Integration of pharmacists into primary care in Scotland

The concept of pharmacists working within primary care teams is not a new one. Several models have evolved in Scotland over the past 20 years where pharmacists, and in recent years pharmacy technicians, have been integrated into general practice and become valued members of the team. Their role in providing prescribing support and pharmaceutical care for patients is well recognised. What is new, however, is the focus on developing these skills further by integrating all pharmacists into the emerging wider health and social care team. Primary care hubs are still developing but the core concept is around planning and delivering services at locality level. ‘Pharmaceutical care service plans’ — detailed plans outlining pharmacy services based on population need — can support that and ensure that the role of the profession is recognised.

While the future positioning of pharmacists in primary care hubs is yet to be defined, the overall strategic direction of optimising the clinical skills of pharmacists to deliver high quality pharmaceutical care is clear. In May 2013, the Scottish government published ‘A route map to the 2020 vision for health and care in Scotland’. Central to the vision is the aim that by 2020 everyone will be able to live longer and healthier lives at home. This aim is also central to ‘Prescription for Excellence’, which was published in September 2013 and outlines the way forward for pharmaceutical services in Scotland over the next ten years.

However, creating the capacity and capability within the pharmacy workforce to deliver the vision will be challenging. Among many pharmacists there is still a lack of clarity around what the new roles will be, what advanced clinical skills pharmacists will need and how they will begin integrating with primary care teams. Alongside that are the expectations of others outside the pharmacy profession. A pharmacist’s role in the primary care team is about improving patient care through their unique knowledge of medicines, not just about reducing the workload of others. As a profession, our priority should be to support patients to get the best outcomes from their medicines through the provision of high quality pharmaceutical care and advice to patients and the multidisciplinary team. This will help primary care services to manage their workload without us having to compromise on our own priorities. This is reflected in the RPS Scottish Pharmacy Board’s 2016 manifesto, ‘Right Medicine — Better Health — Fitter Future’, published on 20 January 2016.

Pharmacists have a wide range of clinical skills. Many pharmacists already respond to symptoms and prescribe for minor ailments or deliver long-term condition review clinics. However, one thing we must be clear about is that pharmacists are not doctors and are not trained to diagnose complex conditions.

The skills required for these new advanced clinical roles will involve enabling pharmacist prescribers to monitor and assess patients with a wide range of conditions. NHS Education for Scotland (NES) Pharmacy already offers advanced clinical assessment skills training and there are opportunities within the multidisciplinary team to practice these skills. Many health boards in Scotland are currently developing ‘Teach and treat’ as a way of supporting pharmacist independent prescribers to gain the skills needed to manage patient case loads. In order to create the pharmacy workforce we need for the future, training from undergraduate level upwards should be reviewed and clinical assessment skill development should be placed at the core.

Integration of pharmacists into primary care teams involves all pharmacists, not just those in GP practices, but from all sectors with the appropriate level of clinical knowledge working with the multidisciplinary team to deliver pharmaceutical care in the appropriate setting. But, it won’t happen overnight. It will take time for people to develop the advanced clinical skills required to safely manage a caseload of patients and it will take time to build the relationships within the profession and the primary care team. However, the benefits to us as pharmacists and the patients we work with will soon become apparent. There are numerous opportunities for pharmacists to integrate into primary care teams, we just have to get out there and grab them for ourselves.