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Pharmacy must embrace its future today and not wait until tomorrow

Nick Kaye articulates why medicines supply and clinical services belong together

Last month, I was privileged to speak at the annual UCL School of Pharmacy lecture. Harry McQuillan, chief executive of Community Pharmacy Scotland (CPS), gave an excellent keynote speech, which amounted to a grand vision of a clinically transformed community pharmacy sector. He urged the audience to move beyond the notion that community pharmacy's main role is ensuring the accurate supply of medicines and instead to think in terms of safe supply.

He made clear he was not talking about displacing community pharmacies’ medicines supply function with clinical services. On the contrary, services can be built through the regular interactions pharmacists have with patients resulting from regular supply. I completely agree with this.

The link between supply and service is baked into our history and is the basis of our clinical future. However, we have to expand our mindset to an end-to-end prescription management role, not just limit ourselves to dispensing. Patients benefit, the NHS gets good value and the business model for pharmacies is more sustainable over the long-term than it otherwise would be. However, we have to expand our mindset to an end-to-end prescription management role, not just limit ourselves to dispensing.

Read more: NPA sets out vision to ‘redefine’ community pharmacy’s role in the NHS

The safe supply to patients of a billion or more items a year is a vital task in and of itself. It is the single biggest therapeutic intervention within the NHS. But it’s also a platform from which to provide healthcare advice and build clinical services. It gives us the regular opportunity to review and manage long-term conditions, with the application of diagnostics and laboratory tests where appropriate. Lifestyle advice and support can be wrapped around a monthly supply of medicines for a range of conditions, such as statins for cholesterol.

Meanwhile, we’ve all experienced that patient who comes in for their reliever inhaler but won’t engage in other parts of the health system for review. Supply allows us to intervene with a potentially life-saving intervention. Another example from my own pharmacy was when a mother was collecting creams that had been prescribed by a dermatologist and were on repeat prescription from the GP for her two-year-old.

Read more: HSCC gives scathing review of DH progress on pharmacy pledges

She had also been prescribed a new cream, which she had requested as she believed her son’s skin was infected. My pharmacist colleague could see the child’s skin there and then, and see it wasn’t infected but needed better managing. Once how to use the cream properly had been explained to her, there was no need for the new cream and the eczema was much improved.

Supply is also an essential component of urgent care services like the NHS community pharmacist consultation service (CPCS) and the forthcoming Pharmacy First service. While not all interventions within these clinical services will result in the supply of a medicine, the ability to make a supply if appropriate is key to completing many care interventions. The NHS has told us that the key to our expanded role will be an ability to complete these interventions, ie deal with a patient so that their problem has been managed in full and they do not require further support in a different part of the health system. To achieve this, our ability to deliver a clinical service and a supply of a treatment together will frequently be the key to success.

Read more: Government injects £645m investment into community pharmacy

Then let’s consider pharmacogenomics. Wouldn’t it be great if after a diagnosis the pharmacist could, with the patient, choose the medicine? Some people can’t metabolise clopidogrel into the active drug. A simple test could be performed in the pharmacy and then the medicine given or not depending on the result – a real-world difference in patient care, shifting us from merely ‘accurate’ to ‘safe and effective’ dispensing of medicines.

The NPA’s recently published vision, Making Changes Meeting Needs addresses this theme. We are ambitious to develop the sector much further as a clinical care and safe medicines supply service, in ways that will cost effectively benefit patients, the public and the NHS.

 

Nick Kaye is chair of the NPA

 

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