Ross Ferguson
COMPARING community pharmacy services in Scotland with England, I think that in many respects, patients are better served north of the border, but I’m not questioning the commitment, dedication or professionalism of pharmacists in England.
The difference is that many of the excellent services provided by pharmacies in Scotland are nationally commissioned — they are part of the national pharmacy contract, unlike the more fragmented approach due to vagaries in commissioning by clinical commissioning groups (CCGs) and other bodies in England.
Local flexibility can be very useful for adapting to change and addressing local healthcare needs, but it shouldn’t inadvertently lead to reduced access to effective pharmacy services.
Not only does it mean some people lose out simply because of where they choose to live, but inevitably it creates confusion and an incoherent message for patients when supposedly there is a national pharmacy network.
Here in Scotland, all the following services are available in every pharmacy:
- Minor ailments
- Smoking cessation
- Emergency contraception
- Gluten free food
- Unscheduled care.
These service are negotiated by Community Pharmacy Scotland and provide real benefits to patients, and enable pharmacists and their teams to provide help, advice and care when it is required.
Moreover, this means the schemes can be promoted nationally, and patients know how pharmacies can help and that these services are available in all 1,250 pharmacies in Scotland. I think this unified and consistent approach provides strength to the Scottish community pharmacy network, and it strikes me that a similar approach in England could be beneficial for the profession, but more importantly for patients.
Minor Ailments Service
Introduced in 2006, this national scheme has helped to encourage people to visit pharmacies for advice before going to their GP for minor ailments. It’s incredibly popular, with nearly 1 million people registered, receiving over 2 million items per year, and the hope is that the scope and reach of the free scheme will be extended.
Patients are registered with a pharmacy and contractors receive payment on that basis, and are reimbursed for the cost of the prescribed medicine.
Smoking cessation scheme
A free 12-week smoking cessation programme available to all patients. The pharmacist writes prescriptions for suitable nicotine replacement therapy (NRT) or varenicline (using a PGD) and the pharmacy team provide help, advice and support for those aiming to quit smoking.
Contractors receive 3-staged payment over the course of the patient’s journey and are reimbursed the costs of the medicine.
Emergency hormonal contraception
As one of the most accessible healthcare professionals, it’s incredible that this service isn’t available in all pharmacies in England. In Scotland, if required we can provide levonorgestrel (Levonelle) or ulipristal acetate (ellaOne) free of charge.
Gluten free food service
Now a part of the national contract, this service means that diagnosed coeliac patients don’t have to go to the GP practice to order their gluten free food. Instead, they fill in an order form, take it to the pharmacy where a prescription is written by the pharmacist and the food is ordered. A much simplified system that makes it easier for patients and pharmacy teams.
Community pharmacy urgent supply (CPUS)
This is a fantastic scheme, and while there may still be confusion about exactly when it can be used, community pharmacists can write CPUS prescriptions for up to one normal prescribing cycle (this is not restricted to 30 days’ supply) of a patient’s repeat medicines and appliances when the patient’s prescriber is unavailable; the surgery is closed or an out-of-hours system is in operation.
It’s like an emergency supply, but better. The patient gets their medicine free (remember there are no prescription charges in Scotland) and the pharmacy gets reimbursed. There is no need record the supply in the POM register, but a copy of the prescription needs to be faxed to the patient’s GP.
Contractors receive a monthly payment for participation in the scheme.
Pre-regs
The recent announcement that Health Education England is introducing centralised pre-registration pharmacist recruitment is interesting news, although at the moment, it will only apply to hospital and be optional for community pre-registration posts.
In Scotland, the current one-year Pre-Registration Pharmacist Scheme (PRPS) is managed by NHS Education for Scotland (NES) for 170 trainees and funded through the Scottish Government. NES manages the national recruitment, training programmes and quality management processes.
This works very well and includes a standardised training programme which ensures high quality training and support using direct learning and distance learning. Pre-reg tutors need to complete a tutor training programme to be approved.
Best of both worlds
I know that the political dynamics in England are vastly different from up here in Scotland (both within pharmacy and the NHS), where comparatively we seem more harmonious, but addressing the current variability in services may be a good starting point to focus on.
Now, I’m not saying everything is better in Scotland, we don’t yet have records access, electronic prescribing, or a nationally commissioned flu vaccination service like in England, but those are on the wish list (well, mine anyway).
Wouldn’t it be fantastic for patients if we could pick the best parts of pharmacy in both countries and replicate them in our own?
Further reading
[1] PSNC database of locally commissioned services
[2] Community Pharmacy Scotland