This is the second part of our exclusive interview with Matt Barclay, you can read part 1 here
How can we deliver pharmaceutical care with growing prescription volume?
It’s encouraging that the Prescription for Excellence (PfE), Workforce and Technology group, are currently taking applications to fund work into investigating the potential benefits of various types of technology including robotics and end-to-end scanning. There is no doubt that the answer to the volume issue lies in technology of some form, which the PfE workstream with evaluate, and development of the pharmacy team themselves. These two areas can support efficient and safe delivery of pharmaceutical care services.
However, I do see the volume as being a positive, as it is a conduit to pharmaceutical care interventions. Without the supply function through the pharmacy network, this value is lost, so this volume/supply must be retained by the network.
There is also the issue of what we deal with within the volume we have. It seems that monitored dosage systems have grown exponentially since they were introduced in the late 80s. Their benefit has a mixed evidence base at best, and it absorbs hours of pharmacy teams’ time in assembly and checking. Other solutions to support patients with complex medicine regimes have to be explored and resourced rather than the ‘catch all’ dosette solution.
This may be an area where pharmacy can provide a solution within the new health and social care partnerships and the integrated joint boards. Delivering care closer to home is a key policy objective and community pharmacy is well placed to support this.
What do we know about the progress of Prescription for Excellence?
The Workforce and Technology group has funding to support exploration of different ways of working and this is encouraging. This seems to be the main strand from the original work streams that is still forging ahead.
The new Chief Pharmaceutical Officer (CPO), Professor Rose Marie Parr, will have to ensure effective implementation of the Scottish Government policy on pharmaceutical care within the community. It is my understanding that a refreshed document is due, and there is a new project management structure in place to support development and delivery. I certainly know Community Pharmacy Scotland (CPS) has been engaged more recently, and we are only too happy to help shape solutions with other colleagues from all sectors to support effective delivery of pharmaceutical care services, which will be required within the NHS of the future.
Do we have a problem with sharing pharmacy developments in Scotland?
I think we can beat ourselves up about this occasionally, but actually Scotland has a good track record in implementing local initiatives nationally. Smoking cessation and emergency hormonal contraception provision are two good examples of this, and the latter in particular could be developed further still, as I know of good practice in some areas which could be used.
Another example through the recent out of hours submission that we are attempting to scale up is the patient group directions (PGDs) around urinary tract infections (UTIs) and impetigo. These have been trialled in a few health boards through community pharmacy with some reasonable evidence of success.
I do think in the new age of integrated health and social care services we need to get even smarter in sharing successful services that make a difference; we can always be better at sharing. With integrated budgets, the opportunities may be there to develop innovative, new models of care to support patients.
We’ve got a new CPO, how has that changed the dynamics of pharmacy in Scotland?
I think the new CPO has brought a freshness to the role and is clearly passionate about the future of the profession. She is also highly respected and brings a lot of goodwill into the role with her. While I witnessed collaboration to a degree previously in my role, recent collaboration for example with the out of hours submission between the Directors of Pharmacy, Royal Pharmaceutical Society (RPS) and CPS was supported by the CPO. This was a first, at a national level, for pharmacy and is hopefully a sign of things to come when it is appropriate.
What are the working dynamics like with the RPS?
Very positive in Scotland. While CPS and RPS are membership bodies with different support needs there is a lot of overlap. The two executive teams of the organisations now have biannual meetings to inform each other of developments. The unified out of hours response and our recently published manifestos (while having some differences) had commonality within them. It seems right that when it benefits our respective memberships then we pull together in a unified manner. Pharmacy advocacy is also something we do separately but with many overlapping messages.
What about pharmacy organisations in England?
In areas which are reserved to Westminster, CPS works with pharmacy stakeholders where necessary. Pulling understanding and know-how together where appropriate is never a bad thing. Recent areas where are trying to develop collaborative approaches include the work on the Falsified Medicines Directive. We have good working relationships with our sister organisations in the devolved nations e.g. PSNC, CPW and CPNI. It is fascinating to hear the successes and challenges experienced by colleagues throughout the UK and how if differs (or not) from those that pharmacists experience in NHS Scotland.
Other areas such as the recent hub and spoke consultation and regulatory issues affect all areas of the UK and we will liaise with others to share knowledge and improve understanding.
Do you see prescribing as an important role for pharmacists in the future?
I am actually a qualified independent prescriber (IP) myself and converted to an IP from a supplementary prescriber (SP) around 10 years ago now. I ran a community pharmacy based hypertension clinic in collaboration with my local GP practice for around two years in the relatively early days. In that context it is difficult to for me not to say I see prescribing as important!
However, I’m still not sure where I see this sitting in a community pharmacy setting on a large scale. It can work (I know this from my own experience and having knowledge of other successful community pharmacy based prescribing clinics), but my experience was very ad-hoc and relied on me working with the local practice and driving development myself. The need, focus, support and resource for clinics has to be identified and then planned accordingly, this is where support for prescribers is needed.
The practice-based pharmacist model seems to have gained a momentum politically and professionally on both sides of the border and I absolutely see a role for those pharmacists and prescribing within that in areas such as polypharmacy. I would like to see this supported more in community pharmacy based practice as well.
How do you see the skill of pharmacist prescribers being best exploited and rewarded within the community pharmacy network?
There is always the potential for independent prescribers to work within frameworks to support patients in and out of hours. Another idea I would have liked to develop in practice (before I took up my national role) would have been how to identify interventions and prevent patients returning to GP practices when items are out of stock and there is a natural substitution possible as I mentioned earlier.
Many long term conditions have algorithms which can utilized within any pharmacists area of competence so that the pharmacist can find a solution once the diagnosis is confirmed and prevent unnecessary referrals to other professionals. Prescribers are ideally placed to act to the top of their license on this. This model would be a first step to the described professional relationship of the doctor diagnosing and the pharmacist then managing the long term condition thereafter.
I hear of good practices and pilots such as ‘teach and treat’ there is potential there for enhanced roles for prescribers in all settings within this.
What does the future hold for community pharmacy?
I’m an optimist and do believe wholeheartedly in the pharmacy profession and the community pharmacy network.
The policy landscape is changing – care closer to the patients home, care of the elderly are all mentioned in PfE and the Scottish Governments 20:20 Vision – but the opening is there for community pharmacy to support and fill these opportunities. It is difficult in the world of community pharmacy to look outside when it seems we have so much to deal with as it is, but we mustn’t stand still and we must look up and out. We must explore new technologies, new ways of working so that we can lead as part of the solution to support the health and social care needs of the population now and in the future.
There will be no new magical pots of money within the current budgetary constraints facing any political administration. With this in mind developing a sound evidence base for community pharmacy services both existing and new is crucial in my opinion.
Having pharmacy advocacy as part of my role, engaging with politicians and other stakeholders, is made so much easier with a firm evidence base rather than anecdote or a wish list. Capturing this evidence base is up to everyone involved in community pharmacy practice, whether that be the pharmacy teams themselves or health board colleagues who support practice within their areas.
Community pharmacy, I firmly believe, is a big part of any solution.
If we met at a conference and were not allowed to talk about pharmacy or the weather, what topic would you choose?
Probably sport would be my first default topic, particularly football. Anyone that follows my twitter account will probably see that I don’t drop much from my personal life in but my love for football does make it occasionally. I am also a qualified football referee so I am also used to criticism and abuse!