The big interview — Scottish Cabinet Secretary, Shona Robison MSP

Shona Robison MSP, Cabinet Secretary for Health and Sport, Scottish Government

 

The NHS is facing significant challenges, how important is the community pharmacy network in helping to address these issues, and how can we make better use of community pharmacies and the skills and knowledge of community pharmacists?
Community pharmacy remains and will continue to be an important part of healthcare provision in Scotland. Over the coming weeks, the Scottish Government intends to publish a ‘next steps’ document which will update the priorities flowing from the activity to date around Prescription for Excellence and set in the current context of transforming primary care, the National Clinical Strategy and Realising Realistic Medicine.

As a profession who are experts in the use of medicines, this is central to the pharmacist’s clinical input to the prescribing process.

The CMO’s first report, Realistic Medicine, puts the person receiving health and care at the centre of decision-making and creates a personalised approach to their care. Its aim of reducing harm and waste and simplifying care while managing risks and innovating to improve are essential to a well-functioning and sustainable NHS.

We see community pharmacists as having a central role in delivering these objectives by helping patients make better use of medicines. The Chronic Medication Service allows community pharmacists to help patients make better use of their medicines in order to achieve the best clinical outcome and assist patients to self-manage their healthcare.

NHS Scotland is recruiting pharmacists into GP practices. Can you see community pharmacists also doing the same roles, but from within their communities?
Our Programme for Government continues with our commitment to a 3 year programme of recruiting 140 pharmacists with advanced clinical skills training to work in GP practices across Scotland. NHS Boards have flexibility to determine how they deliver this, including sessional input from community pharmacists.

I believe it is important that Boards are given the flexibility to put arrangements in place that best meet their local needs. Over the lifetime of the current Parliament all GP practices in Scotland will have access to a pharmacist with these skills.

Are there any plans in place for pharmacy workforce planning?
NHS Boards are responsible for workforce development and planning for their pharmacy staff in the managed service. In the community sector, community pharmacy contractors are independent contractors. As employers they are therefore responsible for ensuring that they have the right number and skill mix of staff in their pharmacy to meet the demands of their business and, importantly, to deliver the range of NHS Services offered safely and effectively.

We will be publishing a national workforce plan shortly which will set out how we improve planning across health and social care, including the contribution of independent contractors.


Pharmacy students have indicated that they want a modular pre-registration year with experience in all sectors of pharmacy. There are some places available in some health boards, but not many – are there any plans to roll this out?
In response to the vision for pharmaceutical care in Scotland, Programme for Government commitments and current and future workforce developments, the Scottish Government established an Advisory Group to explore the evolution of the existing pharmacist four-year undergraduate degree and the one-year pre-registration (4+1) training scheme into an integrated five-year programme to support the initial education of pharmacists in Scotland.

The Advisory Group has undertaken an initial scoping exercise engaging with stakeholders including the NHS and staff and students at the two Scottish Schools of Pharmacy and considering evidence from a range of sources.

The report Five-Year Integrated Initial Education Programme for Pharmacists in Scotland: Publication of Scoping Report published on 5th May provides recommendations for the next steps towards implementation of a new five-year programme. I welcome this report which provides a real opportunity to better prepare our new pharmacists by ensuring they are able to practice in the evolving NHS Scotland health and social care landscape.

Community pharmacists, unlike GPs, don’t get protected learning time. Does that need to change?
In addition to initial education, ongoing continuous professional development (CPD) enables pharmacists and pharmacy technicians to demonstrate that they keep their knowledge and skills up to date in order to maintain and improve their practice.

Building on the experience of Protected Learning Time (PLT) in GP practices, some NHS Boards are developing similar approaches for community pharmacy. This is normally done on a locality basis for themed training topics. The NHS Board covers locum fees while a pharmacist and a member of staff attend the training sessions.

There is still a long way to go as PLT can be a particular challenge to deliver in community pharmacy due to both contractual and commercial factors. However, changes to pharmacy supervision requirements may assist in taking this forward.

Should health literacy be included in Curriculum for Excellence?
I know that the Royal Pharmaceutical Society (RPS) included a specific reference to health literacy in their 2016 manifesto. I agree that it’s very important to build a positive relationship between people and their healthcare practitioners from an early age.

We know how complex the health and care system can feel at times, so we’re currently refreshing our health literacy plans. This builds on the success of our world-leading Making it Easy action plan which we published in 2014, and sets our current goals in the context of how best to support the shift to shared decision-making as signalled in Realising Realistic Medicine.

I know that the RPS is aiming to hold an event on health literacy in the autumn. This will consider how improving health literacy can have a positive impact for pharmacists and people using pharmacy services. We need to get the ideas of how we build people’s knowledge, confidence, skills and understanding into education and training from as early a stage as possible to better support people to live well on their own terms with whatever health conditions they have.

