Pharmacists can help improve the care of patients with long-term conditions across Great Britain

England

Sandra Gidley, chair of the Royal Pharmaceutical Society (RPS) English Pharmacy Board

In England, the campaign to improve care for people with long-term conditions has never been more appropriate. We finally know where we are with respect to the community pharmacy contract and this work will hopefully align with the Murray review into clinical community pharmacy services, which is expected around December 2016. The campaign fits into the ‘Community pharmacy forward view’, which was produced by Pharmacy Voice and the Pharmaceutical Services Negotiating Committee (PSNC) in August 2016, and endorsed by the RPS.

The future for community pharmacy is becoming ever more clinical and pharmacists are ideally placed to take some of the caseload from GPs so that they can, quite rightly, concentrate on their more complex caseload. This is why we are calling for collaborative arrangements for specific categories of patients with long-term conditions to be partly, or completely, managed by pharmacists.

Commissioners need to take overall responsibility for this but they also need to ensure that pharmacists are involved in the long-term care of frail, older people living in care homes and other domiciliary care settings as part of a multidisciplinary team.

That said, the bottom line is that there is a need to take a step back and consider the whole pathway, from prevention and detection, through to treatment and considering interactions between multiple long-term conditions. This is why we are calling for local authorities, and other public health organisations, to target specific health promotion topics, such as stop smoking services, alcohol smart card interventions or dietary advice, that impact on the management of long-term conditions.

It is clear that we cannot continue to do what we have always done and expect the outcomes to be different. That is why we need to get rid of the tired old mantra, beloved by ministers, that “doctors prescribe and pharmacists dispense”. We need to remind politicians, opinion formers and the public that pharmacists are the only health professionals with a master’s degree devoted exclusively to medicines and that they should have a greater involvement in prescribing.

Pharmacists providing direct patient care should have the opportunity to train to become prescribers and this is why we believe that the rules should be changed so that the designated medical practitioner, who supervises the training, can be a pharmacist as well as a doctor or a dentist.

We cannot ignore the financial elephant in the room. NHS money does not belong to one particular health professional and, in times of increasing pressure, it must be used in the best interests of the patient. This is why we need to be making the financial case for pharmacist involvement, as well as the medical case.

We cannot work in isolation so welcome further examples of pharmacists working with others to improve the care of patients with long-term conditions. Such examples all add to the evidence base. RPS England and the English Pharmacy Board are up for the challenge and will be pursuing every available avenue to ensure that the potential of pharmacists is recognised and that pharmacists are used to provide the best patient care.

Wales

Suzanne Scott-Thomas, chair of the RPS Welsh Pharmacy Board

The launch of this policy on long-term conditions is timely in Wales. In October 2016, The Health Foundation released ‘The path to sustainability: Funding projections for the NHS in Wales to 2019/20 and 2030/31’. The report states that “action will be required to reduce trends in acute care through prevention of chronic conditions and better treatment of them and their associated morbidity out of hospital”. Our policy on long-term conditions addresses several of the issues raised in the report.

The development of 64 primary care cluster networks, which have been given the task of ensuring that the health and social care needs of their local population are met, provides new opportunities to think differently about how health and social care is delivered in Wales. Currently, around 50 new clinical roles have been created for pharmacists in primary care clusters. Pharmacists are working in a truly multidisciplinary team alongside GPs, nurses and other primary care colleagues to provide direct clinical care to patients and many are using their independent prescribing qualification on a routine basis to improve patient access to care.

We want to ensure that all pharmacists within the locality have the opportunity to feed into the strategic plans for their cluster. This will ensure more opportunities are created for pharmacists in Wales to train as independent prescribers and fully use their skills for the benefit of patients with long-term conditions. Any new services for people with long-term conditions must be designed to ensure equitable access, care and treatment, regardless of the day of the week.

Increased communication and sharing of information and resources between all registered health and social care professionals is vital to enabling a holistic and coordinated approach to care. Making use of advances in technology to give pharmacists routine access to the Welsh GP record will enable pharmacists to contribute to increasing the safety and quality of patient care. As part of a £750,000 investment, the ‘Choose Pharmacy’ common ailment service provides an IT infrastructure on which further services can be built.

The long-term conditions policy for Wales takes into account several strategic drivers including the principles of prudent healthcare; and that patients must have the opportunity to be decision makers in their own health journey, supported by health and social care professionals, including the expertise of pharmacists for health and medicines information.

At our 2016 Medicines Safety Conference, Vaughan Gething, the cabinet secretary for health, well-being and sport, said: “As the experts in medicines, it is imperative that pharmacists continue to play a leading role in our health system.” We are ready to accept that challenge and look forward to working with the Welsh Government to make our vision for the management of long-term conditions a reality.

Scotland

John McAnaw, chair of the RPS Scottish Pharmacy Board

As people live longer, the number of individuals living with a long-term condition will rise. With medicines being the most common intervention we use in healthcare, the number of people who rely on medicines to control their long term-condition will continue to grow. Pressures on primary and secondary care colleagues have demonstrated the need for additional capacity in the multidisciplinary team to support those people living with a long-term condition, highlighting a clear role for pharmacists.

To maximise a pharmacist’s unique contribution to supporting people with long-term conditions, they must be fully integrated into the multidisciplinary team. A pharmacist’s in-depth knowledge of how medicines work, interact with each other and how and when they should be used, is essential when trying to develop the optimal treatment plan for an individual with a number of co-morbidities. It is more than just following the clinical guidelines, it is about working with people who have a long-term condition and, together, making informed choices on the medicines they should be taking, and the safest and most effective combinations for them.

However, to fully empower pharmacists to maximise their role in the support of people with long-term conditions, change is required.

Pharmacists directly involved in a person’s care should, with that individual’s consent, have full read and write access to the patient health record in the interest of safe and effective patient care. The clinical contribution and intervention of the pharmacist needs to be shared with other members of the multidisciplinary team and the only way to do this safely and effectively is by granting access to a single, shared record. In addition, all pharmacists should be enabled to make a direct referral to an appropriate health or social care professional, such as a physiotherapist or dietician, whenever required, both in and out of hours. With over 600,000 people visiting their community pharmacy in Scotland every day, there is a great opportunity for pharmacists to ensure individuals are signposted to trusted resources and local groups for further information and support.

Community pharmacists are our nearest and most accessible health professionals and their expertise in medicines can greatly benefit people with long-term conditions. There is a major advantage to having community pharmacists support patients to self-manage their own long-term condition and ensure that their care fits in with their lives — this is a key focus for individuals living with long-term conditions. 

Taken together, the changes we request will result in a better journey for the individual, reducing duplication of effort between health and care professionals and improving integration of care provision.