This is an interesting question that should be testing the profession. Do we know – have we thought about it – if not then we will experience tough times ahead. We might want to consider the answer under three sections – reactive, pro-active and creative.
Reactive community clinical pharmacy. This occurs when the pharmacist reacts to the presentation of a patient or a prescription. It includes NMS and MUR, responding to symptoms, minor ailment services and ensuring the safety and accuracy of a prescription (for example inhaler technique assurance). Do we do it – yes we do – but is it of the highest quality and adequately funded? Undoubtedly the answer would be – it varies – it varies from the brilliant to the embarrassing. The profession needs to ensure that there is proper engagement with commissioners and General Practice to ensure that the NHS manages demand. So there is a lot to do to improve reactive clinical pharmacy and ensure that it is fully enshrined within the new community pharmacy contract and properly supported through education.
Proactive community clinical practice. This occurs when a pharmacy team responds in a proactive manner and explores potential issues with their customers. So for example when the pharmacist knows that a customer has diabetes, he/she asks about associated common conditions and for example supports the patient to initiate a preventative foot care program. This also includes medicines optimisation which is a process that considers medicines as part of an approach to deliver focussed improved outcomes for patients. I have spoken to Mr Laird about this before – for example some people with asthma are unfit and this holds them back – if the target is to improve fitness then the pharmacist can describe a suitable asthma care plan including use of medicines to support the achievement of that goal.
Creative community clinical practice. This occurs around the development of a new service to create health and wellbeing. It is strongly linked to the community pharmacy position and opportunities for engagement. Such services should go further, building from the expertise of single pharmacists to generate cohesive service delivery over a wider network. There are pharmacy teams that deliver fantastic services to their populations, but often these are isolated or locally commissioned. There is so much to be said about the creativeness of pharmacy teams and their ability to influence the health and wellbeing of their population, but this needs to be spread and commissioned properly.
There is a lot to think about, a lot to say and even more to do. It may be now or never.