Following Hemant Patel’s open letter to Dr Keith Ridge, chief pharmaceutical officer for England, about putting community pharmacies at the heart of the NHS, Sandra Gidley, chair of the Royal Pharmaceutical Society (RPS) English Pharmacy Board, signalled the intention to reform the contractual framework for them, so that they can focus on service delivery (The Pharmaceutical Journal 2018;300(7910):106).
This is welcome, since significant contractual reform is required before the public will trust pharmacists to provide clinical services such as the management of long-term conditions, as suggested by the editorial, ‘Buying the public’s trust’, of the same month (The Pharmaceutical Journal 2018;300(7910):68–69).
The current contractual framework mostly rewards pharmacies for the number of prescriptions dispensed. So long as that remains the case, the public will discern little change in community pharmacy practice, which is perceived simply as a means of safely obtaining prescribed medicines in accordance with the directions of a medically qualified clinician. Hence, campaigns by the RPS to proclaim a new readiness to consult are unlikely to persuade the public to change the habits of a lifetime.
Why exactly is it that community pharmacists are not seen as clinicians of choice? The primary reason is that, on the whole, pharmacy staff do not converse with patients about their prescription medicines. Consequently, patients do not generally associate the role of the pharmacist with advice on illness or good health.
We recently published the findings of a substantial survey of advice-giving by pharmacy staff, based on the views of a representative sample of more than 1,000 service users who had collected prescriptions from inner-city pharmacies (Health Soc Care Community 2017;25(6):1774–1786). Apart from checking the names and addresses of patients, pharmacy staff made no other interaction at all with 70% of service users.
For perceptions of pharmacy staff to change, the relationship between the patient and pharmacist must be modified. The public needs to become accustomed to experiencing a proper consultation on the use of their prescription medicines.
If a revised contractual framework incorporated a pharmaceutical care consultation as a specified service, the chances are that, in time, the public would come to trust pharmacy staff as healthcare professionals to whom they could look for formal advice. Pharmaceutical care consultations would help pharmacists to:
- Better communicate their expertise in medicines;
- Optimise the use of medicines (for example, by improving patient adherence);
- Reduce the inappropriate use of medicines, including that which leads to hospital admissions;
- Provide new, rewarding tasks to perform, should the automation of dispensing functions accelerate.
Once the public establishes its trust in pharmacy staff as healthcare professionals who advise on the use of prescription medicines, there may well be further opportunities to offer a wider range of health and social care services. This would firmly establish community pharmacy at the heart of the NHS.
Peter H Rivers, Jon Waterfield and Martin Grootveld, Leicester School of Pharmacy, De Montfort University
DK Theo Raynor, School of Healthcare, University of Leeds