Pharmacists can help the NHS celebrate another 70 years

As the NHS approaches its 70th birthday, it is time to maximise the contributions pharmacists can make to healthcare in the future.

Birthday candles

The NHS becomes a septuagenarian on 5 July 2018; truly a reason to celebrate.

Great strides have been made since 1948, which have contributed to steadily rising life expectancy among the UK population. Polio has been eradicated, smoking rates have tumbled and HIV is no longer a death sentence. And as we see in our infograhic, pharmacy has been at the heart of many of these improvements, providing access to effective treatments and ensuring their safe delivery.

But the pressures on the NHS have changed. Lengthening longevity and more effective treatments mean that the leading causes of mortality in modern Britain are less likely to be tuberculosis or pneumonia, and more likely to be cancer, dementia or heart disease[1]
. The public’s lifestyle has also changed, resulting in rising levels of morbidity from diabetes and obesity[2]
.

Far from eliminating disease, its form has changed and multiplied. Three-quarters of 75-year-olds in the UK have more than one long-term condition and, as a result, more than half of this age group are taking five or more drugs[3],[4]
. Treating more people who have more diseases is costly – coming at a time when the health service is experiencing an unprecedented budget squeeze and evidence is emerging that this approach could also be harmful.

In the NHS, there are an estimated 237 million medication errors annually and avoidable adverse drug reactions cause 712 deaths every year, costing a minimum of £99m. According to a recent study, medication-related harm (MRH) affects one in three older adults after discharge from hospital[5],[6]
. Some experts even claim that MRH is the third leading cause of death after heart disease and cancer[7]
.

All these issues mean that the role of pharmacy must change. Pharmacists must take on more of a public health role — as they have with flu vaccination — and, as experts in medicines, help patients and the NHS untangle the complex problem of polypharmacy.

In the community, the NHS has started to encourage this with its programme to place pharmacists in general practices, which are in many areas doing great work. But the government has shot itself in the foot with the recent funding cuts inflicted on community pharmacy.

Many pharmacists now find themselves hard-pressed to get through their core dispensing work, never mind take part in any scheme to review care home patients or screen for pre-diabetes. The talks over a new contract for community pharmacy are an opportunity to shift the sector towards providing a more clinical role, but this cannot be at the expense of its dispensing function and it must free up capacity to deliver these new roles.

Similarly, hospital pharmacists are being urged to spend more time on patient-facing care. A noble aim, but one that is not new. In 1953, the Linstead report also recommended that hospital pharmacists had greater involvement on the wards and could feed into prescribing decisions. For trusts struggling to balance all the demands on them, this would be a wise investment – as Lord Carter pointed out, it could save money and improve care[8]
.

As the health service celebrates its 70th birthday, pharmacy has arguably never been more important. But if patients are to receive the best care in future, the NHS must ensure that it is making the most of its hard-working pharmacists. Happy birthday to the NHS — and here’s to the next 70 years.

References

[1] Public Health England. Health profile for England. Chapter 2: major causes of death and how they have changed. July 2017. Available at: https://www.gov.uk/government/publications/health-profile-for-england/chapter-2-major-causes-of-death-and-how-they-have-changed (accessed June 2018)

[2] Public Health England. Health profile for England. Chapter 3: trends in morbidity and behavioural risk factors. July 2017. Available at: https://www.gov.uk/government/publications/health-profile-for-england/chapter-3-trends-in-morbidity-and-behavioural-risk-factors (accessed June 2018)

[3] NHS England. Improving care for older people. Available at: https://www.england.nhs.uk/ourwork/ltc-op-eolc/older-people/improving-care-for-older-people/ (accessed June 2018)

[4] Gao L, Maidment I, Matthews F et al. Medication usage change in older people (65+) in England over 20 years: findings from CFAS I and CFAS II. Age and Ageing 2018;47:220–225.  doi: 10.1093/ageing/afx158

[5] Elliott R, Camacho E, Campbell F et al. Prevalence and economic burden of medication errors in the NHS in England. 2018. Available at: http://www.eepru.org.uk/prevalence-and-economic-burden-of-medication-errors-in-the-nhs-in-england-2/ (accessed June 2018)

[6] Parekh N, Ali K, Stevenson J et al. Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. Br J Clin Pharmacol 2018. doi: 10.1111/bcp.13613

[7] Gøtzsche P. Prescription drugs are the third leading cause of death. BMJ June 2016. Available at: https://blogs.bmj.com/bmj/2016/06/16/peter-c-gotzsche-prescription-drugs-are-the-third-leading-cause-of-death/ (accessed June 2018)

[8] Winter G & Adcock H. Carter review calls for more clinical pharmacists to be deployed by NHS trusts. The Pharmaceutical Journal 2016;296(7886). doi: 10.1211/PJ.2016.20200670

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Citation
The Pharmaceutical Journal, PJ, June 2018, Vol 300, No 7914;300(7914):DOI:10.1211/PJ.2018.20204995