A Pharmacy in Practice exclusive interview with newly elected SNP Member of the Scottish Parliament, pharmacist, Maree Todd
When the returning officer announced you had won, how did you feel?
I wasn’t ever sure I’d win, but I was reasonably hopeful. I was standing as an SNP list MSP and I was first on the list. In 2011 in Highlands & Islands we won 6 constituencies and still had a high enough share of the vote to win 3 list MSPs as well.
But, on the night there was a good few hours where I thought, “this just isn’t going to happen”, because of the news coming from other parts of the country. Even though we had a very high share of the vote, we weren’t getting so many list MSPs returned. In the end there were only four in the whole country, and I was one.
I was just delighted when the results came through. It’s a huge privilege and great opportunity. I’d worked really hard and I was delighted for all of the teams who had campaigned with me – all their hard work had paid off too.
Will your pharmacy experience and knowledge be useful as a politician?
I think it will, but I would take more broad view. The simple fact of having a scientist as a politician is probably a good thing and I think having health professionals as politicians is a good thing: the professionalism, ethics, integrity, and honesty that comes with being a professional is a useful thing in politics.
I think as a pharmacist, I am conscious of the recognition our profession gets. People don’t know we’re here as part of the health professional scene, so I think the simple fact of me being in parliament and talking about it will help raise the profile of the profession. I always think that we’re a little bit invisible, despite the fact we are the third largest workforce of health professionals.
I’ve worked in mental health for 20 years and I’m absolutely sure my experience in mental health will be useful to me, as it is a high-profile issue for this parliament.
Will you miss your role as a pharmacist?
Yes, definitely, I was really sad to leave. I took 3 months’ unpaid leave to campaign, and gave one month’s notice and didn’t return to work. I’d worked in the same hospital for 20 years and in mental health people’s illnesses don’t go away, so you build up a relationship over that whole course of time.
It felt like a real grieving process when I finished up, as my boss has been like a professional mentor to me as well as a friend. I went there as a very young pharmacist, very newly qualified, and developed hugely professionally and personally so it felt like leaving home.
Do you have any main objectives as an MSP?
I would like the Highlands and Islands to flourish as we have some particular challenges up here in terms of demographics.
A lot of young people leave the area and older people come in, so it just makes life difficult in communities, and it’s a challenge for our health service.
I’d like to try to get things going economically so that young people have the opportunity to stay. I’m not going to manage that on my own, we are all going to have to work together and we’ve already started.
I think that being a health professional and working in a multidisciplinary team will help, we need to pull together all of the MSPs and work with the MPs as well, so we can try to work out priorities to make sure we can actually achieve some things in the term of my office.
When was the last time you spent some significant time in a community pharmacy?
It was 12 years ago.
Did you read the Community Pharmacy Scotland (CPS) and Royal Pharmaceutical Society (RPS) manifestos before the election?
I did, but in amongst everything else I read, so I’m not sure I can remember it all. I read them as I was interested as a pharmacist.
I know that both CPS and RPS were represented at conference, and I made sure I met them and a lot of my SNP colleagues met them as well, so I think being at conference is a really good idea for the profession.
A multiple pharmacy chain also recently got in touch with me and invited me to visit one of their stores to find out what they do, so there is definitely an outreach from the profession to politicians, which I think is very useful.
Do you support the extension of the Minor Ailment Service?
It’s not something I know very much about. I chatted to my local community pharmacist, and I’m not sure how many people require access that don’t already get it, so I’m not sure how necessary an extension is.
But, I absolutely think that consulting your community pharmacist first should be more the norm, if that’s what they are trying to achieve by extending the minor ailments scheme, then yes I would support that.
I know there are prescriptions that undoubtedly could have been dealt with by a community pharmacist rather than take up GPs’ time.
What about access to the emergency care summary or patient records?
It’s absolutely essential. I worked as an NHS Education for Scotland (NES) postgraduate tutor for a while and coming from hospital, I just cannot understand how community pharmacists work blind with their hands tied behind their backs. It’s just ridiculous that they don’t have access to that and more.
