Pharmacists have been bombarded with "visions" for the sector over recent years, but even the most jaded raised an eyebrow at the Scottish government's Prescription For Excellence published last month.
In an ambitious 10-year plan, the government called for all pharmacists to become independent prescribers, taking on a greater clinical role across all settings, while technicians take on an increased dispensing role. Pharmacists could deliver more services in partnership with GPs, the government proposed, with patients building a relationship with a named pharmacist.
With its progressive action plan and government backing, it's easy to see why pharmacy representatives praised the document as "groundbreaking". This month, the Pharmacists' Defence Association (PDA) submitted a similar proposal to the English government, emphasising the need for an increased clinical role for pharmacists. So should England be looking to follow Scotland's example?
Bring out the best
For many pharmacists, the Scottish plan is an opportunity to expand their role by cementing their clinical ambitions. "The general view is positive in terms of a more enhanced clinical role [and a] better relationship with patients," says pharmacist Stephen Riley, a member of the PDA steering group that suggested many of the recommendations that appear in the Scottish vision. Offering an expanded range of clinical roles for pharmacists to pick from could "instil a better form of career progression", which Mr Riley says is "lacking in the community sector".
And Independent Pharmacy Federation chair Fin McCaul is unequivocally supportive of the Scottish government's plan. "We're delighted to see a plan that promotes the best of community pharmacy and has been signed off by a minister," he says.
Mr McCaul particularly singles out for praise the Scottish "commitment to the prescribing role": a major component of the vision is the plan to make every pharmacist an NHS-accredited independent prescriber by 2023.
Empowering each pharmacist with prescriber status is one way to bypass the bureaucracy of the current health system, says Pharmacy Voice chief executive Rob Darracott. "A step change in the use of independent prescribing skills would not only simplify things for patients and reduce red tape, but enhance care through better use of pharmacists' skills around medicines use," he says.
But, while the government's ambition is to be applauded, there are worries about how the initiative would be implemented. "I'd be concerned if every pharmacist who graduated became a prescriber from day one, because I don't know whether they'd have the experience," says Mr Riley. "When you do a prescribing course, you have to spend time with a GP or another prescriber, and I don't think you'd have the opportunity to pick up that experience as a graduate."
Encouraging patients to register with a named pharmacist is another key objective, but one that could cause friction with the larger multiples. Cormac Tobin, managing director of Lloydspharmacy's parent company Celesio UK, criticised this proposal at the Pharmacy Show in September, labelling it the "wrong move" that would prevent patients from deciding where they received their care. It was "not acceptable" to take away a patient's freedom to choose when and who they go to, he said.
Mr Tobin's reaction wasn't a surprise for Aniruddh Patel, owner of Savages Pharmacy in Burnham-on-Crouch, Essex. "I can see why the corporates are worried, because they won't have the flexibility of moving their pharmacists wherever they feel like," he says. "As an independent contractor, I'm all for it."
Mr Riley feels Mr Tobin's concerns are unjustified. "I've not seen anything in the document that says the patient has to register with a pharmacist for life," he says. He gives the example of GP practices, where patients are free to register with another practitioner in their area if they feel they will provide a better service.
"You can't run a patient-facing system and services like long-term condition management on an ad-hoc basis," Mr Riley says. "People like to see the same practitioner and build a rapport with them. I can't see how it's going to restrict people."
Devil in the detail
The debate over named pharmacists is one example of the lukewarm reaction the Scottish government's proposals received from the multiples. At the Pharmacy Show, representatives of Boots and Rowlands voiced cautious support for the principles of the Scottish vision, but said they were waiting for more information about how they would be implemented.
This hesitancy was reflected by some C+D readers, with 29 per cent of 82 pharmacists who responded to a C+D poll this month saying they were unsure whether the Scottish plans should be adopted in England until they heard more details.
NHS Lambeth clinical network lead Ash Soni says that the destination may be right, but his concern is also how pharmacy gets there. "If we were to do this in England, you'd be looking at a planned programme." This would involve setting out the specific training pharmacists would need to attain over the coming years so they would be ready to embrace an expanded clinical role, he says.
The PDA's road map for England has already called for the English government to follow its Scottish counterpart. The document sets out proposals for pharmacists wishing to take on a greater clinical role to become independent prescribers, seeing their patients on an appointment basis.
These "clinic" pharmacists would focus on patients with long-term conditions, while their "patient-facing" colleagues would deal with those who walk in without an appointment, treating minor ailments under a nationally commissioned scheme.
Mr Patel sees the PDA's report as "a real curveball that could enlighten many and scare many at the same time". But it faces the same problem as the Scottish vision: a lack of detail about how the changes would be implemented in practice. "I'd like to see some more information," says Mr Patel. "Hopefully it will develop into something concrete and we can actually say ‘this is what you need to do'."
For Mr McCaul, though – like the two-thirds of C+D readers who want England to follow Scotland's lead – concerns about implementation are less important than the ultimate goals in the Scottish government's sight. "There are some challenges with the proposals," he concedes, "but these are minimal in the context of the overall direction of travel. We applaud the Scottish team and look forward to seeing what we can learn from this in England."