Guest Writer - North East London Local Pharmaceutical Committee

April 2008 saw the publication of the latest Pharmacy White Paper: Pharmacy in England: Building on Strengths, Delivering the Future.  This white paper sets out a road map for the future direction of pharmacy.  

The principal aims of this white paper are: to continue the shift in emphasis of pharmacy services away from dispensing and supply towards the provision of more clinical services; to continue to move away from pharmacists being paid solely on the basis of the volume of prescriptions they dispense towards pharmacists being rewarded for the quality of the services they provide; and to make better use of the skills of pharmacists and the pharmacy team.  

We need to reposition pharmacy as the first port of call, and develop pharmacy as a healthy living pharmacy.  We know that pharmacy is one of the few health services accessed by people who don't generally engage with healthcare - we must build on this strength.  

We need to increase the range of services commissioned through pharmacy.  Services that could be commissioned through pharmacy can be broadly grouped into three categories.  First, there are those services that utilize the accessibility and convenience of community pharmacy, including minor ailments, emergency contraception and broader sexual health services, and screening services, for example the NHS health check.

Second, there are those services that build on pharmacy's increasing role in health promotion and disease prevention, including stop smoking, weight management, and alcohol services.

Third, there are those services that build on pharmacists' expertise in supporting patients with their medicines taking.  We spend £12 billion on medicines in the NHS in England, at least £8 billion of which is in primary care; but we waste at least £1 billion (not to mention the associated environmental impact).  We need to do better.  We need to improve outcomes from use of medicines.  We should maximize the value of medicines use reviews to improve patient outcomes.

Improvements have been made to give pharmacy greater prominence and to make the commissioning of pharmacy services easier for PCTs.  Pharmacy is mentioned specifically for the first time in the 2009/10 Operating Framework for the NHS, and PCTs are asked to pay due regard to the White Paper's contents.  There have also been a number of high profile publications such as Pharmaceutical Needs Assessments (PNAs) as part of world class commissioning - Guidance for PCTs (January 2009), and World Class Commissioning: Improving Pharmaceutical Services (March 2009).

Solid foundations have been laid for the future commissioning of pharmaceutical services, but the profession now has to prepare itself to deliver those services safely and to a high standard.

We need to improve communication between pharmacists and other healthcare professionals, particularly GPs.  LPCs should work with PCTs, LMCs and practice-based commissioners to ensure that pharmacy is included in strategies and plans for service redesign.

Community pharmacists, naturally, have some concerns about how they should go about providing the extra services that it is now possible for them to offer. It is time for pharmacists to rise to the challenge.  Community pharmacists need to look at redesigning the way in which they operate.  The innovative use of skill mix is a good starting point.  Pharmacists should ensure that they only do the things that only they can do.  For example, employing dispensers and accredited checking technicians would enable the pharmacist to deliver clinical services.  Pharmacists need to ensure that support staff are suitably trained to enable service redesign.

Pharmacists should look at workflow within the dispensary and ensure that dispensary design and layout enables safe working: the National Patient Safety Agency has produced a guide to assist in redesigning the dispensary (Design for patient safety: A guide to the design of the dispensing environment, which is available from the NPSA website at www.npsa.nhs.uk).  

Premises need to be fit for purpose.  Patients increasingly expect consultations to take place in private, and commissioners will expect pharmacists to deliver clinical services from suitable consultation rooms.  If pharmacists want to deliver a wider range of clinical services then they will need to ensure that their consultation rooms are suitable.  In any case, premises should present a professional image.

Historically, pharmacists have not been very good at recording interventions. Pharmacists must improve recording of interventions and consultations, because in future we will be developing a range of indicators and metrics to assess the quality of pharmaceutical services, since without measurement it is impossible to demonstrate quality improvement.

Pharmacists need to consider how to maximize the use of technology to facilitate innovative ways of working. In future, we will increasingly rely on electronic recording and reporting systems - one computer terminal will not be sufficient.  If pharmacists and their teams are to record interventions made over the counter and during MURs and other consultations, alongside dispensing prescriptions transmitted via Release 2 of the electronic prescription service (EPS), then a single terminal in the dispensary will be insufficient.  In order to future-proof the pharmacy at least three terminals will be required - two in the dispensary (one for labelling and one for checking), and one in the consultation room.  We also need to look at how we can use new technologies to improve patient safety, e.g. by using barcoding systems.