Starting a new job is always daunting. But when your predecessor held the post for 22 years, you’d be forgiven for feeling more daunted than usual. When Rose Marie Parr was announced as the successor to Bill Scott in the role of Scotland's chief pharmaceutical officer, she was aware that the task ahead of her was huge.
Not only did Dr Parr have to maintain Scotland’s reputation as a pharmacy innovator – taking responsibility for pharmaceutical care in Scotland and shaping policy in primary and secondary care – but she also had the challenge of putting her own stamp on a job that was shaped for so long by someone else.
Scotland's first female chief pharmaceutical officer tells C+D that, when taking on the post, she was “acutely aware” that Scott held the role for almost a quarter of a century and left behind a “great legacy in pharmacy”. Dr Parr says she was “both humbled and pleased” at the appointment and passionate about improving pharmaceutical care for the people of Scotland.
Dr Parr’s CV shows she is more than a match for the demanding role. With more than 30 years of pharmacy experience, she has worked at NHS Education for Scotland since its inception in 2002 and is an honorary professor at Strathclyde and Robert Gordon universities.
Dr Parr’s strong background in education and training are certainly a plus considering the Scottish government's goal to turn the entire pharmacist workforce into independent prescribers. And, despite having only been in the role for 100 days, she is already making her mark – setting out five clear aims for her next 100 days.
A new chapter
The past year has been one of political significance in Scotland. The tides are turning towards ever more independence from the rest of the UK. Despite last September’s referendum voting against full independence, the landslide victory of the Scottish National Party (SNP) in May marked a new chapter in Scotland’s story.
Against this backdrop, Dr Parr is keen to establish pharmacy’s role with the new government. This brings her to her first goal: improving the way that pharmacy delivers pharmaceutical care to patients. “For us, it is about trying to support that GP model while being part of a multidisciplinary team,” she says. By taking a collaborative approach, Dr Parr believes pharmacy can help people live independently for longer. She is confident those in power will support these aims – the government is clear about where it wants to be and pharmacists can “usefully come behind and support that”.
Dr Parr’s optimism may be well-founded, if comments by health minister Shona Robison are anything to go by. In August, Ms Robison voiced plans to create ‘community health hubs’, in which pharmacists would work collaboratively with GPs to look after patients with acute conditions. It certainly shows an appetite for using pharmacists more widely – and Dr Parr says work has already begun to make this model a reality.
“We are trying to transform some of these new models and test them in primary care and community care as well,” Dr Parr explains. “We want to look at developing community health hubs and a model for patient care that might be quite different.” She stresses that it is about using the member of the healthcare team “with the most suitable skills” to help the patient.
Working in a multidisciplinary team is a running theme throughout Dr Parr’s vision, which ties in nicely with government plans to recruit 140 pharmacist prescribers into GP practices. For Dr Parr, this scheme underpins her aim for clinical pharmaceutical care of patients to come to the fore. “We want to see pharmacists working like this in the future with a more clinical basis,” she says.
The landslide victory of the Scottish National Party in May marked a new chapter in Scotland’s story
A ‘clear narrative’
It would be impossible to talk about this clinical focus without mentioning the Prescription for Excellence. The strategy document for Scottish pharmacy – a detailed vision of how the sector should progress by 2023 – was hailed as groundbreaking when published in September 2013. One of its most notable aims was to turn the entire pharmacist workforce into independent prescribers, and Dr Parr reveals 1,000 pharmacists have already been trained up. Arguably, this strategy sets Scotland apart from other parts of the UK – many of the ambitions detailed within the document are innovative, such as aim to establish the use of robotics in pharmacies.
Two years on and the document is still heavily influencing policy. Dr Parr explains that, when it arrived in the post, she “did a stocktake” of the Prescription for Excellence. She stands behind its aims, and feels they need reiterating. In fact, it is the driving force behind all of Dr Parr's five goals for the next 100 days, which she describes as a “refresh” of the document.
Her second aim – to improve the outcome and increase the safety of medicines use – is clearly based on the Prescription for Excellence. Although the objectives were touched on in the strategy document, she feels they needs to be set out more strongly.
“There is a lot of really good work already but there is a burden of harm for medication,” she tells C+D. “It is about how we make that patient safety journey easier and looking at drug therapy to achieve a better quality of life.” Dr Parr acknowledges that her patient-centred strategy is a “huge area” of work. “How do we make that clear to pharmacists and prioritise that model going forward?” she asks.
Clearly, she is keen to communicate the message as effectively as possible. Dr Parr rang up the Scottish health boards in her first month in the role – speaking to pharmacists and members of their teams about her aims to refresh the vision for pharmacy. “I have already communicated with pharmacists and most people think that it is a good thing to put patients at the centre,” she says. “We do owe everyone that clear narrative.”
Communication, communication, communication
This emphasis on communication leads on to Dr Parr’s third aim, and one that she is clearly passionate about: creating engagement with the profession. She is working with other chief pharmaceutical officers to discuss policy areas in pharmacy that “may be shared” and “taken forward across Great Britain”. “One example of this is the closer working with the chief pharmaceutical officers and other key stakeholders around the rebalancing work and future changes to the Medicines Act,” she says.
But it is clear that Dr Parr’s passion for communication isn’t limited to the corridors of power. “I am relishing going round Scotland speaking to pharmacists,” she says. She is focused on improving the lives of grassroots pharmacists – and this forms the basis of her fourth aim of “trying to articulate what the pharmacy profession and professionalism means”. Dr Parr is concerned that pharmacy perhaps lags behind other professions in communicating its professional status.
It’s certainly a topical issue – the General Pharmaceutical Council launched a consultation on what patient-centred professionalism means in April.
Improving the career pathway of pharmacists, she feels, falls under the same umbrella. And she believes there is room for improvement in this area. “The Prescription for Excellence is a strategy for patients but pharmacists also need to understand what their career pathway might be,” she stresses. This is a "big area" for her. "We can work with pharmacy schools and bring it more into mainstream education and training,” Dr Parr says.
“I am relishing going round Scotland speaking to pharmacists”
A reputation for innovation
On top of all of this, Dr Parr needs to ensure Scottish pharmacy doesn’t stand still – it has rightfully earned a reputation as an innovator over the past few years through its focus on services and the Prescription for Excellence.
Her fifth and final aim – to make better use of existing data to highlight how pharmacy can make a different to patient care – should hopefully keep up the pace of development. Dr Parr is also optimistic that technology can play its part in achieving new models of practice, and reveals there is pilot work being done to determine how technology and barcoding can help support the pharmacy workforce.
It all sounds promising. In fact, it seems the rest of the UK could learn from Scotland – so how has it managed to earn its pioneering status? Dr Parr says it is partly down to favourable circumstances. Scotland doesn’t necessarily have different ideas from the rest of the NHS, she says – citing the example of plans for pharmacists to work from in GP surgeries in England, Wales and Northern Ireland. But its size has helped turn those ideas into a reality. “Scotland is a really good size and we know our community well,” she says. “We can do things more easily than some others can.”
“The main difference in Scotland is that we know our audience and we know what we spend on health,” she continues. “We know we have real issues around multimorbidity and there are links between obesity and levels of deprivation.”
Dr Parr certainly has her work cut out for her. She isn’t underestimating the task of chief pharmaceutical officer and would be happy if she could “pull together any of the five areas” in her next 100 days in office.
Scottish pharmacy may be leading the way but – as Dr Parr sums up – there is still “a lot of work to be done”. That is one thing all of the UK's chief pharmaceutical officers could agree on.