What are your thoughts about the minor ailments scheme? Should it be expanded to cover a larger range of conditions, and are there any plans to publicise the concept of “Pharmacy First” to help relieve pressure on GPs and A&E departments?
A pilot to test an extended Minor Ailment Service (MAS) began at the end of January this year. The pilot involves the current MAS being extended to all patients registered with a GP practice in the Inverclyde area of the west of Scotland, and expanded to include treatments for the most common, uncomplicated conditions normally requiring a GP prescription. Importantly, the first line of intervention is to promote and support self-care when it is the case that this is the most appropriate course of action.

This year-long pilot is being evaluated locally throughout as part of the Inverclyde New Ways of Working programme of projects, with the overarching aim of exploring the impact of an extended MAS on increasing access to appropriate primary care. Any further development of the national service will be dependent on the evaluation findings and associated recommendations, which will report in due course.

The Pharmacy First approach in Forth Valley and Grampian, which focuses on opening up access to treatments such as uncomplicated UTIs and impetigo, is also being considered as part of the Transforming Urgent Care national implementation plan and how best this might be rolled out across Scotland. Detailed proposals are currently subject to approval.

How can we improve communication within primary care and between primary and secondary care to ensure people experience more joined up care?
We have a well-established ePharmacy Programme in Scotland which underpins the services delivered in community pharmacies. The new version of the electronic Patient Care Record (PCR), which is due to be rolled out shortly, will include tools to help facilitate communications and referral between community pharmacies and GPs.

In addition, all NHS Boards across Scotland have or are finalising plans to implement Hospital Electronic Prescribing and Medicines Administration (HEPMA) across the course of the next few years.

When will community pharmacists have access to patient records to enable them to do their jobs more safely?
In relation to pharmacist access to patient records, hospital pharmacists already have permission to access the Emergency Care Summary, for medicine reconciliation purposes. Community pharmacists have indirect access by calling the relevant GP, or through a dedicated phone line to NHS24.

We have convened a Short-Life Working Group (SLWG), with membership including the Information Commission Offices, Information Governance specialists, Caldicott Guardians, Scottish Government, the BMA and RCGP – with GMC and patient representation invited. This SLWG will work together to create a Scottish Code of Practice between Health Boards and GP practices to promote the safe sharing of information across boundaries in healthcare, and within the multidisciplinary team, in accordance with the Data Protection Act.

What’s your view on the Amazonization of pharmacy?
While we are continuing to invest in technology, the key element of community pharmacies continues to be patient care and provision of expert clinical advice, not just the supply of medicines. I am aware of recent reports about the use of online pharmacies, some of which are UK-based and registered with the regulatory body, the General Pharmaceutical Council, and some of which are based overseas and may not be regulated. It is vital that patients are assured of the safety and efficacy of their medicines and understand there are potential risks when buying from unknown sources. I would urge patients to use their local pharmacy and never take prescription medicines without a valid prescription.

To test whether robotics and other digital technologies can improve efficiencies in community pharmacy we have provided funding for a range of automation pilots. Work is well underway to install the automated systems and there are plans in place to evaluate the findings.

In England, the community pharmacy network has suffered significant cuts to funding. Is community pharmacy funding in safe hands in Scotland? Will you invest in the future of community pharmacy to help make better use of medicines?
While I am aware of the potential impact of cuts to pharmacy funding in England, the Scottish Government recognise the important role our pharmacy network in Scotland provides in services and access to healthcare advice in all our communities.

Working with colleagues in Community Pharmacy Scotland, the priority is to ensure that all current and future funding is determined on the basis of sustaining and the long-term stability of the community pharmacy network in Scotland and its vital contribution to transforming primary care.

Many CCGs in England are now not funding gluten-free food. Will the pharmacy Gluten Free Food Service continue in Scotland?
There are no plans to phase out prescriptions for gluten-free food staples. Prescribing of these products are subject to ongoing monitoring and review as are all areas of prescribing activity.

What would the NHS look like in an independent Scotland?
Health services are already devolved and we have used our responsibilities to determine and tackle our own health priorities. Our progressive approach to healthcare and health promotion has led to, for example, the abolition of prescription charges and we have led the way on tobacco and alcohol policy. We have also developed our own community pharmacy and GP contract arrangements to meet the needs of our communities.

Should the people of Scotland determine that independence was in the best interest of our country’s future we would have the full fiscal freedom to better support and protect Scotland’s National Health Service as well as provide new opportunities to tackle health inequalities.

Of course, central to this will be the settlement negotiated with the rest of the UK. It is likely we would become responsible for all regulation of health professions, the Human Medicines Regulations and Controlled Drugs legislation and we would ensure that regulation is maintained in the best interests of patient safety and the consistent treatment of healthcare professionals

 

 

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