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Opportunities

• Pharmacist prescribing for minor ailments would get the pharmacist increasingly accepted and integrated as part of the health team. Public perception is that community pharmacists are not part of the NHS.
• Planned location of pharmacies, rational distribution and mapping. Integrated pharmacy provision
• A new model of remuneration for community pharmacy based on services not activity
• Improving skill mix
• Breaking down professional barriers
• Patient in the centre
• Recognition of professional expertise
• Partnership working between primary, secondary and tertiary care and other disciplines - maximisation of expertise between professions and improved communication between professions
• Patient centred public health agenda
• Optimal use of medicines
• Reduced inequalities
• Pharmacy screening services
• Patient uses of alternative therapies

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Strategic Issues

• Remuneration issues - improve the contractual arrangements
• Communication strategy required
• Manpower and skill mix
• Remember that drivers for change change and advance too
• IT developments
• Patient centred approach - empowerment of the patient. Choice vs Safety arguments - is it safe to choose not to take a medicine? Should choice of community pharmacy be restricted in certain conditions where full support is required?
• Risk assessment
• Flexibility vs fragmentation
• Referral processes - improve access to the primary care team
• Outcome measurement
• Cost of medicines
• Balance between current and future models
• Identifying and meeting patients / carers / consumers needs
• Education of public, marketing of profession and raising awareness of pharmacy role to patients / consumers / other professions
• Reduce the 28% readmission rate within 28 days of hospital discharge due to drug related morbidity

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Challenges

• Learn from mistakes
• Skill mix
• Group pharmacies - why have two pharmacies serving a population of 6000 when there could be one pharmacy with two pharmacists providing a better overall service?
• Team working within pharmacy
• Rural and deprived areas - problems increased by abandonment of retail price maintenance
• Pharmacists must engage with LHCCs and build relationships with other professions.
• Change public perception of community pharmacy using media, schools etc.
• Retaining core values while moving to a new structure to allow extended roles
• Should all community pharmacies carry the NHS Scotland logo on their shop fronts?

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Meeting the Challenges

Community Pharmacy

Patients value quick dispensing. They will discuss some clinical conditions, but problems such as lack of privacy and in some cases poor access to a pharmacist mean they do not utilise the pharmacists expertise as well as they could. Incorporation of the NHS logo into all shop fronts would identify the link between community pharmacists and the NHS and improve the public perception of them as members of the primary care team. Involvement in patient forums and a strategy of public involvement in the pharmacy strategy would also help.

Proper marketing of pharmacy and publication of positive stories of the NHS in the media would help with the major selling of pharmacy that is required. Multidisciplinary learning would help market the profession to other professionals.

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Public Health

There are information gaps within the profession and beyond. There were suggestions that pharmacy constituencies be formed, whether mirroring MP or MSP constituencies or being a specific pharmacy constituency was open to debate. It would be very useful for contracting and needs assessment. Contracts and extended roles could then be allocated on a constituency basis.

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Partnership

It is important that pharmacy engages with LHCCs and care teams. The recommendations of the LHCC Best Practice Reference Group must be considered.

There must be a commitment to map out and roll out successful model schemes.

Community pharmacy must engage with the hospital service. One way is the production of joint formularies. Realignment of hospital admission and discharge services would also be helpful. It was noted that some services were being relocated from Primary Care Trusts to LHCCs.

The partnership must be both horizontal and vertical. Managed Clinical Networks had many implications. Communication was vital. It was important to identify the right people and their responsibilities. They must be able to link with others in the unified boards, local authorities, GPs and other agencies outwith the health service.

The links with unified boards may mean considerable changes in the constitutions of advisory committees.

There must be investment in IT and a commitment to IT development, complete with timescales. For proper integration of IT systems, a common drug dictionary is required, so that e.g. on different systems Aspirin = Aspirin = Aspirin.

Proper partnership with the staff involved in all of this is essential.

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What Next?

All of the papers produced at the meeting are to be compiled into a report and sent out to attendees. Delegates were asked to identify what they felt should be the next steps. The response was

• Between the meeting and the strategy publication, there should be workshops around the country discussing the ‘shaped’ strategy.
• There should be appendices in the strategy describing pilot projects and other innovative schemes.
• A workgroup should be set up to market pharmacy as a whole.
• There should be clear commitments and timescales.
• There should be review and revision dates for the strategy.
• Dates for the assessment and roll-out of pilots should be identified.
• Public consultation on the strategy should be built into the local meetings.
• There needs to be a distillation of the key themes produced for consultation with the profession and the public.
• A group should look at the incentives and barriers to change, involving grass roots members of all professions.

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