Scotland’s Chief Pharmaceutical Officer (CPO), Professor Rose Marie Parr, delivered the keynote address at the Celtic Conference in Edinburgh last month, looking at the role of pharmacy as Scotland continues its journey to integrate health and social care services. Professor Parr began by drawing attention to the deep-rooted inequalities in health that persist across the country.
“Pockets of deprivation in Scotland are absolutely real and significant, and it’s there that we see real poverty and what that does to the health [of those people]. So although we may have gorgeous, green, remote and rural areas, we absolutely do have pockets where health gain is never to be seen.”
“Integration is the word”
Looking at broader trends, she reflected:
“It’s wonderful that people are living older, but we are living older with a bit more disease, and it’s how we cope that matters. It’s about self-care and self-management. But it’s not just about how the ‘worried well’ cope but how people in more deprived areas cope as well.”
“Each of our countries have got different ways of coping with that and here it’s the realistic medicine agenda where we are trying to change the culture; it’s not all about drugs and it’s not all about medicine. It’s also about wellness and care…people potentially want to be treated at home, they don’t really want to be treated in a big hospital…it’s about being in a more homely setting for people who may be needing support.”
“The vision for pharmacy hasn’t changed for a long time”, Professor Parr notes, “And that’s a good thing I think.”
“We have at least ten years of consistency of saying we want to be a bit more integrated and an enhanced part of a modern NHS in Scotland; we have had pharmaceutical care at the heart of what we do and pharmacy for a long time.”
“Integration is the word”, she states emphatically.
“We do think it’s the right thing to do to talk about care, not just medicines. There is something there in developing an interprofessional team and talking about the whole team, not just pharmacists when we talk about delivering pharmaceutical care.”
Key to this interprofessional collaboration is the part being played by the recently appointed clinical fellows. As part of the implementation of the Scottish Government’s latest pharmacy strategy, achieving excellence, the fellows bring together colleagues in medicine, dentistry and other areas.
The Scottish pharmacy clinical leadership fellowship scheme, launched in September 2018, aims to provide NHSScotland with a group of senior pharmacists and pharmacy technicians ‘committed to pharmacy development’ who ‘have enhanced the capability to offer leadership in their workplace and potentially at national and international levels’.
The role of community pharmacists
On the innovations taking place across Scotland to improve pharmacy, Professor Parr states:
“One of the key issues for me is about the expertise of pharmacists and technicians being able to help people, whether it’s through initiatives like pharmacy first which has been trialled over a number of months and that’s worked really well for patients and for GP practices.
“We have got community pharmacists taking up prescribing courses, because at the end of the day why would you not want that to happen…when, in essence, we are at the heart of prescribing.
“There’s lots of work to be done I think around our systems before we can achieve all of our ambitions.”
An advocate of communities having more say in where pharmacies are cited, Professor Parr suggests the framework for pharmaceutical care planning needs to be modernised:
“It is right and proper that we build on what community pharmacies been doing for the last ten years or so.
“[Looking at community pharmacy] I think ambitions here are fantastic, that we should be the first port of call to support the wider NHS. This is where we want to go; it is the high street clinical aspect that’s vital as its where we have clinical people talking to patients and their carers and adding health value from cradle to grave.
“We should be in the right place at the right time, I don’t think we are presently.
“I do think we need to talk through that how best we can get that network of community pharmacy in the best place for people in need. We need to make sure we are joined up and we absolutely aren’t joined up in Scotland in the way we should be.”
“[The framework] needs to be updated; this means legislation changes that need to be consulted upon and it needs to move on I think in an evolutionary – and not revolutionary – way.”
Up to 70% of GP practices in Scotland have pharmacists present now, but the CPO advises the sector needs to look at how that number can be increased.
“This is a growing area – some it can be challenging and can be frightening. We are creating a pharmacotherapy service in Scotland where we are placing pharmacists and technicians and others within GP practices to try and help the chaos that is prescribing and repeat prescribing in a GP practice.
“…because of where we are in our health service and the scramble for some health professionals including GPs and nurses, pharmacy is almost the answer for everything…
“Pharmacy is the new black.”
No “pill for every ill”
Professor Parr emphasises a key part of the most recent strategy focuses on the safe use of medicines.
Warning against a culture that expects a“pill for every ill” culture, she reflects that “this isn’t quite right”.
“If we don’t have a conversation with patients generally about the new shiny pill that may also cause lots of problems…it will be those people who can afford the new medicines being actually able to take them.
“We don’t want to be there…We know the biggest problem about medicines and where we actually fall down…is at the interface – we need to look at [the interface] in all healthcare settings how can we make that better.”
Recruitment & retention
No area of the health service is without workforce recruitment and retention issues, and pharmacy has proved to be no different, the CPO reflects. To change how some services are delivered and to shift the burden of prescription management away from GPs, Professor Parr acknowledges:
“It’s really hard asking people to do clinical work when actually the risk of this will sit with them. If you ask GPs who takes over this in referring and not referring, the GP gathers up those clinical risks and we are now asking pharmacists and their staff to do that too, so I understand it’s a scary place to be.”
Again, she notes, the role of one of the clinical fellows will be to look at the skillset of pharmacy staff to ensure they are equipped to adopt such risks.
“There is something in there about how we codesign with both technicians and pharmacists as we go forward; this will be really important because that’s what it’s all about really, shifting the balance of workforce.”
“It is the people in this room and the people out there; it is the thousands of people in the NHS that will work to make this possible, and I’m sure it will not be the same or the way we designed it, it will be better.”