Community pharmacists in Scotland are being given an increased role in a reformed NHS out-of-hours service, following a Scottish government-commissioned independent review into urgent care.
Pharmacies in Scotland will become one of four destinations to which patients will routinely be referred if they need urgent care when their normal GP surgery is closed. Giving pharmacists access to the electronic patient record is also recommended as part of the changes, in order to improve the sharing of information across health professions and sectors.
“We must think anew about what is best for both urgent and emergency care for the people of Scotland,” says Sir Lewis Ritchie, professor of general practice at the University of Aberdeen, who led the review and published the report on 30 November 2015. “We should now move towards a seamless service, which not only meets the needs of patients, but also offers a valued working and learning environment for all those delivering health and social care services.”
The report — ‘Pulling together: transforming urgent care for the people of Scotland’ — says community pharmacists should be encouraged to become enhanced practitioners and prescribers. Clinical conditions that pharmacists can manage through the use of patient group directions should also be expanded as part of the reforms, it says. The national minor ailments service also needs to be better promoted.
The proposed out-of-hours care model will have a national network of urgent care resource hubs, which will take referrals from NHS 24, Scotland’s national telecare service. The hubs will coordinate services and decide where callers should be directed to and who should treat them.
The four referral options for urgent care will be a local urgent care centre, a home visit (for example from a GP or community nurse), a community pharmacy or another community-based service, such as social services or community psychiatric nursing. Urgent care centres will be located in each health board district, co-located in urgent care resource hubs, hospital emergency departments or minor injury units.
“GPs will no longer be the default healthcare professionals to see patients for urgent care,” says the report. They would in future be expected to take on the more complex cases while other patients would be seen by a new out-of-hours workforce which would include, among others, clinical pharmacists, physician associates, advanced nurse practitioners and paramedics.
Shona Robison, Scotland’s health secretary, says the review will form the framework for the long-term future of out-of-hours care in Scotland. “Our NHS is facing different demands from those of a decade ago and we need to ensure all parts of the system work as effectively as possible to support an ageing population and more people with more complex, multiple conditions.”
Source: Royal Pharmaceutical Society
John McAnaw, chair of the Royal Pharmaceutical Society’s Scottish Pharmacy Board, welcomes the proposals. “There are key recommendations that support pharmacists having a greater role and profile in the delivery of unscheduled care, which is very positive, and the RPS is committed to help develop and support the expansion of the pharmacist’s role in out-of-hours care in the months and years ahead,” he says.
“We are also delighted to see that pharmacists will at last be ‘plugged in’ to the electronic patient record, and eventually be able to electronically share and receive information from other healthcare providers. This will be a key enabler for pharmacy into the future, and ultimately benefit patients and improve patient safety.”
The Scottish government has made £1m available to fast track a pilot of the urgent care model. The government’s detailed response to the recommendations and a national implementation plan is due to be published in spring 2016.