Opioid replacement programmes benefit society overall

listen to ‘Methadone policy in Scotland’ on Audioboo

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The Scottish Drugs Strategy Delivery Commission has set out it's recommendations and vision for methadone policy in the future north of the border. Sir Harry Burns, the Chief Medical Officer for Scotland, has acknowledged the effectiveness of opioid replacement therapy and the use of methadone in reducing the spread of diseases such as AIDS and hepatitis.

A community pharmacist myself in Scotland, I am, unapologetically, a strong supporter of the methadone programme and opioid replacement therapy in Scotland. It benefits patients and the public. Patients benefit from it because they receive therapy through a legal source. In nearly all cases, patients receive their therapy from a community pharmacy where pharmacists can supply the medicine in accordance with a legally valid prescription signed by a legally appropriate prescriber. It benefits the public because such programmes have been shown to bring a reduction in crime, as demonstrated in the tablet on page 24 of the report. Those who say that such programmes should never exist need to imagine what the serious consequences of abolishing those programmes would bring to society. On this issue, you've got to be careful for what you wish for.

But despite my support for opioid replacement therapy, I can totally understand some of the criticism that is made of such programmes. There has always been a common assertion from many that patients are left "parked" on methadone. There is no denying that in such cases that patients have been enormously let down and questions will have to be raised as to why this is happening in some parts of the country. The report released today certainly suggests, under 'recommendations 1-2' on page 107, that there should be a focus on increasing the cohesion the different approaches in order to reduce drug misuse. I agree. I have to admit that all of us in healthcare should be doing more to work together in tackling the ongoing issue. Success of those programmes should always be based on how many patients we can get drug free rather than just how many people we can get on it in the first place.

The report mentioned the word "enmity" on page 106. None of use can afford to engulf ourselves in any form of enmity with regard to opioid replacement therapy. Doing this is dangerous and benefits absolutely nobody. And it will certainly hinder any future progress that is needed in order to improve the quality of services that are provided to patients who need all the support necessary in order to help improve their lives.

All patients who use opioid replacement therapy are human beings after all and should never be snubbed by society. Rehabilitating those people who are suffering with substance misuse brings economic benefit, reduces crime and makes our country a much safer place to live.

Scottish pharmacy - moving on up

listen to ‘Wilson Review’ on Audioboo

The Wilson Review's recommendations, published yesterday, into the provision of pharmaceutical services in Scotland are encouraging. I personally give the thumbs up to the report released yesterday and believe that the report yesterday paves the way for pharmacy to move onto the next stage in it's evolution of providing excellent, quality healthcare for patients in Scotland.

There are four areas I want to specifically focus on in this blog post with regard to pharmacy in Scotland and this specific review from Dr Hamish Wilson and Professor Nick Barber.

1. Public relations

This is an area which is growing in importance and needs to be given high priority. In recent times, we, as a profession, have faced some very unfavourable headlines/press stories, whether it's the Which? survey findings or the highly controversial and infamous 'Methadone Millionaires' story.  In point 19 of the report, the image of the community pharmacy being seen as 'commerical' is mentioned and concerns were raised about staff changes and lack of continuity in terms of patient-pharmacist interaction when it comes to specifically communicating with the same pharmacist on a regular basis.

There is no doubt that community pharmacies have to be financially healthy in order to continue provision of the services they have to offer. They are not directly part of the NHS, but do provide NHS services which they are reimbursed for. Operating at a loss is no viable option. Community pharmacy contractors need to become profitable in order to survive. And I would go even further - the NHS can look to community pharmacy at a time like now when financial resources are becoming more finite than ever before. Community pharmacy provides excellent public health services to the public whilst at the same time maintaining a successful business model. Community pharmacy has nothing to be ashamed of when it comes to being branded as 'commercial', as long as it maintains it's professional and ethical commitments to healthcare and pharmacy service provision and remains within legal and ethical boundaries.

However, we pharmacists overall need to do a lot more when it comes to promoting a positive image of what we do and of ourselves. Operating within a new system which allows us to provide a consistent and high standard of quality, as suggested in point 19, is a very worthwhile suggestion and should be looked at further. The idea of a pre-booked appointment with a pharmacist within a system that fully supports this mechanism is understandable and I can see the logic behind this.

I would also suggest more of us should become media trained or develop an increased awareness of how to engage with the local and national media. Journalists will not just dismiss us hastily just because we happen to be pharmacists. They will listen if we have something worthwhile to offer them in terms of an enlightening story or development about what we can offer the public in terms of providing healthcare services.

Personally, as a presenter of a weekly radio show on Victoria Radio Network, I ran a regular feature up until July called 'Healthy Matters' where I enlightened listeners of the station in hospital, across Kirkcaldy and online about popular topics surrounding health such as healthy eating/living/exercise, smoking cessation and how to deal with the hot weather. Creativity goes a long way in any area of life and pharmacy is not exempt.

There are many ways for us to promote positive health and we pharmacists are blessed with the knowledge and ability to enlighten the public in a positive and helpful manner. And it will improve their perception of us as a profession.