Is that something you can influence?
I certainly will. We don’t know what committees we are on yet, but there will be more opportunity for me to do that if I am on the health committee, which I’m hopeful of, but absolutely, whatever I can do to try to improve that. [A day after we spoke to Maree it was announced that she had in fact been appointed to the Scottish Parliament’s Health and Sport Committee].
Are there any services that should be introduced into community pharmacy as a priority?
I know that in some parts of the country we treat UTIs in community pharmacy and that seems very sensible; a common, simple infection that needs treated with antibiotics. It’s well within our professional remit and provides increased access, so that would seem obvious.
Pharmacists are really good at providing evidence-based care and there are some easy areas we could go into to improve care and access.
In my own role I had just completed a prescribing course and was going to see out-patients treated for anxiety, with the aim of improving quality of prescribing and increasing access to specialist care. I think the same applies to community pharmacy, where we can improve the quality of prescribing, and make it easier for people to get access.
Can GP practice pharmacist roles be performed in community pharmacies?
There is a technical issue here, as pharmacist prescribers needs a prescription pad, which has to be linked to a GP practice. Why they have to be affiliated I’m not sure, perhaps it’s to do with costs and audit. But that makes it difficult to prescribe in community pharmacy, as pharmacists will be prescribing for many patients from different practices.
I think community pharmacists could do all of the GP practice pharmacist roles. For my mental health pharmacist role, where people are quite hard to reach and don’t often come along to appointments as they have slightly chaotic lives, being in community pharmacy would be a great thing.
I think we have to look at that and try to make that happen, but as ever, there are barriers.
What changes need to be made in community pharmacy to allow it to fulfil its potential?
There needs to be access to records, pharmacists need to be linked in with the rest of team and be able to give professional advice based on the full picture.
I think the public perception of pharmacy is a challenge, and I think our profession needs to do a little bit more about that.
I look at what has happened in hospital pharmacy and they have very much moved away from the supply side of things to the clinical side, and I think that really needs to happen in community pharmacy as well. In almost all jobs (not just healthcare) there is a move to humans doing things only they can do, things that add value.
It will happen that we end up with automated dispensing, community pharmacists will be doing face-to-face activities that can’t be done by a machine.
In hospital, one of the things that transformed the profession was the professionalisation of support staff, and in community at the moment there aren’t recommended numbers of staff. I think that might be a useful way to release pharmacists from the dispensary, by ensuring they have backup from an appropriate number of qualified staff.
For example, our pharmacy technicians in hospital are doing what I would have started off doing as a basic grade pharmacist. Technicians also do all the dispensing and the clinical check happens remotely, and some are clinically trained in medicines reconciliation.
What can be done to make the transition from secondary care to primary care smoother for patients?
We work through a process of medicines reconciliation – it’s quite shocking how many errors there are on discharge and how easy it is to prevent those errors.
I think the process of medicines reconciliation at the interface is really important, but there are a lot of IT challenges which have made it difficult. We’ve had e-discharge letters for about a decade, but loads of GP practices in Highland don’t accept that and we still have to post or fax them.
Would it be useful to send the discharge prescription straight to the pharmacy?
Absolutely, and certainly in psychiatry we think that closer links with community pharmacy would be a really good thing.
We have ad hoc links when patients use compliance aids, or when they are on drugs we think might be difficult to obtain, but there’s not a routine way to get in touch with community pharmacists.
There are confidentiality issues here, as we have to check with patients to make sure it’s OK for us to contact the pharmacy, but for me that should all be automated, they should have a community pharmacy that they register with and use that all the time.
How can use of technology enhance patient care in community pharmacy?
Access to records is a huge barrier, so we need to sort that. Things like care home visits could also be carried out. Here in Highland and Islands, a primary care pharmacist is piloting the use of telemedicine to give advice to homes remotely. Technology is useful in remote areas, as you can provide professional advice without having to travel.
