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Community pharmacy – the Cinderella profession

Ross 2
Ross Ferguson

the past few months I’ve had a seductive glimpse of the future of community pharmacy in Scotland, and I really think that this time it is achievable. It’s shiny, bright, within reach, and I want it. Not just for me, but for future generations of pharmacists, and of course for the people who use pharmacies.

It’s a future where independent prescriber pharmacists take professional responsibility for caseloads of patients, use clinical skills to diagnose and treat common clinical conditions, where we collaborate regularly with others in primary and secondary care, where patient safety practices are embedded in community pharmacy services, where we have access to patient records and we’re supported by a robust IT infrastructure and a team with the right skill mix.

We will then able to help make serious inroads to tackling the oft-repeated challenges faced by the NHS, and become (and be seen as) a critical pillar of primary care.

But as new futures go, is it that dissimilar from the one that we always hoped for at University? One that I fully expected to have when I was a student 20 (ish) years ago? Back then the hallowed text was the Nuffield report, it extolled the virtues of community pharmacists getting out from behind the dispensing bench and taking on new roles. Sound familiar? Since then we’ve had umpteen vision documents, and while there have been tweaks here and there (a few new services added on), the reality on the ground hasn’t changed.

I’m doing a weeks’ locum this month and I know that I’ll be checking around 500 items a day, over a 9.5 hour day with no real break. And for the majority of community pharmacists this is a common scenario.

Change ahead
Well, it’s just possible that after a long, complicated gestation the community pharmacy caterpillar is going to be reborn.

Why now? Well, the way I see it in England contractors have reached a point of no return, something has to give. The Community Pharmacy Forward View and the North-East London Local Pharmaceutical Committee’s vision document Indispensable pave the way under the threat of serious cuts in funding. Draw your own conclusion as to why there are two documents.

But in Scotland, it’s a more positive change.

To me, it feels like the professional stars have aligned: our Chief Pharmaceutical Officer, Rose Marie Parr has enthused people with her straightforward talk, her understanding and her collegiate approach. She has helped galvanise and unite the various pharmacy bodies in Scotland, and pharmacists at the leading edge are sharing their great work and forging a path for others to follow.

I’ve said it before, but it’s worthwhile noting again: we have some great people in Scotland working for the Scottish Government, the NHS and the Scottish pharmacy organisations — they speak the same language and (for the most part) have common objectives. But don’t mention the elephant in the room – the prescription volume – we still need to address that. Hopefully, once the evaluation of automated technology in community pharmacy is complete we’ll have a clearer idea of how we can best overcome that.

So what has prompted this positivity? Well there’s a consensus that community pharmacy can and should be a real force for change and it’s not only us saying that.

Dr Catherine Calderwood, Scotland’s Chief Medical Officer: “We are changing our thoughts, we are moving treatment out into communities, away from hospitals and, in doing that, I would say pharmacists are absolutely ideally placed at the right time to become more involved. And I think we need, as has been the commitment of Prescription for Excellence, to really invest and develop the pharmacy profession.”

Dr Andrew Buist, GP and Deputy Chair of the BMA’s Scottish GP sub-committee:
“We want to move out of areas like chronic disease management, health promotion, public health, and immunisation.

“We see these as areas that should be moved to be the responsibility of integrated joint boards, and there may be opportunities for community pharmacy.”

“I absolutely do see pharmacists as the experts in therapeutic use of medicines, and I welcome new enhanced models of care for clinical community pharmacists and the need to spend less of your time dispensing by using more pharmacy technicians.

“There are great advantages in collaborative partnerships between community pharmacists and GPs, especially over complex, long-term care.”

Professor Rose Marie Parr, Scotland’s Chief Pharmaceutical Officer:
“There’s a really positive future for pharmacy and community pharmacy. There is a clinical, digital future, but we need to get better with the IT and we need to allow pharmacists to focus on pharmaceutical care.

“The Future is really bright for pharmacy. We’re wanted everywhere, but we need to be really sure that we work in a safe and effective manner.”

Making it happen
And that’s all great, but we need to act on this, we need to make it happen, otherwise conference after conference, year after year, we’ll continue to trot out the same well rehearsed phrases (ideally placed, underutilised resource – you know the drill) to the same audiences. Then go home, feel good about things for a few days and nothing changes.

So, the challenge is making this happen on the ground, harnessing a network of beleaguered pharmacists who have endured the difficult times. It’s time to start making small changes that can make a big difference, as well as focus on the bigger challenges, and once we tackle the elephant in the room it really will release the potential of community pharmacy.

We are being courted by an enticing version of a better future, hopefully the days of community pharmacy being a Cinderella profession are over. But the clock is ticking…

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