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Final word: Charting a course for pharmacy

In the second of our series of articles looking at different aspects of the future of the sector, Harry McQuillan considers the increasingly clinical and risk management-focused role that community pharmacies have in keeping people well and as close to home as possible

Last month, I discussed how, as a network, we need to make the most of each and every interaction with our patients and the public. This month, I want to explore the shift in focus from accuracy of medicines supply to safety of supply. 

We are fortunate to be starting from a solid base in Scotland, with long-established services in place to support those with both acute and longer-term conditions. Each of these, however, needs further development to really maximise the potential of community pharmacy teams.

Clear road map

For NHS Pharmacy First Scotland, there is already a clear roadmap in place – a dual approach of adding further PGDs to treat more conditions, while also increasing our number of independent prescribers and providing them with the clinical skills required to assess patients in the community pharmacy setting. 

Andrew Watson, the Pharmacist IP in Bridge of Earn, is in the vanguard of Pharmacy First Plus [PFS+] and has been providing the service since 2018. “Building awareness in the community was key to ensure the establishment and growing success of PFS+,” he says. 

“Liaising with local GP practices on how the service would benefit their patients and help save on GP practice time with appropriate referrals has helped strengthen already well established links. Due to our location in a rural setting, some patients need to get two buses to visit their GP, but our pharmacy is within walking distance of their home. For them having local access to PFS+ and easy access to a face-to-face consultation – most of the time without the need for an appointment – is invaluable.

“Feedback has been very positive and consultation numbers have increased a lot thanks to word of mouth.

“For me personally, providing this service to patients is very rewarding as I am able to utilise my clinical knowledge and skills. The combination of appropriate advice, treatment and onward referral helps to ensure that my patients continue to receive a high level of safe and effective care.”

Righting a wrong

I am also certain that our pharmacy technicians will shortly be able to work from patient group directions, righting a questionable wrong that has in some ways restricted practice in the community for years. 

Yes, we will need to work with our colleagues in APTUK and NHS Education for Scotland to determine and deliver the education and training requirements to make this a reality in practice, but I have every faith that pharmacy technicians are ready and more than able to step up to the plate in this respect. 

Radical change

We also have a plan for Medicines Care and Review, our offering for those with long-term conditions. That said, radical change will be required if we are to enjoy the impact and consistency of practice that the NHS PFS service delivers for the country. That the current service (and its previous iteration, the Chronic Medication Service) still has far to go to is more a systems issue than one of delivery. 

We start from a strong base as there are nearly one million people registered for this service and hundreds of thousands more interactions recorded. The benefit of hindsight tells us that what is lacking is a clear focus that targets higher risk elements of pharmaceutical care and a remuneration model that actually rewards good quality care or, in other words, improved patient outcomes. 

We will empower pharmacy teams with a suite of tools (many of which they already have) and put them in control, deciding with patients who would benefit most from these interventions without setting arbitrary targets. 

Over time, we will build intervention tools that seek to address common medication-related issues. While we already have what we need for warfarin, lithium and methotrexate, one of our new areas of focus is on the over-use of SABA inhalers. 

Valued relationships 

As I mentioned in my previous article, research shows the special trust people place in their local pharmacy teams, with seven out of 10 people saying this is the major driver behind their choice of which pharmacy to use. I am convinced this is what we must build on going forward.

In time, I have no doubt that we will make good use of our pharmacists’ prescribing skills and expertise in medicines
for long-term conditions too, but this will require some careful thought to ensure we truly add value to our citizens’ healthcare.

There is also huge untapped potential in screening and preventative pathways involving community pharmacy – no other healthcare team enjoys the frequency or volume of contact with the public that community pharmacy does.

We are in the early stages of looking at how we can bring together those relationships and innovative digital solutions to spot the problems of the future before they have an impact on our patients and the wider NHS. This can absolutely be a whole-team effort and one we are very excited about, so watch out for more on this in the coming years.

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