Towards a Strategy for Pharmaceutical Care Forum
15th May 2001

This report is compiled from notes taken during the meeting, is for information only and does not constitute formal minutes. Consequently, I take no responsibility for any inaccuracies, errors or omissions. Opinions expressed within the notes are those of attendees and have been included for completeness. However, this does not necessarily mean I agree with them.

Towards a strategy for Pharmaceutical Care

Hamish Wilson (Head of Division B-Primary Care Unit, SEHD) opened the meeting by setting the context for the strategy and pointing out that it will be a strategy for pharmaceutical care, not a strategy for pharmacy or pharmacists.
He outlined the drivers for change and the objectives of the day, which were to get a broad-based input into the strategy and identification of key challenges and priorities.

Bill Scott (Chief Pharmaceutical Officer, SEHD) presented a short look at how pharmacy had developed over the past 50 years and where it might go in the next ten.

Alison Strath (Chair, Scottish Executive, RPSGB) outlined the current situation and the solutions and opportunities for pharmacy in ‘Our National Health’. She also presented some of the challenges that would have to be met in order to progress to where the profession wanted to be.

Pat Weir (Health Council Member, Argyll & Clyde Local Health Council) gave a perspective on how pharmacy was perceived, rightly or wrongly, by patients.

The meeting broke into the first set of workshops to look at the opportunities provided by 'Our National Health', the main strategic issues to be tackled and the main practical challenges.

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  • 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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  • 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?

The second set of workshops was intended to take forward the most important issues identified by the participants.

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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.

There were seen to be 5 requirements to proceed

  • A definition of pharmaceutical care
  • Descriptions of the roles and responsibilities of all those involved
  • Agreement on core services
  • Development of specialist services
  • Money to drive the change

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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.

Lifestyle advice should be provided, but it is important that all sources supply the same advice. A referral system is required, rather than suggesting the patient sees their GP, it needs to be a more formal system, and it should be possible to refer patients to the other professionals within the primary care team. It was noted that membership of the LHCC Public Health Group covers a wide range but that pharmacy was conspicuous by its absence.

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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.

It was agreed that there should be a clear plan of what steps are to be taken so that everyone is clear on the timescales. However, it was pointed out that political will and timings may preclude some or all of the above happening as fully as desired.

Secretary for Scotland
Guild of Healthcare Pharmacists

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