Scotland has long displayed a talent for identifying the care role for pharmacists and expanding that role by supporting clinical aspirations for pharmacists, and made central to their total National Health Service delivery.
The HealthierScotlandStrategy document published in August 2017 and titled ‘Achieving Excellence in Pharmaceutical Care’ aims to “strengthen the role of pharmacy in both hospital and the community”, and “offer the best possible person-centred care”.
Scotland’s chief pharmaceutical officer Rose Marie Parr – who launched the strategy alongside a community pharmacy team in Glasgow – said she wants to encourage more people to use pharmacy as a “first port of call”.
That the document identifies and embraces services that are typical of pharmacy means that pharmacists are recognised for their traditional skills, ending the isolation from the public health sector that has frustrated pharmacists for so long.
In Australia, prior to the introduction of the Pharmaceutical Benefits Scheme (PBS), community pharmacy was always the first port of call.
Minor ailments solutions, self care and primary health care solutions offered from community pharmacies meant that effective and economical pharmacy services underpinned a very large segment of need for Australia’s population.
PBS introduction, along with Medicare changed the direction of the flow of patients because the first port of call became the free doctor, followed by the pharmacist dispensing the free prescription.
Pharmacy, at that time did not have the political savvy or strength to prevent what became a hijacking of pharmacy “turf” by the medical profession and pharmaceutical manufacturers.
The latter created incentives for doctors to prescribe “brands” and offered the brands cheaper than pharmacists could compound them – which interested the PBS funders, the Australian government.
Thus, the seeds were sown for pharmacy’s isolation from the public health system and the brake that ensured an economic counterbalance to the marketing muscle of the “brands” which funded the incentives for the medical profession to support brand prescribing and the resultant expensive mess that the system has evolved to.
What happened in Australia was similarly attempted in most western economies.
But Australian pharmacy seemed to be isolated for a lot longer where medical peak bodies have continually engineered issues such as the current “turf wars”.
Scotland is focussing its efforts into a segment called Pharmaceutical Care, defined as:
“The focus of the knowledge, responsibilities and skills of the pharmacist on the provision of drug therapy with the goal of achieving definite therapeutic outcomes toward patient health and quality of life. ”
These priorities fall into two key areas:
1. Improving NHS pharmaceutical care
• Improvements to NHS pharmaceutical care services across Scotland
• Delivering safer use of medicines for the people of Scotland
2. Enabling NHS pharmaceutical care transformation
• Ensuring capability and capacity by further developing the pharmacy workforce
• Developing a digitally enabled infrastructure
• Planning and delivery requirements for sustainable NHS pharmaceutical care services
There are nine platforms to support the two key areas of Scotland’s pharmacy initiative.
They are:
* Improved and increased use of community pharmacy services.
* Pharmacy teams integrated into GP practices.
* Transformed hospital pharmacy services
* Pharmaceutical care that supports the safer use of medicines
* Improved pharmaceutical care at home or in a care-home
* Enhanced access to pharmaceutical care in remote and rural communities.
* Pharmacy workforce with enhanced clinical capability and capacity.
* Improved service delivery through digital information and technologies.
* Sustainable services that meet population needs.
All of the above have been advocated for here in Australia over the last decade by various pharmacy thought leaders and professional leadership organisations.
But Scotland is probably the first western economy to recognise the importance of community pharmacy as the anchor or hub for all community health services in a supported and integrated fashion.
That it should be the “first port of call” is recognised and supported by government ensures that a logical and recognisable process exists for other health professionals and patients, whereby pharmacist are able to provide their traditional blend of health services to the full level of their competence.
And past that level providing a form of triage or referral to other health sectors.
Community pharmacy has always been the traditional patient mentor in the field of health literacy – the key ingredient that empowers patients to embrace self care or be able to take responsibility for their medical conditions with a knowledge base that allows for patient empowerment.
Improved health literacy directly correlates to improved quality and economic costs in healthcare delivery
“Our vision is for pharmacy as an integral and enhanced part of a modern NHS in Scotland.”
“Community pharmacy already plays an important role in the provision of NHS pharmaceutical care, providing highly accessible services for people both in-hours and out-of-hours.
We want more people to use their community pharmacy as a first port of call.
Central to this is to ensure that services such as the Minor Ailment Service (MAS), the Chronic Medication Service (CMS) and Public Health Service (PHS), core elements of the NHS services provided in community pharmacies, are being delivered to their full potential.
It is through making full use of the clinical capacity in community pharmacy that real gains in clinical care can be made.
It is also where the community pharmacist’s contribution to multidisciplinary team working takes its place to open up access to primary care for everyone and reduce workload at GP practices and other local healthcare services.”
While Australian pharmacy thought leaders have identified most of the workable components contained in the Scottish health plan, they have not succeeded in harmonising and intrgrating the political processes or allaying medical profession fears of a “turf war”.
The current climate appears to be enquiring as to “what turf war” as it appears only to exist at the top end of the medical professional organisations.
In other words, it has been an unnecessary disruption adding additional costs to health care delivery that are not sustainable.
Emulating the Scottish initiative should occupy pharmacy leaders because it is a concise process worth adapting to the Australian health system.
A workable system that represents a cohesive solution in the form of a supported framework by all participants would certainly be a positive change to what is currently endured.