It is now well over 20 years ago that i2P proposed that community pharmacy develop a system we titled “Pharmacy-In-The-Home”.
The reason for such a proposal was because of the predictions for an ageing population demographic, expanding and potentially reaching a figure of 28 percent of total population.
We argued that an ageing population would be a less mobile group and that the capital cost of providing nursing homes would become too expensive and would outstrip government funding ability.
The solution was always going to go down the pathway of supporting a patient in their own home – a solution preferred by the majority of ageing patients and increasingly supported by government because of the large cost savings available.

For pharmacy to make a relevant contribution it meant that clinical and other support services needed to become mobile and portable.
Technology has favoured this type of development through the provision of telehealth-type products such as Skype that coupled with highly portable tablet computers.
An informational website was also envisaged to manage various elements of the entire system (drug information, condition information, appointment booking system, online communication etc.)

The proposed service model required the development of a clinical services pharmacist and a clinical assistant.
The system envisaged would have a clinical assistant visit a home and organise communications back to a central office within a community pharmacy linked to a clinical pharmacist or alternatively, a clinical pharmacist visiting a patient home and linking back to a clinical assistant.

In practice, a mix of both of these formats would have to be utilised.

Australian community pharmacy has slumbered on to this point in time where seniors now exceed 15 percent of total population, with health services demand rapidly increasing because of the level of chronic illness needing to be treated.
All primary health care systems have not kept pace with the increased demand and they remain uncoordinated, fragmented across various health professions with little attempt at integration.
The gatekeepers of the central segment of primary health, the GP’s, seems completely disoriented and disorganised, focussing on disrupting other health professions in the belief they are involved in “turf wars”.

But finally, a glimmer of pharmacy progress.
Not in Australia, but in Scotland, where a pilot study titled “Pharmacy Anywhere” has just been successfully completed.
Pharmacy in Scotland, I believe, leads the world in pharmacist clinical services.

The pilot was conducted in a geographical area that was remote and hard to service clinically because of travel distances and existing communications systems (a problem not dissimilar to many regions of Australia).

NHS Highland backed the pilot study and funded clinical pharmacists already attached to GP practices.
These clinical pharmacists were also accredited prescribers.
The pilot could have worked just as well using a community pharmacy as the hub of the system.
NHS Highland reported:

“Pharmacy Anywhere tested whether clinical pharmacy services could be provided remotely using telehealth.
The aim of Pharmacy Anywhere was simple.
We had already developed a clinical pharmacy service for dispensing GP practices that worked.
The problem was that providing that service across NHS Highland was impossible due to our challenging geography and recruitment difficulties in remote locations. Pharmacy Anywhere used two forms of telehealth to enable pharmacists to provide patient care remotely: remote access to medical records and video consulting.

Overall, Pharmacy Anywhere worked.
The clinical pharmacy service was delivered safely and effectively by telehealth, and, crucially, patients liked it.”

The full report of the pilot study is found at the following link NHS Highland – Pharmacy Anywhere Report and it is recommended that you download it, read it and store for future reference.

The original i2P system of Pharmacy-In-The-Home was designed to link in with Self Care promotion and the development of a Minor Ailments System.
It was originally envisaged that pharmacist prescribing was to be an important central component.
Because of conflict of interest issues it was thought that dependent prescribing would be assigned to employed community clinical pharmacists while independent prescribing would be assigned to contractor or self-employed clinical pharmacists (not having a pecuniary interest in a community pharmacy)

Coincidentally, two reports have been released by the Grattan Institute that amplify some of the points discussed above.
Mapping-primary-care in Australia relates to the dysfunction of Australia primary care, and  Access all areas discusses problems relating to GP numbers, distribution and the thought that pharmacists could assist in managing five percent of existing GP “simple” consultations as a means of freeing them up to manage “complex” patients.

While the Grattan Institute reports discuss clinical pharmacists deployment in a fairly conservative manner, i2P would reinforce the following:
* Community pharmacy has always been a major provider of primary health care services and still remains so.
* Australian clinical pharmacy services lag behind the rest of the world and pharmacy leaders need to do their job and rectify this deficit.
* The best use of community pharmacy would be for it to coordinate and integrate a majority of primary health care services.
This is possible because of the nature of the pharmacy profession, its accessibility, the high standards of existing service and patient satisfaction, and the levels of training of all participants.
Most importantly, the ability of a pharmacist to build health literacy levels within patient populations.