What does your role involve?
The role is a new one developed after a recent restructure within the organisation approved by the Community Pharmacy Scotland Board. The title is Director of Operations (DOO), but in business terms it is also commonly referred to as a Chief Operating Officer.
Harry McQuillan (the CEO) and I are currently still shaping what good looks like for the role for CPS, as this is the first time Harry has operated with a DOO. I am personally excited about the potential the role has for me and the organisation.
It allows Harry to engage more with external stakeholders as I take more accountability for operations within the office to ensure that the strategic direction set by the CPS Board is reflected throughout the organisation. In practice this is reflected through the line management structure and having overall responsibility for planning and controls within CPS.
You still work as a locum occasionally. Are there parts of the job that frustrate you?
As my job is mainly a weekday role I locum at weekends. The out of hours role we have is significant, and being able to contribute to that by supporting patients is very rewarding. I feel it is important for me to reflect the pharmacy network as it is, and working as a locum gives me a sense of what works in practice and informs my national role.
I remember with fondness the relationships I developed with the public when I was based permanently in one pharmacy practice. Obviously it’s difficult to replicate this when you are an occasional locum, and while it is the nature of my situation I do, at times, yearn to follow through the journey with a patient when I make an intervention.
Other things that frustrate me probably frustrates many other practitioners:
- Lack of access to records (which could only enhance what I do out of hours for patients)
- Being unable to provide direct solutions when you nwo the casue of the problem: uncomplicated UTI, substitution therapy.
What simple things could be done to improve the community pharmacy experience for patients?
Give them access to their own records. I say this as a simple solution, but I appreciate the potential obstacles. However, as a patient who occasionally accesses services myself, I don’t see why I should not have a form of record to enable me to access NHS services including community pharmacies.
England are pressing ahead with Summary Care Record access for community pharmacists, and I am hopeful Scotland will follow shortly. I’ve been with CPS for 5 years now, this is something that we and the RPS have lobbied heavily for since even before I was in post. I feel a groundswell of voices (even outside the profession) are finally realising the value of pharmacy/patients having access for both patient care and the need to support the wider healthcare system.
What simple things could be done to improve the community pharmacy experience for pharmacists?
Improving the IT infrastructure to support seamless patient care (e.g. WiFi for tablet use etc), having the right tools to support services is an important enabler.
I’d also like to see legislation tweaked so that pharmacists can be empowered to use their medicines knowledge in to provide substitution therapies under certain circumstances (e.g. manufacturer can’t supply). While it can happen to a point already, I think certain frameworks could be developed that would allow pharmacists to do this without the need to contact the prescriber, thereby supporting the needs of the patient in a timely manner.
What has happened to the Chronic Medication Service (CMS)?
CMS was rightly described by the former Chief Pharmaceutical Officer as “the jewel in the crown of the Scottish pharmacy contract”. The principles behind the service are right, no-one can argue with community pharmacists having a greater role in the management of peoples’ long-term medical conditions.
In reality, while there is a lot of good practice going on throughout the network, it is a service that needs a boost to get back to first principles in terms of what we want to achieve for patients.
The serial prescription side has been dogged with IT glitches, and is so dependent on GP engagement to work. Again there are good examples of this working, but unfortunately, despite the efforts of many stakeholders, this has not yet become commonplace as was once hoped. We need to learn from areas where it works and replicate that across all health board areas. This NHS approved system should be the way forward for prescription management.
While the serial prescription element is important to manage workload for busy community pharmacies, the biggest impact to patient care comes from speaking to the public about their long-term conditions and associated medicines. Ensuring they get the best out of these medicines will have such a positive impact on individuals (e.g. improving concordance, reducing waste and reducing medicines misadventure) and the profession, as pharmacists record and measure their impact across the country.
These interventions are not complicated, and that is something in community pharmacy we forget. The social intervention, simply checking in with patients for a minute can often make a difference. When patients realise they have an accessible healthcare professional that will listen, it is priceless. Of course recording these interventions through CMS could be smoother, but we should never underestimate the value even the smallest intervention can make to a patient.
Enabling Wifi access and therefore tablet led consultations is something that is being developed, and this may help more intuitive recording of interventions in the future.
Recording these interventions is also important to develop the evidence base for pharmacists through CMS. Evidence will become increasingly important for accessing public funds to support development of further NHS pharmacy services.
I know, and almost every other member of the pharmacy team knows, what they deliver day in, day out for the public in Scotland, but an irrefutable evidence base would further justify continued support for the pharmacy network. If we can get CMS right in terms of capturing this evidence base it would be so important.
Going back to disease state protocols may seem like a backward step for some in terms of holistic, polypharmacy type approaches to care which is advocated in policy, but for CMS I believe that this could be built up over a number of years to give pharmacists the confidence, focus and know how to make effective interventions.
Not implementing these protocols (which lie empty within the PCR drop down menu) was an error in my opinion early on, but it is not too late to look at this again. Once the practice is established then pharmacists will (and often do) look at the whole patient and we can maybe even introduce a polypharmacy tool into the PCR as CPS has suggested.
Read the second part of our exclusive interview with Matt Barclay here