Closer ties with general practice — and primary, secondary, tertiary, mental health and social care —
are essential to improve the contribution of pharmacists to patient care and to secure better prospects for the profession.
As demand on the NHS increases, the pharmacy workforce swells and the NHS pursues new ways of working, pharmacy’s role in English healthcare will need to adapt too.
The English Pharmacy Board’s latest campaign, launched on 17 March 2015, calls for the pharmacy profession to work more closely with our GP colleagues and other healthcare professionals in primary care.
Much attention is likely to fall on one element: the drive to see more pharmacists working within GP practice teams, the subject of a joint agreement between the Royal Pharmaceutical Society (RPS) and the Royal College of General Practitioners.
In this proposed role, the pharmacist would handle medicines-related issues in general practice, liaising with providers such as hospitals and care homes to reduce errors, review medication and address polypharmacy.
An appropriately skilled pharmacist, integrated into the GP practice team, will be able to contribute considerably to practice workload — an important benefit to the NHS at a time when there is a shortage of GPs and practice nurses.
Vitally, this is also a huge opportunity to develop new roles for the pharmacy profession at a time when the growing workforce and not having a cap on student numbers has caused concern about future job prospects.
Around the country, we already have examples that show when pharmacists work closely with GPs and implement the RPS medicines optimisation principles, it provides patient benefit and good value. For instance, the Care Homes and Medicines Optimisation Implementation Service (CHAMOIS) in Leeds, in which specialist pharmacists undertook medication reviews of residents, provided positive benefits for the local GP practices’ patients and demonstrated that this is a sound investment.
Wider integration needed
All pharmacists can contribute to these new ways of working and this move should not be seen as a threat to the ambitions that pharmacists have in all sectors to improve patient care and optimise the use of medicines.
But this proposal is only one of a raft of changes we need to how pharmacy works as part of the wider health system.
On a local level, better integration of community pharmacy in care pathways is essential to support patients with their medicines and to have a more direct patient-facing role in chronic disease management. This would ensure medication reviews and patient outcomes are delivered consistently and more effectively.
Commissioners must recognise this potential and act to bring pharmacists’ expertise into these pathways to support patients with their medicines use and achieve shared decision-making.
The NHS Five Year Forward View, the plan that will shape the future of the NHS, will enable local negotiation about the place of pharmacists in new models of care, including the proposed multispecialty community providers, and the primary and acute care systems.
There is untapped clinical capability, capacity and accessibility in the pharmacy workforce. There are also clinical and financial imperatives to address the suboptimal use of medicines in an NHS where 17% of hospital admissions in people aged over 65 years are a result of problems with medicines and up to 50% of people are not taking medicines as intended.
Working more closely with GPs is one way of seizing the opportunities arising from this work, to become an essential and integrated part of patient care — particularly around the prevention of ill-health and delivery of medicines optimisation.
But it isn’t the only way. We need much wider collaboration with public health and social care too. If we achieve this, it will provide professional opportunities for pharmacy and result in better care for our population.
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