So here is my challenge. A simple challenge given to me at a meeting. A flip chart where someone drew two circles – one general practice and one hospital based care – primary and secondary care they said and smiled. They asked – where does community pharmacy fit – and handed me the pen.
This is simple I said and drew three additional circles on the page:
The first circle sat far away from the others. Community pharmacy sits outside the others as a completely separate entity from the traditional NHS. It represents the first port of call for much of the population. It provides a simple contact point for people to get health and well being advice, pharmacy first services for common conditions and a wide range of public health services including simple screening for cancer. It is of vital importance in empowering people to look after themselves without needing to access the ‘NHS’ – an early gatekeeper. There remains a lot to do to make this a reality as it is a bit piecemeal at the moment.
The second circle sat next to general practice, but not overlapping. Community pharmacy is an alternative service provider to patients. Some patients may choose to have elements of their care delivered within a pharmacy. It is not difficult to see joint registration and full sharing of medical notes to support this. I have blogged before that I would like to see community pharmacy have a bigger role in managing GI complaints, contraception, asthma, immunisation and skin conditions. We can make this happen and when services are offered to AQP, community pharmacists should be prepared and ready to offer patients choice. It doesn’t usurp General Practice – it sits neatly beside.
The third circle overlapped General Practice and I sneaked in a few more – dentists, optometrists, community services, social care, charities, voluntary services and housing. And drew a large circle around all of them. This is the new definition of primary care – where we integrate these and other local services (sorry to the loads that I have missed out) where everything comes together to look after people with complex issues. Of course I mean those who are old, but we must recognise that many conditions are not solvable with a pill and everyone needs to work together.
With a gentle smile I put the pen down and fielded questions. So where do we start?
That is very simple. I can do the first today and there are some great examples around and a huge need within the whole system for this to happen. We must start to manage demand as a matter of importance. We need to think differently about the profile of community pharmacists and work on patient perception. A simple start would be for all clinicians to ask ‘what did the pharmacist say’.
I can do the second next – it will need a little training, but there are examples of contracts and consultant/specialist pharmacists out there. We must plan to expand capacity without creating additional pressure on the system.
And the third – the golden ticket might take a little longer. There is a lot to do to redefine primary care and deliver it. Working together takes visionary and charismatic leadership, giving all parts a seat at the table, sharing problems and creating solutions that work. Some of the elements of this jigsaw don’t even recognise the pieces, let alone have an understanding of what can be achieved. But we have to start somewhere – it’s now or never.