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Overprescribing review calls for pharmacists’ and pharmacy technicians’ skills to be upgraded

A government-commissioned review has concluded that the skills of healthcare professionals, including pharmacists and pharmacy technicians, need to be upgraded in order to tackle overprescribing.

Led by England’s chief pharmaceutical officer Dr Keith Ridge, the review highlighted the increasing the number of “clinical” pharmacists working in primary care networks (PCNs) and widening the use of Structured Medication Reviews (SMRs) as two existing approaches in the NHS long-term plan “aimed at addressing overprescribing”.

While the NHS long-term plan is already increasing the number of pharmacists and pharmacy technicians “in the NHS”, “our recommendations would extend this demand further”, Dr Ridge wrote in the document, which was published today (September 22).

“It is vital that the workforce is able to expand to fill these extra roles without any dilution of quality,” the review added. "This means the healthcare system as a whole will need to expand provision of training and development, including upgrading existing skills."

It also recommends that the Department of Health and Social Care and the General Pharmaceutical Council (GPhC) work with stakeholders to expedite the implementation of pharmacists’ initial education and training reforms, “including allowing for more extensive clinical placements”. “The GPhC should develop a similar programme for pharmacy technicians,” it continued.

Health Education England (HEE) should instead work on a programme “that facilitates the current registered pharmacy professional workforce to have their enhanced and standard level of clinical skills recognised”, which would give pharmacists the opportunity to become independent prescribers.

C+D reported last month that HEE had been commissioned to develop a three-year education and training programme for PCN and community pharmacy professionals, which is expected to start “in the autumn”.


National clinical director for prescribing


Among other recommendations set out in the review – which ministers have accepted in full – it was suggested that a new national clinical director for prescribing should lead “a funded programme of work in partnership with relevant national organisations to implement this review over the next three years”.

The review also estimates that 10% of items dispensed in primary care are overprescribed and recommended “cultural changes to reduce a reliance on medicines and support shared decision-making between clinicians and patients, including increasing the use of social prescribing”.


Use skills of all pharmacists to tackle overprescribing


Responding to the review, the National Pharmacy Association (NPA) argued that the “clinical skills of all pharmacists should be used to tackle the overprescribing of medication”.

NPA vice chair Nick Kaye said: “Community pharmacists could play an increasingly important role in ensuring effective prescribing, for example through SMRs and as independent prescribers.

“That will improve patients’ access to advice and deploy the expertise of pharmacists to good effect. The clinical skills of all pharmacists, not just those working in GP practices, need to be brought to bear further on this important agenda,” Mr Kaye added.

Community pharmacists can also help their patients make the most of their medicines once these are dispensed, through new services such as the Discharge Medicines Service and the extended New Medicine Service, Mr Kaye continued.

Meanwhile, the Pharmacists’ Defence Association (PDA) argued that the report "does not go far enough in acknowledging the role that pharmacists can play in improving patients’ health and addressing this issue once and for all".

The PDA called for the NHS to ensure pharmacies are “adequately resourced so that pharmacists have the capacity to have the necessary conversations with patients”.


The role of pharmacists and community pharmacy


Leyla Hannbeck, CEO at the Association of Independent Multiple pharmacies (AIMp), welcomed the review and said it “should be embraced by the profession”.

She believes that community pharmacy “should be centre stage” to the reforms that will follow the review’s recommendations, as any changes are “likely to impact on the sector and concentrate disproportionately on cost and will thus have a complex and uneven impact on the network”.

“It is therefore crucial that the sector is engaged within this journey and is a key influencer in driving patients’ and the public’s expectations,” Dr Hannbeck added.

The Royal Pharmaceutical Society (RPS) has also welcomed the review. Chair of the RPS English pharmacy board Thorrun Govind said that “pharmacists across the country will be eager to play an active role, working alongside the patients and communities they serve, to reduce the harm that medicines can cause when overprescribed”.

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