Like world peace, who could disagree with PSNC's five-point plan announced this week? Well, I can agree with four of the goals for new services out of five – minor ailments, long-term conditions, support for frail and older people, and the diagnosis of respiratory disease. These are key public health challenges facing the NHS. They remain challenges because they are not properly managed; yet they could be, with effective application of pharmacists' skills.
The frail and the elderly and long-term conditions – particularly respiratory disease – are significant factors in frequent hospitalisation. Minor ailments are also a major drain on resources. We’ve been talking about this one for so long that we all know the facts – a large chunk of GPs’ valuable time is taken up with common minor conditions, without counting those who roll up at A&E seeking help with trivial, inconsequential complaints. This makes a pharmacy minor ailments scheme a must-commission service.
Scotland, of course, has an impressive national minor ailments scheme. Northern Ireland had the makings of one but sadly it was, in the view of the government, abused and so drastically diminished with many products deleted from the formulary. Despite this government myopia, what was clear was the potential of the scheme to divert patients from GPs towards pharmacy. This is important because it could, for example, reduce overuse of antibiotics for management of upper respiratory tract infections. So there could be many positive outcomes.
Minor ailments aside, what is less clear from the five-point plan is what these other national pharmacy services might look like, how they will be integrated with GPs and secondary care services and how they will be monitored. Commissioning a service requires that vision; a specific health need is identified, a service specification created to address that need, a service level agreement designed to support outcome monitoring and recurrent funding made available. Unless all these steps are followed, the good idea remains, well, just a good idea.
Where I disagree with PSNC is in its bid for a commissioned service that gives pharmacists more power to supply urgent medicines. This is not a service need – rather a need to modernise an archaic system that relies on paper-based prescriptions.
Instead of this, I would like to see a commissioned ‘disease prevention service’. Healthy living pharmacies offered great hope to provide this at a local level but a commissioned service failed to materialise. I believe we need one nationally that supports brief interventions on four key areas: smoking, nutrition, exercise and stress, with signposting to appropriate services such as stop smoking. This would have enormous benefits for the public, the profession and the NHS.
Terry Maguire is a community pharmacist in Northern Ireland with 30 years' experience. He is recognised as a pioneer in the development of pharmacy services in the UK and beyond, having developed a model service for pharmacists in screening for raised cholesterol in the 1980s, and a smoking cessation programme in the early 1990s