The future is rosy – said the Minister responsible for Pharmacy. But what are the small changes that might make a real difference to the profession and the way that pharmacy operates. Here are a few suggestions:
- Co-registration – patients should be able to co-register with a community pharmacy of their choice in which a nominated pharmacist becomes jointly responsible with their care in association with the GP practice. It is a simple concept – know your GP and know your pharmacist. Registration would open up the better inclusion in NHS Choices, the identification of expertise and services and the sharing of clinical responsibilities.
- Access to medicines – the main routes for pharmacists to supply/prescribe medicines to patients is limited and restrictive. PGDs are a lot of work and qualifying to become an independent prescriber a lot of hassle to find so few opportunities in community pharmacy to use the skills. I have long advocated a new legal category of independent community pharmacist prescriber (limited) which might allow thousands of community pharmacists to prescribe from a limited range of medicines in the course of their practice. A community pharmacist with a prescription pad (albeit a limited list) could be important in the mind of a patient.
- Access to technology – I appreciate the need for pharmacists to have access to some further information about patients and the commitment from the Secretary of State to make this happen. However, in the first instance I would like to see the ability of the community pharmacist to book an urgent appointment for a patient, particularly outside the normal opening hours of the practice. I would also like to see commissioned extended opening hours pharmacies having the ability to support teleconsultation with the doctor on call.
- Underwriting and support of emergency supply – many patients don’t know that there is a provision for emergency supply of medicines. Scotland operates a PGD for this purpose and at least one CCG has agreed to pay for medicines issued in this way. One other CCG has specific arrangements around the emergency supply of blood testing equipment. Underwriting the supply of medicines is a small commitment for CCGs to will make this route of supply simpler.
- Co-operative ventures. Like Elvis, most pharmacists are ‘taking care of business’. But several pharmacies have linked together in some way. There is a need for Pharmacists and Pharmacies to visualise a different way of working, perhaps in federations or partnerships to ensure that their interests are properly represented locally. In my opinion there is often a gap between pharmacies, pharmacists and the local commissioners. I appreciate that there are a number of representative bodies in this area, but there remains a need to drive and support delivery as well.
- The Royal Pharmaceutical Society – I may have been critical in the past, but I am changing my view. The team seems stronger and are clearly turning their attention away from quasi-regulation to true representation. There are some strong and dedicated people there and when someone in a senior position says less standards more stance – well I am impressed. They are well on the way of creating a credible Royal College – a suitable amount of general sucking up to start with – but now moving with incredible speed and engagement. I would like to see Dave using a JFK quote – ‘my fellow pharmacists ask not what the profession can do for you, but what you can do for the profession’. Time to stand up and be counted – it’s now or never.
- Sharing innovative practice. I often dream of the world that I want pharmacy to be. The annoying thing is that someone is already there. I am constantly staggered by the extent and quality of service that pharmacists provide. I am constantly disappointed that these examples are not led right across England. I don’t know why this is! Are we too analytical – do we believe you can’t talk about anything until you have ‘evidence’? Hoisted by our own rope perhaps? In all my years in the NHS, I have seen major structural change and service development, based on a flimsy ideology and a corrupted understanding of the problem that needs to be solved. Pharmacy needs a step change in the way we advocate pharmacy service development. Pragmatism and drive, rather than hope and a vision. I remember Judith Smith’s quip – ‘Pharmacy has had more visions than the Old Testament’ followed by it’s now or never and JDI.
- My name is…- this is a significant drive in the NHS. Years in hospital clinical pharmacy practice I emphasised the need to introduce yourself to the patient in the bed watching faces going past – My name is… I am responsible for…. You can ask me….. It takes the conversation and the relationship to a personal level. I often hear someone saying – can I speak with the pharmacist? Every pharmacist should respond with – My name is…. The next pharmacist responds – My name is… I am part of the Pharmacist team here. Every member of the team should introduce themselves by name – the pharmacist has absolutely no excuse. The best already do this effortlessly.
- Showing that you care. A very wise pharmacist said to me – ‘they don’t care what you know – until they know that you care’. I don’t know where this quote comes from or whether he made it up himself, but 30 years on it is still in my mind.
- Confidence. I don’t know whether any of this is true, but in a way it doesn’t matter – it is what we believe. Pharmacists belong to the third largest healthcare profession. In a week more people interact with a pharmacist than all other healthcare professions combined. Pharmacists can offer a solution or be the base for the solution to many of the issues currently facing the health and wellbeing of the population.
- Building on relationships. So many other health professionals say nice things about pharmacists and pharmacy services. So many leaders throughout the NHS suspect or believe that pharmacists and pharmacies are part of the solution. Please don’t just accept this – think how this belief can be channelled and expanded.
I am sure that you can think of other small structural, procedural, legal and emotional changes that could add up to significant change