A 10-Year Clinical Pharmacist Service Plan – Scottish government Style

The referendum in Scotland deciding on whether it remains a part of the United Kingdom or becomes a sovereign nation once more, is expected to be an almost “line-ball” result, which means that half of that nation will be disappointed, whatever the result.
The date chosen for the referendum is not just a random date.

It is the anniversary of when James VI of Scotland also inherited the English crown in 1603, and it is the date of the signing of the Acts of Union in 1707, to unite the sovereign Scottish and English parliaments, forming Great Britain.
The date, therefore, is symbolic and is significant for many Australians who can trace their family history back to 1603 and the “Plantation” of Northern Ireland by Scottish and English “undertakers”.

My surname is Johnston which is of Scottish origin and appeared in written records around 1194, after an invasion and occupation of Britain by the Normans.
The name is originally derived from a Norman noble called “John” who received a land grant from Robert the Bruce (called a “tourn” – an old English word meaning “a large farm”).

All of his followers became members of the Johns-tourn clan, not all being blood relatives, but all adopted the clan name as a surname.
All Johnston’s with a “T” can trace their origins back to Scotland and the parish region in Scotland where John’s tourn was located was called “Annan”.
One of the first Johnston’s in Australia was Major George Johnston, who came with the First Fleet. He was granted land for a farm that he called Annandale, which is now a well-known inner city area of Sydney.

Whatever the outcome of Scotland’s referendum, that country will still continue to “punch well above its weight” as it has done in the past, producing many of the “greats” in law, medicine and industry. This article was begun immediately prior to the referendum, and for interest the NO vote won the day.

What is not generally known is that the Scottish government is the first national government to produce a 10-year plan for the pharmacy profession, which is a source of pride for me, and the reason for the family history background.
It is a plan that embodies many of the ideas that have been introduced through i2P, most from original thinking and internal research.
It is a plan that could be adopted by the Australian government without modification, and I am pleased that they have made the distinction of a clinical pharmacist as the prescriber within pharmacy.
This type of approach pushes aside all of the “garbage” that is flowing from the Australian Medical Association in their unethical “war” on pharmacy here in Australia.

The Scottish government’s plans for pharmacy: what it wants to see-

* Clinical pharmacist prescribers working in partnership with patients, GPs and other prescribers.

* Further development of the pharmacist’s contribution to the management of common clinical conditions.

* An education and training framework that helps pharmacists deliver pharmaceutical care to patients in all settings.

* Development of the use of home visits, telehealth and mobile apps to respond to the needs of different age groups.

*  Patient registration with a named pharmacist

* Better use of the pharmacy workforce, such as technicians and assistants.

* All patients receiving pharmaceutical care, including polypharmacy/medication reviews where appropriate

* National services for cardiovascular health, care of older people in care homes and at home, alcohol and substance misuse, mental health, sexual health and children

The proposals have been described as “visionary and ground-breaking”.
They would free Scotland from the shackles of the norm established across the rest of the UK in a long-term strategy that proudly dared to be different.

No, it wasn’t the Scottish bid for independence – this was the 10-year vision for pharmacy announced nearly a year ago.
The ambitious and forward-thinking document set out plans to train all pharmacists as NHS-accredited independent prescribers, encourage patients to register with a named pharmacist and allow technicians to take on a greater dispensing role.

The proposals initially received an enthusiastic response from pharmacists and organisations including the Royal Pharmaceutical Society.

The attempt to transform Scotland’s pharmacists into an army of independent prescribers is the most ambitious part of the plans, Community Pharmacy Scotland (CPS) chief executive Harry McQuillan believes.

He is broadly supportive of the principle, which he says would help “plug the gap” in health services created by the demands of an ageing population. But Mr McQuillan says clarification is needed over who will have ultimate responsibility for a patient’s prescriptions. There could be an overlap of responsibilities, particularly where pharmacists are looking after patients on repeat prescriptions as part of Scotland’s chronic medication service (CMS).

Given the potential for professional overlap, you may expect GP’s to be resisting the move – but this hasn’t been the case so far. In fact, Mr McQuillan says time-pressured GP’s are on board with increasing the number of prescribing pharmacists.
Some reservations exist among both pharmacists and GP’s in terms of adjusting to this new paradigm. But increasingly both sides are warming to the proposal, unlike what is happening through the AMA in Australia today where they are trying to eradicate pharmacy from primary health care.
The Scottish government view is of an expanding role for pharmacists in the clinical space.

One area provoking practical concerns is the plan to encourage patients to register with a specific pharmacist.

This is not as problematic as it first appeared.
Although the loose wording of the plans could be interpreted as requiring patients to interact with the same pharmacist every time, in reality it would only involve a pharmacist being nominated to oversee a patient’s overall care.

Of course, it will be nine years before these aims are expected to fully materialise.
It can be difficult to imagine how pharmacy will transform over this period, during which Scotland will undoubtedly go through significant political and economic changes – even if the Better Together campaign triumphs on September 18.
But the general feeling is that the basic 10-year plan will survive, simply because it makes sense.

As Scotland prepares for its referendum on independence, it seems many private contractors feel powerless to decide their own fate.
This is akin to the dilemma currently in Australian pharmacy.
In Scotland, they too are not being recognised by government, but there is a push to change this thinking.
If that is unsuccessful, it will hold back the clinical pharmacist sector in terms of growth and potential.

The government may have the ability to push through the changes without much input from the profession.
But to truly get the sector on board, pharmacists must be allowed a say in the future of their sector as well as their country. Whether the government will recognise this, however, remains to be seen.

Meanwhile, Australian Pharmacy remains in a backwash with limited leadership ability coming to the fore, being bullied by the medical profession and divided internally through PGA policies suppressing the private contractor clinical pharmacist.

And would some Power the small gift give us 
To see ourselves as others see us! 
Robert Burns


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