2. Education/development

Pharmacists and pharmacy technicians have a professional obligation to commit to continuing professional development. NHS Education for Scotland, in my personal opinion, provide many excellent learning opportunities for pharmacists and after my pre-registration placement was completed south of the border, I benefited enormously from the seminars they had on offer towards the end of 2012 and in the early stages of 2013. I have no doubt that I will not be the only pharmacist who forms such an opinion or a similar assertion. Their support is vital and I am confident that it shall continue for a long time to come.

But the biggest challenge and worry for me is the lack of inter-professional networking. There is frankly next to none of it and sadly very little window for opportunity to enhance such opportunities to engage with other kinds of healthcare professionals. I recall at university taking part in inter-professional networking events which I found welcoming because it gave me the opportunity to talk to other healthcare professionals and share thoughts and ideas. But it isn't just the lack of inter-professional networking that worries me. I feel I'm not getting to know my other fellow pharmacy professionals in areas that I work in. And that's a shame because loneliness isn't exactly a comfortable feeling to experience. I like talking to new people and engaging with other people and that motivates and re-invigorates me. One of the benefits of the seminars provided by NES was that you got to communicate with other pharmacists and pharmacy professionals/employees.

The recommendation in bold on point 51 of the report is one of the most important - local networks, organised by local NHS boards, is an excellent idea. It will bring professionals and employees together, create new links and is especially important, because we have to remember that not every pharmacist or person involved in pharmacy is necessarily a member of the recently formed Royal Pharmaceutical Society. The fact that not everyone needs to sign up to the professional body means, inevitably, networking opportunities can only go so far. A recognition of the necessity for closer integration of pharmacy professionals can only be welcomed and seen as positive step forward, if the recommendation in point 51 is implemented.

3. Challenges for the profession

Point 60 highlights the need for pharmacists to be inter-connected with other healthcare professionals when it comes to accessing relevant information about a patient's medicines and care. The biggest drawback for pharmacists in community is a lack of access to doctor's notes and records for patients which limits our ability to make fully rounded and sound decisions in the dispensary. I haven't personally had much experience in hospital pharmacy but I can only imagine that they are more integrated into the healthcare team in hospital and that they are able to readily access patient notes, enabling them to make more substantiated decisions about a patient's pharmaceutical care.

There is no doubt that the Chronic Medication Service is an enabling platform for pharmacists to develop care plans and work more closely with GP's and provide long term care for patients who are taking specific medicines in the long term. But in reality, the service hasn't really taken off nationally and many issues remain and need to be resolved if CMS is to take off and become an overall success. It can still be an overall success but many issues need to be discussed and resolved in order to enable the service to flourish.

One of the other big issues that we face is tackling non-adherence to medicines. It is in the interest of the whole NHS that medicines prescribed and dispensed are used to it's full clinical effects in order to enhance clinical outcomes for patients and deliver value for money for our health service. Point 9 in the report states up to just over 15% of hospital admissions are a result of non-adherence to medicines and monitoring issues. Again we need to constantly remind ourselves in pharmacy that our role is not to be underestimated. We are the medicine experts after all.

4. The future

Despite the ongoing challenges and issues we face in pharmacy and healthcare in Scotland, I am very reassured by this honest, insightful and enlightening report. The duty for all of us in pharmacy is to constantly engage with stakeholders and our political representatives to push pharmacy up the political agenda and constantly reassure our colleagues across healthcare and society that we have a role in the nation that is worthwhile.

But we can be very proud of the health of the pharmacy profession in Scotland. Quite frankly, we are blessed north of the border with one of the finest contracts for community pharmacy that has ever been devised and implemented anywhere in the world. And I say that with no apology whatsoever. Smoking cessation, the minor ailment service and the provision of urgent supply - just a selection of some of the unique services we offer in Scotland that have benefited patients in the Scottish National Health Service.

I take my hat off to all past and current Scottish Governments for recognising our value in healthcare and continue to urge them to engage and listen to what we have to say for the future of pharmacy healthcare provision in Scotland. Many countries, worldwide, are taking a look to Scotland with interest and, dare I say it, envy and will no doubt be inspired by how far pharmacy has advanced in Scotland.

Pharmacy student? Pre-reg? Maybe even newly qualified?

Image courtesy of Salvatore Vuono / FreeDigitalPhotos.net

Pharmacy student? A pre-registration pharmacist? Or maybe even just newly qualified?

I would like to hear from you as I plan to carry out a personal investigation into the growing crisis facing the pharmacy profession with regards to pharmacist unemployment and particularly our young people in the profession who's futures matter for the future evolution of pharmacy.

And this is where your important role comes into play. I want to hear from you with regards to your hopes, aspirations, concerns and even fears about where your future is going.

I would also welcome any input from the General Pharmaceutical Council, Royal Pharmaceutical Society, academics, community, hospital and industrial pharmacists, pharmacy leaders and entrepreneurs, managers, journalists within pharmacy/healthcare or any other person directly or indirectly related to the pharmacy profession.

