The future role of pharmacy within the NHS is far from certain. Technology has the ability to automate much of the dispensing, and pharmacists and their professional body, the Royal Pharmaceutical Society (RPS), have long sought an expanded role in clinical practice. Those gathered at the RPS conference in Birmingham in early September will have heard, once again, that the future for pharmacists will go beyond dispensing.
Delegates heard how hundreds of pharmacists will soon provide ‘medicines optimisation’ — an NHS buzzword that means helping patients make the most of their medicines — in general practice. Similar ventures in the accident and emergency (A&E) departments of hospitals and NHS 111 call centres are proving to be promising new avenues for making the most of pharmacists’ skills and improving pharmaceutical care. In addition, new integrated care organisations — sitting between community and hospital — are set to emerge in the next few years to offer a range of outpatient clinics and diagnostic services, all of which will require pharmacy expertise.
England’s chief pharmaceutical officer Keith Ridge gave an address in which he spoke of the potential of technology, such as robotics, to transform dispensing and improve the use of medicines within the NHS: “It’s easy to see how clinical pharmacy will, and must, quickly dominate pharmacy practice,” he said.
“Some will embrace change more readily than others and some will be able to adapt more quickly, but throughout we must ensure patients and the public are nothing but beneficiaries,” he added.
Yet, this journey, which started even before the report ‘Now or never: shaping pharmacy for the future’ was published by the RPS in 2013, still has several barriers to overcome, including workforce issues, national contract and education.
While initiatives and new schemes are giving pharmacists exciting new opportunities, it will be some time before they become a realistic option for many pharmacists and change how pharmacy is practised. Around 2,500 new pharmacists enter the workforce each year, joining over 50,000 pharmacists registered in Britain. Yet only around 250 experienced pharmacists will be employed in GP practices in the NHS England pilot lasting three years.
Roles in A&E and NHS 111 may similarly be scarce to begin with, and it will take time for the NHS to create the integrated care organisations that speakers at the conference outlined as a hotbed of potential roles for pharmacists.
Still there is little progress on the five-year integrated MPharm degree — surely essential to provide the pharmacists the NHS will need to fill an expansion of these clinical roles in future. Ridge bemoaned the lack of developments on this front. Although some universities run integrated degree courses, it is far from widespread, despite being long discussed as a better option than the four-year degree and a year of preregistration training. Even when all universities are offering integrated courses, it will take five years before the first cohort of students register as pharmacists and the health service and patients begin to see the benefit.
No mass conversion from dispensing to clinical practice will happen without a fundamental change to the dispensing business model. It has been suggested by many in the profession that technology and centralised dispensing facilities will provide a safe and efficient means to release pharmacists from this role, giving them time to see patients. More than a billion prescription items are dispensed by community pharmacies each year, growing at a rate of over 3% per year, which gives some sense of the scale of operation needed to replace pharmacists’ role in this essential service. The Pharmaceutical Services Negotiating Committee (PSNC) quickly objected to recent proposals from the RPS and the National Association of Primary Care to replace the existing national contract, rooted in dispensing, with a clinical outcomes-focused approach. “The PSNC will battle to protect this principle,” said chief executive Sue Sharpe. This shows the practical and political challenges that await in any overhaul of the financial and operational basis of community pharmacy.
Moreover, any change to the pharmacist role can only happen when allied to greater use of the wider pharmacy team. Ridge explained there was still much to do to guarantee uniformity of practice by pharmacy technicians, for instance.
After years of waiting, we are at last seeing more patient-facing clinical positions open to pharmacists from all sectors — if only for a minority at this stage and, for many, this is only through pilot projects. If a larger proportion of the profession are to have the chance to access these clinical roles, we need politicians, professional bodies and contractor organisations to overcome these substantial challenges quickly.
Nevertheless, the pharmacists pursuing opportunities in general practice, A&E and other settings are already seizing the chance for a clinical future without waiting for a consensus.