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The big interview: Martin Green

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Community Pharmacy Scotland Chair, Martin Green

Who was involved in developing the CPS Vision?
The Vision was the output of a CPS Board strategy day in May. Members of the Board alongside member of the CPS Executive sat and debated the strategic plan of the organisation to ensure that the pharmacy network in Scotland remains at the forefront of Scottish Government thinking when it comes to primary care services for the public in the future thereby safeguarding the pharmacy network we represent.

Once drafted the Vision was essentially signed off at the subsequent full Board meeting by Board representatives.

What were the most contentious elements of the Vision amongst those involved?
Much of the Vision was, and we believe, is not contentious and is what most people will recognise are reasonable asks and statements from pharmacy stakeholders and indeed others e.g. pharmacists are the experts in medicines and pharmaceutical care, greater public health involvement, patient safety, working to deliver more services as part of a wider primary care team, Pharmacy First.

When you hear the phrase ‘decoupling’ and ‘flexibility in supervision arrangements’ this naturally arouses debate.

On the first point we only talk in terms of the procurement and assembly of medicines i.e. the technical aspects of the supply process.

We 100% believe the supply should occur at the pharmacy in the heart of every community as this is essentially the hook to the great care we provide. However, using the pharmacy team and/or technology to carry out this important technical function in a safe manner would free the pharmacist to deliver the clinical care and allow patients to derive ‘maximum benefit’ from their prescribed therapies alongside their other wellbeing needs.

So, we are in no way talking about remote warehouses assembling prescriptions for patients with drones delivering to the door with no pharmaceutical care thereby cutting out the pharmacy network (to be fair no-one in Scotland is talking about this anyway).

For us that fails to capture the value in the pharmacy network and would naturally be a threat to the viability of community pharmacies, so we believe ‘decoupling’ the technical aspect in a safe and responsible manner would enhance that value further as pharmacists would be delivering more face to face care that is so important to the public we serve and potentially a greater benefit to the wider NHS.

We know that community pharmacies are extremely busy, so we need to think of new ways to make the volume of prescriptions our friend and not this enormous workload that shackles our highly trained teams to dispensing benches. Once we do this our pharmacies will still be busy and the focus for medicines supply but crucially capacity should enable pharmacists to deliver even more!

The second point around supervision is a current area of great debate amongst sections of my colleagues across the UK. It was also an area of great debate as part of our strategy day. Again, let me be clear, we are not advocating operating individual community pharmacies without pharmacists.

One of the great strengths of community pharmacy is the accessibility and the health professional on the High Street, it is one of our common messages to political decision makers for instance through our advocacy work. However what we are being exposed to from our NHS partners is the language of change: ‘enabling primary care transformation’, ‘new ways of working’, ‘Health and Social Care integration’,’GP cluster working’, increasing care at home for an ageing population’, ‘Realistic Medicine challenges’.

None of this necessarily means we have to change and indeed for some it may not, but we believe that to make community pharmacy play a bigger role in meeting these challenges and be part of the solution, we may have to change to allow our impact to be fully realised. This may involve the development of robust and safe systems to allow the supply of medicines in the absence of a pharmacist where the pharmacist deems it professionally responsible to deploy their skills in a different setting on occasion to interact with patients and the wider primary care team.

This is one for the innovators to develop in conjunction with regulation and other partners. As part of the Rebalancing programme of work we understand that decriminalisation of inadvertent errors is first and must happen but beyond that there should be scoping to look at how the pharmacy team operates and how best it benefits the community they serve.

The Vision was developed before Achieving Excellence in Pharmaceutical Care was published – what are your views on the Government strategy and how it fits with the CPS Vision?
We are supportive of the strategy and were pleased that community pharmacy was so integral to its delivery. Rose Marie has publicly stated that our Vision aligns well with the strategy and we would concur. What we realise we must do now as a network is enhance what we do now to support delivery of AE.

CPS has called for changes to the supervision requirements in pharmacy. Can your Vision not be achieved within the current RP regulations?
It does not necessarily mean change for all, as we have examples of great practice already in Scotland but we believe that if the change is enabled in regulation and is demonstrated to have no detrimental impact on the services we provide in terms of safety and delivery then why would we wish to stifle our members who wish to innovate and employ a slightly different approach to (in their view) enhance what they want to do?

Some contractors are concerned that there is an agenda in the UK to use pharmacy technicians in pharmacies without pharmacists, to reduce the costs of the service. What is your view on that?
We do not believe this is on the agenda in Scotland. I think in Scotland we can promote a Vision like this, because we have a Government, by and large, who understand and do what they can to support the community pharmacy network. Achieving Excellence is a tangible example of that. Our relationships with the department, which are not always perfect, do not lead us to the conclusion that pharmacies will be running without pharmacists and if it did we would be opposed to this.

Are there risks involved in allowing supply of medicines when the pharmacist is absent?
I think there are risks in pharmacy currently all the time when dealing with medicines hence why we are working with the Scottish Government to engage in a programme of Continuous Improvement in the services we provide. Safety climate surveys through the patient safety programme have largely been embraced by the pharmacy network so we can take on the principles of learning from errors and safer ways of working. We have to take these principles and build on them for the future in whatever way we operate.

Therefore, our teams and technology (e.g. scanning technologies) can enable safer ways of working which ultimately may enable the community pharmacist to work in a slightly different way. The vast majority of this different way of working will still happen from the pharmacy as it can now but if safe and robust processes are developed any risks should be minimised in the future and crucially release the pharmacist from the technical parts of the process while overseeing the clinical aspects potentially even improving safety around medicines through conversations with patients.

How can these risks be managed?
Through robust procedures, and in our Vision for some pharmacies this may be delivered through technology alone, some with staff only and some with a hybrid approach.
Is there a danger that some contractors may use this opportunity to save money by reducing the number of hours pharmacists work?

Not in my opinion. I’m not sure taking the largest asset you have from the pharmacy would support your business and community pharmacy’s place in a modern NHS. Any change in regulation would have to be consulted on and we would look to safeguard the community pharmacists’ role within any proposed regulatory framework.

If the ailments scheme is to be extended to include more conditions, do we need specific pharmacy guidance (e.g. SIGN) on using an evidence based approach to minor ailments?
I believe the latest additions as part of the Inverclyde MAS pilot are largely based on evidenced based guidance and certainly this should be the case for any additional conditions.

What are the challenges that need to be overcome to achieve your vision?
Decriminalisation has to happen first and foremost. This spectre hanging over the workforce is not helpful and this should have been addressed long ago to bring us into line with other healthcare professionals.

In Scotland we also have an ongoing evaluation of various forms of technology and while we believe it can be an enabler to support new ways of working we await the results of this with interest around autumn of next year to inform that view.

Another challenge is financial. The reality is that our public finances are undergoing significant pressure and this is unlikely to change in the short to medium term. The community pharmacy financial model must provide a fair return for our members investment and in turn our members do, and should continue to, deliver a valuable service to the public. Any pressure or shift in Government position on this would jeopardise the pharmacy network and potentially stifle progress required to deliver AE and our own Vision.

Are you positive about the future of community pharmacy in Scotland?
There is a lot going on and many challenges facing community pharmacy and, indeed the NHS, in Scotland. So far community pharmacy owners and their teams are continuing to meet and deliver on that challenge.

In AE we have a strategy grounded in reality and one that supports the role of community pharmacy so we are on the same page with Scottish Government policy. If investment is forthcoming to support the pharmacy network we believe that the future of community pharmacy in Scotland is one that should see it have a sustainable future and continue to deliver benefit for the people of Scotland.


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