Your time and input will be hugely valuable to me as I hope to seek solutions and answers with regards to this growing crisis and also instil hope for everybody so that a bright, positive and prosperous future exists for the pharmacy profession.

If you are interested in helping me then please e-mail me: anas@officialanashassan.com

I look forward to hearing from you.

Latest Scottish Pharmacy Review magazine

I am delighted to announce that just a few minutes ago, I discovered that my article regarding why politicians do understand community pharmacy in Scotland has been published in the latest edition of the Scottish Pharmacy Review.

To take a look at it, please visit: http://www.pharmacy-life.co.uk/ and head to the 'Magazines' section.

Please note that only suitable healthcare professionals within the pharmacy sector will be permitted to access this section of the website.

Then make your way to the latest magazine. I feature at the end of the magazine.

Alternatively, if you are expecting a copy at your community pharmacy place of work then you can check me out in the magazine too! Print or online, I'll be there!

Politicians DO get community pharmacy in Scotland

Forget recent negative comments about pharmacy, lets applaud our politicians in Scotland for showing insight into community pharmacy and what pharmacists can do for our communities.

Scotland has always led the way when it comes to taking the quality of our healthcare forward, particularly since devolution came to life in 1999. And Scottish community pharmacy has also led the way when it comes to showcasing the talent, ability and innovation that equates to the success story that is community pharmacy and our talented community pharmacists in Scotland.

The budget across the country in all areas of life is being squeezed year on year. But having said that, the publicity that community pharmacy is winning is a welcome boost for pharmacy in Scotland. The last few weeks has seen our profession attacked so unprovokedly, unnecessarily and unacceptably by a minority of elected representatives.

But if you take a look at the MSP's visit section of the Community Pharmacy Scotland website then it really is not fair to ignore the hard work MSP's are making to actually recognise the welcome value that pharmacists in Scotland bring to the NHS and healthcare provision.

And whether its Scotland's First Minister or members of all the political parties or none from Holyrood who take time out of their busy schedule to see community pharmacists in action, the work that they undertake on the observational visits is more than enough to combat the unfair accusation levelled at politicians that they seem to be doing 'nothing' about pharmacy.

Its also worth noting that pharmacy in Scotland is the envy of the rest of the United Kingdom and beyond. When the new pharmacy contract was implemented, it demonstrated that pharmacy in our nation was ready to elevate to the next level.

The Minor Ailments Service has enabled the much welcomed autonomy given to pharmacists to be able to directly support patients who may not have the time to see the GP but still receive appropriate treatment for a minor ailment. Whether its athlete's foot, a cough, eczema or even hay fever (the list is not exhaustive, see the full list here) then this much welcomed service has been a major success story in Scotland, enabling pharmacists to make full use of their patient-focused skills and freeing some of the GP's time. Some other parts of the UK are now implementing a similar kind of service, like Wales, however many more patients in other parts of these islands still don't benefit from such a service.

The Acute Medication Service see Scotland's pharmacies accepting GP10 prescriptions including barcodes on them. A patient with a prescription can wait less longer as all the pharmacy needs to do is scan the prescription, receive the content of the prescription electronically without the need to input data into the dispensing computer and then just get the pharmacist to check to clinically check the prescription before the patient receives their medicines. Convenient for patients. Convenient for pharmacies.

The Scottish pharmacy contract also contains an element which is the Public Health Service and this enables pharmacies to play a role in enabling their patients to be encouraged, educated and supported in self care. Pharmacies are expected to take part in campaigns run nationally (where they normally have to display a health promotion poster) covering public health issues such as smoking cessation, healthy eating and annual flu vaccinations.

And finally, the Chronic Medication Service. In England, these are called Medication and Use Reviews (MUR's). But Scotland has its own unique service. It is broken down into three stages. Stage I consists of the patient registering their interest, with full permission given by them, in using the service if they are taking medicines for long term conditions. Stage II involves the pharmacist using a pharmaceutical care plan in order to identify the needs of their registered patients regarding their care and addressing those needs. And Stage III involves establishes the integrated effort of care provision where the GP issues a prescription at appropriate time intervals over an agreed period of time where at the end of that period of time an 'end of care summary' is sent to the GP electronically covering issues such as compliance and any recommended courses of action that the GP may choose or choose not to take.

After all that detail, it is fair to say that our politicians, stakeholders and pharmacy leaders have gone beyond the call of duty when it comes to addressing the needs of patients who utilise pharmacies and also has enabled pharmacists in Scotland to make maximum use of their clinical and patient-focused skills within a nationally agreed framework.

Our elected representatives must maintain, sustain and protect the defence of the role of the pharmacist within the healthcare system in Scotland, and the rest of the UK. But in a time when one negative comment or assertion can ignite a passionate outcry of lack of fairness and a sense of victimhood, lets pay tribute for a change to the vast majority of our politicians for recognising the hard work that pharmacists perform in Scotland's National Health Service.