Technology also means that people who might traditionally have been in hospital can now be looked after in the community. I’m sure there is a role for pharmacists in that, ensuring medicines are being taken properly, but they don’t necessarily have to be in the same place as the patient. The difficulty with IT is we don’t want to replace the personal contact, but we can have a carer on the ground and IT links to a professional.
What are your thoughts about dispensing hubs?
I know that it’s going to damage the profession, but I think it’s inevitable with the way technology is going. I think the profession needs to realise that we have to focus on things that warehouses can’t do.
One of the reason I got involved with NHS says Yes campaign [a campaign by NHS staff to encourage a Yes vote in the Scottish independence referendum], is that I believe that what is happening down south, even though it’s a completely different service, is such a huge market that it is a threat to us in Scotland. It will be very hard us to be very different from what happens in England and Wales.
What about the expected oversupply of pharmacists?
Well, there’s definitely not an oversupply in the Highlands and Islands — that’d be great. I think we have to keep an eye on that, but we also have to keep an eye on the expanding roles as well, there are loads of things pharmacists can do to plug some of the gaps that are appearing in primary care, some roles that GPs traditionally did and some roles in mental health that psychiatrists do will be done by pharmacists.
If we keep developing the profession and moving into new roles we won’t have to worry about the extra workforce.
Is there a problem with professional autonomy in community pharmacy?
It’s difficult to say, as I’ve not worked in community pharmacy for so long. At the time I worked there, I knew very well I was a health professional, so when I was asked to do things such as link selling, I just said “no, I’m not doing that”.
I think there are always tensions there, but it’s up to professionals to remember they are a professional and put that first. If pharmacists felt they had to move their focus from their other professional duties and focus on targets, then that’s not appropriate.
Are you a member of the RPS Faculty?
No, I’m not a member. I think it’s slightly early days, but the Faculty is a good thing.
When I compare our profession to the medical profession, there is no clear pathway, but that’s something we really need. I certainly felt that as a hospital pharmacist specialising in mental health, that while there were things I could do and organisations I could join, it contrasted with my medical colleagues who had an absolutely clear training pathway for them. I think we need to be a lot better at that in our own profession.
Should pharmacy technicians be allowed to become members of the RPS?
Yes, I don’t see why not. They are registered professionals. Our technicians are unbelievably professional. There would be a cost issue for them, so they would need to consider what value it added for them.
What would Scottish independence mean for the NHS, patients and pharmacy?
I think that the Scottish NHS is like an advert for independence. Look at what we can do when we do things differently.
From the moment we got our own parliament we steered off in quite a different direction. Back in late ’90s both countries started to introduce competition and the marketization of the NHS. As soon as we go our own parliament we stopped all of that and went back to a universal service and a joined up approach, not the fragmentation that happened down south.
It sounds like a good idea to have different health boards in competition with each other, but communication is key to good healthcare, so fragmentation is a bad thing.
In Scotland we’ve got free prescriptions, so we are back to first principles of the NHS, we’ve got free parking in hospitals, we’ve taken a different direction with public health and we introduced the smoking ban sooner for example.
Working in psychiatry I think the minimum pricing of alcohol pricing policy is really useful, and it will be one of many very useful strategies we use to weaken that damaging relationship that we in Scotland have with alcohol, so I think it’s allowed us a freedom.
Isn’t it horrific that health inequality is described by the Glasgow effect all over Europe, so our country is known for its health inequality? If we had independence, we absolutely would have all the tools at our disposal to tackle health inequality, as it’s not really about health it’s all about wealth.
What are you looking forward to most about being an MSP?
I’m enjoying it all so far, it’s a really steep learning curve, and it’s different from everything I’ve done before, but there are opportunities to make a difference. Most of us become health professionals as we want to make a difference and this is very similar.
The chance to get amongst the many issues and challenges we face is fantastic and there is a real opportunity to make a difference in people’s lives.
Maree Todd is the SNP MSP for Highlands and Islands and an independent prescriber pharmacist specialising in mental health. She spoke to Ross Ferguson