Community pharmacy seems to have had more than its fair share of knock backs lately, given the essential advisory, medicines supply and clinical triage roles that pharmacists and their teams provide to patients and the public.
Last year’s funding cuts resulted in 79% of contractors in England seeing their income fall, and more recently we saw community pharmacists apparently excluded from involvement in the group advising Jeremy Hunt on a strategy to reduce medication errors. In addition, the report of the advisory group omitted any opportunities to utilise community pharmacists in tackling errors.
So what is the government missing out on when it fails to consult with community pharmacists on policy matters, such as the reduction in medication errors?
Twenty-five years practising as a community pharmacist gave me first-hand experience of the important role that the sector provides in medicines safety. More than one billion prescription items are dispensed in community pharmacies every year and the research report that informed Mr Hunt's strategy estimated that there are 66 million potentially clinically significant errors per year, 71% occurring in primary care. Prescribing in primary care is estimated to account for 33.9% of all potentially clinically significant errors.
Community pharmacists already intervene to prevent many prescribing errors. The availability of additional information, such as access to the summary care record, will have increased that opportunity. Mr Hunt’s measure to allow hospitals to access GP prescribing data will allow retrospective analysis of likely contributory causes to harm – though causation may be difficult to determine – but fails to address early prevention of errors.
Community pharmacists could enhance their safety role by formal engagement in identification of risky prescribing in vulnerable groups; for example, regular use of non-steroidal anti-inflammatory drugs without protective proton pump inhibitor cover and in patients at risk of acute kidney injury. Enabling a more formal referral of concerns to GPs by community pharmacists would enable data to be captured and harm to be prevented. Where GP surgeries have a practice pharmacist, community pharmacists would be able to work with them to raise concerns. This would be a good investment of resource in my opinion.
The research report found that prescribing and monitoring errors are most likely to have the potential to lead to moderate and severe harm respectively. Community pharmacists could be involved in checking that patients have had the required test within the necessary timeframe for a defined list of high risk medicines. Again, a good investment of resource.
Deploying community pharmacists to reduce medication errors is a no brainer, as they are perfectly positioned to intervene at the point of supply, when an error has slipped through and before it reaches the patient. As readily accessible medicines healthcare professionals, why wouldn’t you utilise their expertise?
Cathy Cooke is a former community pharmacist