I remember in early 2005, when I was still in first year at university, the new community pharmacy contract was announced. We were told that it was an exciting time to be a pharmacist – and we were excited! With the introduction of advanced and enhanced services those working in the community pharmacy sector would get a chance to utilise their clinical skills and knowledge developed at university.
In that year, the biggest change was the introduction of medicines use reviews (MURs). Now we are seeing them phased out of existence. What was once lauded for making community pharmacy more clinical has unfortunately become pharmacists' byword for pressure. The number of MURs carried out slowly became another target to reach, much like the number of items dispensed.
So it’s probably not surprising the service has been shelved. That being said, it did bring an incentive for a premises refit to install consultation rooms, which was a much needed addition to make the community pharmacy a real clinical environment. Prescription intervention MURs in particular were useful for patients and they will likely be missed.
I remember having a chat with another pharmacist once, who asked: "Would you deny a patient a conversation to help them with their medication if you weren’t being paid for it?" I answered "no", but the other pharmacist seemed less certain – they were adamant that a pharmacist should be paid for their time. Without MURs, will we be able to continue to sit down with a patient and have that important conversation?
Structured medicines reviews are now to be carried out by ‘clinical’ pharmacists in GP practices. Perhaps they are best placed to conduct a review, as they have access to patients' full medical record and can make changes there and then. However, one of the key strengths of community pharmacy is the amount of patients we see, and therefore the number of interventions that could be made. I also can’t help wondering if community pharmacists and GP pharmacists are now competing for services.
The Community Pharmacist Consultation Service (CPCS), which replaces the Digital Minor Illness Referral Service and the NHS Urgent Medicine Supply Advanced Service, provides opportunities to support patients without going to the GP. We also have a few extra services thrown our way supporting primary care networks (PCNs). There’s not much detail yet, but I’m hopeful the CPCS will integrate community pharmacy with the rest of the PCN, so that we can demonstrate what we can offer.
While these changes are exciting, there’s a huge elephant in the room and I can’t help feeling uneasy. The continued underinvestment in community pharmacy will continue to make staffing pharmacies difficult, putting more pressure on existing teams. If we weren’t already doing more with less, with these new services we certainly will be.
I remember speaking to a former pharmacy minister about the stresses we were facing, caused by the funding cuts. He tried to assure me that the government’s main focus had been to get pharmacists out of the dispensary. He asked: "Isn’t that you want?" I wonder, with one less body in the dispensary, will there be enough staff to ensure dispensing can still be done?
With all this in mind, and thinking of the university students of today, would you still tell them that it’s an exciting time to be a community pharmacist?
Nahim Khan is a GP pharmacist in Warrington, a lecturer at the University of Chester and a relief pharmacist for Boots
The views expressed in this article are Mr Khan's and do not necessarily represent those of his employers.