There is so much talk about community pharmacy we are again in trouble not seeing the wood from the trees. Integrated here and integrated there, vital roles and changing care models are all the rage. Sometimes I am not sure where community pharmacy sits, who they ‘face’ and what they are a part of.
But it might be helpful to explain to managers some of the issues that they really face and where they might sensibly use community pharmacy – ‘the healthcare professional on the high street’.
The NHS is in a tizzy – demand is increasing and activity is brutal. Bursting at the seams and not going to get any better in the near future. To the positive some services like stroke have been a success, but that is about bypassing all of the tosh and taking people straight to where they get the best intervention. I can’t wait to see the results of the urgent elderly assessment centres – you just know it makes sense.
The world and their aunty, however, are talking about additional services and very few people are talking about people – with the exception of Jeremy Taylor who is pushing his water uphill. The NHS England managers are fixated on doing more for less as a mechanism of retaining the hordes – rather than about changing the world. It is totally wrong – you should be looking to do less, better.
Do I have to say it? The most cost-effective care is self-care. Now I am not suggesting that we encourage people to operate on themselves, but, when you think about it, there are a lot of conditions that people could self-manage, knowing that a whole team is around them if required.
Of course we can investigate things, visualise your internal organs, provide a diagnosis and treatment and then bully you relentlessly to take it until you cry. It is all about labelling illness and it creates despondency and a dependency that is really sad. It’s all about performance and metrics – if you have a diagnosis you must have a tablet and you must take it as you are told to.
Our health service plays a part in creating dependency, isolation, hopelessness and passivity. This wasn’t what Mr Bevan intended. No – his vision was quite different.
So our only real opportunity for survival is people. We have to help people to increase their confidence, we have to connect them with others and their families, we have to give them hope and empower them. We have to help them feel that they are in control of their conditions. We have to help them feel well. And persuade them that they can do it themselves and they don’t need the constant attention of their doctor.
That is why I am so excited about the role of community pharmacy in ‘first care’ situations.
- So tell me why every community pharmacy doesn’t have a large touch screen where people can access NHS choices and get some help navigating around?
- So tell me why every community pharmacy does not have a minor ailment or pharmacy first scheme in place that delivers NHS care and acts as a platform for expansion?
- So tell me why community pharmacists are not engaging groups of patients with specific conditions to provide community based education and support – connecting people in their communities?
- So tell me why community pharmacists are not providing services which could be called enhanced self-management or simply services for conditions where people don’t need to access a doctor. Contraceptive services, for example – forgive my ignorance, but a woman that wants contraceptive advice and service provision is not ill – so why do we send them to the doctor?
So for goodness sake people – get a grip – take care of yourself. You can do it!
And NHS England rather than always providing additional medical services – commissioning investigations, measurements and monitoring – think about the goal here – empowering people to manage themselves.
And Community Pharmacy – it may be now or never – but we do need a cohesive plan – where you are the focus of first care and self-care and the ‘new’ gatekeeper to the NHS.
Anyway I’m off to the ‘knit and natter class’ to get people talking about their medicines – forget this one to one stuff – group discussions in the community is the way to go.