squeeze on the NHS budget, which they rely on for over 85 per cent of income. Profits in community pharmacy are being driven down by reductions in funding for medicines procurement and by constraints on the global sum.
Technologies such as robotic dispensing and online prescribing, combined with judicious use of skill mix (in particular using technicians to do much of the work of dispensing), point to a need for fewer pharmacists. As a result of these pressures, some estimates suggest 7.5 per cent of England’s community pharmacies will close by 2016.
There is a window of opportunity for pharmacists to help solve the wider problems faced by the health and social care service, most particularly urgent care, the pressures on general practice and the care of vulnerable older people (especially those receiving social care), who typically rely on multiple medications, yet we know that as many as half of these drugs are not taken as intended.
Our report Now or Never is clear that much of the responsibility for shifting pharmacists’ work from dispensing medicines towards providing more direct patient care lies with the profession itself.
‘The third largest health profession deserves a seat at the NHS policy and decision making table, which it is too often denied’
The groups that represent pharmacists − and there are many − must unite around a clear narrative of pharmacists as care givers, setting out what services the public should expect from pharmacy and how the skills of pharmacists can be best used within local primary, urgent and long term care federations and networks.
This shift in focus for pharmacy must be supported by the Department of Health and NHS England. NHS England, as the commissioner of community pharmacy, should be using its position to shift funding from the dispensing and supply of medicines to paying for pharmacists providing care.
Its local area teams should work with the new local professional networks to share evidence from new models of care, encourage the development of pharmacy networks and federations and ensure that pharmacists are a core part of wider primary and urgent care developments.
CGGs must play a part
Local commissioners, whether in clinical commissioning groups or local authorities, also have a role to play. They must be ready to listen to pharmacists proposing new models of care and use the profession’s expertise to devise solutions for unacceptable standards of medicines use, especially in the residential care sector.
They must also ensure they consider tenders for contracts led by pharmacy on equal terms to those made by other professions.
Less tangibly, but perhaps even more importantly, there needs to be a change in the way in which we all view pharmacy. The third largest health profession deserves a seat at the NHS policy and decision making table, which is too often denied.
As pharmacists step up to the challenge of delivering better care to patients in a time of financial austerity, they must be welcomed and supported by an NHS urgently seeking ways to do the same.
Judith Smith is director of policy at the Nuffield Trust