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Which way forward for pharmacy?

Pharmacist Mark Robinson learned a lot at the debate on how to address the Which? report on poor medicines advice in pharmacy. Personally he thinks the answers are very simple, and the GPhC knows it

The subject was a difficult one: considering ways to improve the performance of community pharmacy following May's Which? report revealing poor medicines advice. And the afternoon was certainly an interesting one; running a meeting together in this format was described as a first for the RPS and GPhC, but I hope it will be the first of many.

To kick off, it was interesting to hear the GPhC talk about its plans for the future: setting standards for pharmacy owners, a new inspection regimen and development of a new set of enforcement abilities.

This was followed by two presentations and a wide-ranging discussion with a veritable panel of experts covering topics from pharmacist education and MCA training to patient attitudes and P med self-selection.

And a facilitated workshop, run under the Chatham House rule with members of the press excluded, was an interesting experience. Each table came up with and submitted a set of objectives, which the GPhC and RPS took away with them. It was a peculiar way to end a meeting – no list of action points, objectives or responsibilities. I must say that I felt a little deflated, but I hope that they will be forthcoming.

The GPhC must speak up clearly and not be distracted by the current ‘its everyone's business' answer, followed by a raft of discussions and guidance and endless blathering

Personally, I think that the answers are very simple and the GPhC knows it: it is about patient perception, access to pharmacists, owner responsibility and a contract based on outcomes. It is the first time I have listened to the GPhC and I have to say I was impressed. But it must speak up clearly and not be distracted by the current ‘its everyone's business' answer, followed by a raft of discussions and guidance and endless blathering until Which? repeats its research and shows again that nothing much has changed.

Patient perception is very important in this respect. I was encouraged by the confirmation Which? provided that people feel that they get good service and information from a pharmacist and that the public wants better access to pharmacists. We have a right to feel proud of the work that we do to support patients, sometimes against the odds.

The public are clearly very supportive, but we must ensure that their voice is heard. We are British after all, and we're told that we as patients are not as challenging, questioning and perhaps not as knowledgeable as our American or European counterparts. Do we believe that medicines are sweeties or commodities? Have we lost our respect for them? The public has to build up its knowledge and capability to use medicines to their best effect and it is important that we work with them to achieve this.

With regards to GPhC standards, it's clear that contractors are the key to the solution. The pharmacy contract must be changed to provide a focus on patient outcomes, perhaps with an element parallel to the quality and outcomes framework (QOF) that has been so successful in general practice. Everyone knows that community pharmacy, like general practice, is a business and contractors will, generally, do everything that is possible to secure maximum income.

GPs have proven this concept over several years, but I understand their is an issue about deciding on measurable patient outcomes. The QOF is supposed to be based on structure – process – outcome, but, for many areas, it simply reflects structure and process, while outcomes are assumed. Whatever community pharmacy QOF requires – be it training, feedback, patient contact, HLP, service delivery, whatever – pharmacy owners will organise it and pharmacists will find they are supported to deliver it. Be sure that it will all filter back to universities and training providers in super-quick time.

So, as I see it, there are two potential solutions to the issues raised by Which?. The first is for NHS England to create a QOF for community pharmacy. I believe this would be relatively simple to put together, it doesn't really matter what is in the first one because it's bound to change every year; stretched and tightened to support increased delivery and improved patient outcomes. The real job is to get the assorted pharmacy bodies aligned and singing from the same hymn sheet.

The second solution lies in the hands of Public Health England and the local authorities. This would require a drive from patient groups, through whom we must educate the public and encourage them to ask for advice.

Mark Robinson is a pharmacist and director of consultancy Medicines Management Partnership

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