The expression "designed to fail" could have been invented for the Department of Health, as the announcement of the Pharmacy Urgent Care pilot last month demonstrated how differently clinicians and politicians view services.
A clinician sees a new local service that improves patient care and outcomes, and works to spread the learning and improved practice nationwide. A politician sees a new local service that improves patient care and outcomes, such as a minor ailments scheme or a CCG-funded emergency supply scheme, and instigates a committee to design a poorer version of what already works so well.
It’s a fact of life that patients run out of their repeat medication. Their pharmacy can make an emergency "supply", but in reality this is an emergency “sale” – as the patient pays the cost of the drugs, and asking payment for expensive drugs like rivaroxaban or a combination inhaler just isn’t practical.
The only answer is to “loan” drugs against a future prescription, which is neither satisfactory nor legal, for the patient to call 111, where it costs the NHS £100 to write an out-of-hours prescription.
So our CCG, like many, recognised that a local service to reimburse the drug cost and pay the pharmacist a service fee is more cost-effective, improves patient care and encourages medicines adherence. Importantly, there are no restrictions on access into the service, because most patients come to their 'pharmacy first' thanks to all those campaigns.
But what do we get offered by the Department of Health (DH)? A pilot, for a service that already has proof of concept from all over the country, and a requirement to refer all patients first to 111, so that a call handler can then refer them back to me. That's going to work great at 5.30pm.
Yes, the pharmacy flu service started as a trial a few years ago and now seems embedded, so maybe I'm just impatient. But it’s so frustrating that we have to go through this rigmarole for basic stuff, when the real sustainability and transformation for the NHS and patients is for pharmacies to handle long-term conditions.
The Royal Pharmaceutical Society has absolutely got it right. When our hypertensive or diabetic patients need another prescription, why do they need to go back to their surgery? Medication reviews – we’re already doing them, and it wouldn’t take much for medicines use reviews to be added to the patient record via PharmOutcomes or write-access on the summary care record.
Blood pressure or serum glucose checks are easily within the capability of a trained healthcare assistant, and an increasing number of pharmacists are graduating with the prescribing qualification, so will be able to titrate the dose.
This is the direction we must travel, with benefits for patients, the NHS, and for pharmacy. So instead of designing to fail, we cannot let the DH fail to design this service.