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The future of community pharmacy

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IMAGINE a scenario in which the Scottish Government is no longer prepared to pay for community pharmacies to dispense and supply medicines, but instead prescriptions were dispensed in Health Board hubs.

Last year, Bill Scott, Chief Pharmaceutical officer and Alpana Mair, Deputy Chief Pharmaceutical Officer at the Scottish Government made it clear that hub dispensing is their favoured approach to create dispensing efficiencies and they had started to look for possible locations and have discussions about procuring dispensing robots. It was expected that this evidence-gathering period would take around 2 years and then decisions would be made.

Surely this announcement must have sent shockwaves through the contractor body, Community Pharmacy Scotland, and into the roots of the community network. As an ex-contractor it certainly got my attention. A fundamental change like this would be catastrophic for community pharmacy as huge chunks of dispensing related income could disappear. This would have implications for pharmacists and pharmacy staff as well as owners.

Certainly, the decision to use a public forum to announce this crucial strategy (the Health and Sport Committee) and the fact that CPS was not even on the Prescription for Excellence steering group has only served to exclude and antagonise contractors. Astounding really. Why ignore the largest stakeholder expected to help deliver Prescription for Excellence? Unless of course, the NHS has chosen to sever the close ties that they appear to have enjoyed until now. Are the days of Scottish pharmacy being the envy of the rest of the UK now in the past?

So, if all dispensing (except acute prescriptions, presumably) were dispensed at hubs, how would that work? One of the great successes of the community pharmacy network is the ease of access – the majority of people live within a mile of a community pharmacy, so patients wouldn’t appreciate having to make the trek to the Health Board hub to pick up their prescriptions every month.

Delivery to all patients isn’t really an option and certainly isn’t conducive to the provision of quality pharmaceutical care. So how would prescriptions get to patients? Perhaps a well-distributed nationwide network of community based outlets that housed healthcare professionals?

But the threats to community pharmacy don’t end there. What about the proposal in Prescription for Excellence to have NHS employed clinical pharmacists providing pharmaceutical care in locations other than community pharmacies? And remember the plan is for patients to register with pharmacists, not pharmacies.

Will pharmacies be relegated to being glorified medicine distribution points? Digesting Prescription for Excellence with a sprinkling of paranoia and taking into account the plans for dispensing hubs, one could be forgiven for thinking that NHS Scotland is trying to alienate or sideline community pharmacy.

The idea of dispensing hubs does make sense as the current system is bursting at the seams and community pharmacists struggle to find dedicated time to deliver pharmaceutical care to their patients. There are a number of examples where it’s already happening in Scotland and they work incredibly efficiently, so it looks like it could be a real model for the future. Of course the danger is that instead of releasing pharmacists time to perform clinical roles, that time is slowly eaten up with more dispensing of the dreaded monitored dosage systems.

Let’s face it, the slow progress of serial dispensing (which it was hoped would streamline the dispensing process) means that so far the time-saving benefits that were expected for pharmacists haven’t materialised.

But, the development of hubs only makes sense if it’s contractors and community pharmacists who drive this innovation – they have the expertise to make it happen.

Fortunately, however, it seems that common sense may have prevailed if rumours of a slight change of heart by the NHS mandarins are to be believed. Nevertheless, something still needs to be done to take control of the rising prescription volume and to release pharmacist’s time to deliver pharmaceutical care.
Regardless of how it happens, making dispensing efficiencies — and really that’s just an ill-disguised euphemism for reducing the costs of the service – will drive down NHS costs by reducing dispensing income.

We can only hope that for the survival of community pharmacy these savings are used to pay for professional services delivered by independent prescriber pharmacists in a community pharmacy setting to improve patient outcomes. If not then, the future is bleak for a profession that will soon have a glut of graduates vying for the few remaining vacancies once they qualify. And of course a surplus of qualified pharmacists will lead to reduced salaries – little wonder then that calls for a cap on the number of pharmacy students has been ignored.

For decades now we’ve talked ad infinitum about community pharmacy being at a ‘crossroads’, but it’s quite possible that we’re now facing a precipice.

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