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.

Royal Pharmaceutical Society's Faculty - what is it and how can it benefit you?

© Royal Pharmaceutical Society (used with their permission)

In the coming months, a brand new development will commence and be up and running - Faculty from the Royal Pharmaceutical Society.

And what is it? It is a new programme which recognises the development and progression of pharmacists. It aims to be a simple yet effective professional programme which helps pharmacists identify what they require in terms of knowledge, expertise and experience at different levels of practice.

Faculty will be aimed at those who have completed their first years of practice as a pharmacist and as the Faculty develops, facilities will also be made available to newly qualified pharmacists as well. The Faculty will enable a pharmacist to demonstrate to patients, the public and employers, their capability of delivering services at a recognised level. A pharmacist will also be able to network with other fellow Faculty members to share their knowledge and experience as well.

Next Monday, 22nd April, at the Novotel, Edinburgh Park in the west of the Scottish capital, a major launch event is due to take place in order to enlighten pharmacists across the East of Scotland Local Practice Forum area about Faculty and it is set to be a very well attended event. It will begin at 6:30pm for 7pm with a buffet included and a set of speakers from across the profession and beyond. It is an open event so anybody can come.

If you are a pharmacist or involved in pharmacy, why don't you come and join too? It's sure to be an event not to be missed.

Are prescription charges in England fair?

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Should English MP's be only allowed to vote on English
matters?

Patients on the NHS in Scotland, Wales and Northern Ireland do not have to pay for their medicines. However, NHS patients in England will still have to pay for their medicines, unless they are officially exempt. And with prescription charges per item rising to £7.85 this month, many people south of the border are still questioning why the levy still exists and whether it should go.

Earlier today, I tried to obtain statistics online to find out how many patients in England are exempt from the levy for prescriptions. But sadly the publications hosted by the Health and Social Care Information Centre with those details were unavailable.

However, to illustrate the overall situation regarding prescriptions in England, the Pharmaceutical Services Negotiating Committee have a graph titled "12 Month Rolling Items Dispensed" which shows that at around November 2011, the number of prescription items dispensed broke through the 900 million item mark. And that figure is slowly escalating to a billion. And in my experience working in England last year, the majority of patients do not pay for their prescriptions.

If this is generally the case across England, then I suppose one can be forgiven for questioning the justification for a prescription charge. With the prescription item fee rise this month, it is very clear that the coalition at Westminster has no intention to review the levy. But, politically, you cannot blame some people for raising another issue of whether English MP's should only be allowed to vote on issues affecting England.

And I don't blame them for that. I think it is a major pity and, frankly, astonishing that politicians at Westminster have never considered raising the idea of installing a mechanism to ensure that England has the ability to fully decide on what policies they want implemented, without MP's from other parts of the United Kingdom voting also on those issues despite the fact it will have absolutely no relevance to their constituents.

The Royal Pharmaceutical Society's Neal Patel voiced his opposition to the 20p increase in prescription charges on behalf of the society. I can understand his comments and he is certainly not wrong to give the impression that the exemption system needs to be reviewed.

But in an age of austerity and cuts in public spending, rising costs for medicines and lower employment prospects for pharmacists, are free prescriptions across the whole of the UK really affordable?

Multiple sclerosis medicine to become a Schedule 4 Part I controlled drug

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Image courtesy of adamr / FreeDigitalPhotos.net

A well known cannabinoid mouth spray is to have its schedule changed under the current Misuse of Drugs Regulations 2001.

Sativex®, which was previously placed in Schedule 1 of the regulations, will now become a Schedule 4 Part I drug from next month. First licensed as a medicine obtainable on prescription in 2010, the medicine is designed to tackle spasticity and neuropathic pain in patients who are diagnosed with multiple sclerosis.

Sativex® will not have to be kept under lock and key and the spray will not fall under the normal prescription requirements for Schedule 2 and 3 controlled drugs. However, keeping records of the stocking and dispensing of Sativex® is still strongly recommended, despite not becoming a legal requirement from next month.

Source of information: Royal Pharmaceutical Society; click here for more details of next month's legislation changes regarding Sativex®.

Exploring chronic pain in pharmacy

Last night pharmacists across the Kingdom of Fife and beyond congregated at Victoria Hospital in Kirkcaldy for a special seminar on chronic pain management. The event consisted of talks from specialists and a series of workshops where pharmacists and other personnel discussed issues ranging from the effectiveness of over the counter medicines for pain relief to more complicated treatments through exploring a series of pre-set case studies.

What was so striking about last night was the diverse range of opinion and personal learning experiences that participants shared, particularly during the workshop sessions. It became clear to me personally that pain relief is not just some sort of an irrelevant issue that can be brushed aside in pharmaceutical care. There's much more to it.

For instance, one of the consistent highlighted issues that kept coming up was attitudes towards over the counter treatments. It became apparent to me that many perceive simple and basic treatments, such as paracetamol over the counter (or even in a GSL pack) as ineffective and simply because they were being sold without a prescription.

A former British Prime Minister once used an infamous catchphrase, "back to basics". And as far as pain relief is concerned, maybe it is time to head back to basics. Even us pharmacists should become more aware of the opportunity that may arise through speaking with our patients about their medicines, in the fact that all our patients may require is just a chance to put their concerns and thoughts forward about what they are taking and how happy or unhappy they are with the medicines they have been prescribed to achieve the desired therapeutic outcome.

Its amazing how much one can learn from even an event like this. None of us have seen it all and there is always an opportunity to learn something new. It was a terrific night and was especially fun talking with fellow pharmacists about their experiences as well.