With the dawning of a new century comes the perfect opportunity to develop a clear and positive vision of what we want for the future of our profession. What is the vision? In my mind’s eye, it is to make pharmacy an integral part of everybody’s thinking in the new evolving health service and to ensure that, when medicine is discussed, there is an immediate association with the pharmacy profession.
In helping to ensure this vision becomes a reality we are fortunate to have had a head start in the form of the Royal Pharmaceutical Society’s Pharmacy in a New Age strategy, a process that started some five years ago. We also have a great track record. For many years now community pharmacists have been delivering a remarkable service to patients, dispensing over 500 million National Health Service prescriptions a year nationwide, offering health advice every day of the year to more than 1 million people and helping people towards self-care and taking greater responsibility for their own health. This is an amazing achievement and provides a solid foundation on which to build.
In hospitals, too, pharmacists take responsibility for huge drug budgets, supplying complex services to very ill people, and advising clinicians on appropriate drug regimens. All this is relatively unsung and unknown in the outside world. Contrast this with the United Kingdom drug industry, which has a worldwide profile and has been the darling of successive governments and stock markets alike. However, even this golden apple is facing new challenges. The increased merging of companies and their globalisation means that the strong focus that the UK has had in the past is slipping.
Pharmacists have long been talking about being at the crossroads. With the advent of PIANA there was at last the opportunity to see which road the profession should be moving down. Of course, that vision has still to be achieved. But PIANA was the first time that an attempt to determine how the profession should be shaped had been made. There has been a serious misconception that PIANA somehow poses a threat to community pharmacy. Nothing could be further from the truth. The Society wants to build on the extremely strong network already in place. But there needs to be recognition that however comfortable life is there will always remain a need to move with the times. The health service around us is changing and the public has expectations that are growing. Pharmacy has always been on the periphery of the primary care team. What has been apparent over the past few years is that Governments have laid plans about the health of the nation with little or scant regard to pharmacy. This fact alone should be a sufficient signal to the profession that it has to move into a more mainstream position within the primary health team, otherwise others may offer to do what we know pharmacists do best.
There needs to be a recognition by the profession that, with the development of e-commerce and greater information technology links, some of our bread-and-butter supply side is likely to be eroded. This only strengthens the argument that we must develop and demonstrate the added value that pharmacy can offer. The position of the pharmacy at the heart of every community is a great strength. We are able to supply prescribed medicines. We need to develop this further, in line with the recommendations of the Crown report, to make the fullest use of pharmacists’ skills. This would include prescribing for a wider range of patients, managing repeat medication and being able to treat those patients who are exempt from paying prescription charges, thereby releasing pressure on general practitioners’ surgeries.
Pharmacists are in pole position to be the first port of call with regard to self-medication, but in an aggressive commercial world we need to develop further and become much more prominent within the health team. We need to get to a position where, whenever medicine is discussed by either a health professional or a patient, the next thing mentioned is pharmaceutical input.
We have a model in hospitals. Over the past 30 years we have moved from a situation where pharmacists were involved exclusively in hands-on supply. While they still maintain control and are responsible for how drugs are supplied and for their quality, they have now extended their contribution to health care using their clinical skills, working with highly skilled and trained staff. In some cases this has developed even further to create highly specialised clinical pharmacists. This model is beginning to emerge in the primary care setting. But time is the enemy: we cannot wait the 30 years it has taken for the hospital model to develop. The profession must grasp the challenge and make sure we are involved more centrally in a health service that is evolving rapidly. We also need to ensure that there is a model of payment that will allow this to develop quickly.
The health service is going to move to a far more patient-focused service. Services will fit patients’ requirements and needs rather than patients fitting services. In community pharmacy we already see the patient as the customer, and pharmacists work hard to accommodate their individual needs and to retain their business. We have always been aware that customers can vote with their feet and go elsewhere. Pharmacy is in a unique position in providing easily accessible expert health advice direct to customers, which leads to increased levels of patient self-care.
The Society now has a clear commitment to support pharmacy practice research to underpin the drive to move the profession forward. In a policy climate where strategic decisions are made on good evidence, this focused research is essential to influence policy. It is interesting to note that, in a little over eight years, we have gone from a position of having virtually no practice research, to founding a trust and 10 chairs of pharmacy practice. The same sort of effort and focused thinking must now be applied to getting pharmacy into frontline government policy and research planning.
A hundred years ago there was no pharmaceutical industry. Since the 1960s, the development of medicines has raced forward. The money invested in research and development has produced companies which are the blue chip stock for the financial world. Many of the pharmaceutical companies are now global with products that have transformed health care and revolutionised people’s expectations and quality of life. This pace of change is set to continue with the development of gene therapy. The mapping of the genome and the ability to read an individual’s “genetic fingerprint” opens new realms of personalised treatment and, more importantly, it offers the opportunity to prevent disease. Pharmacists must ensure that they are the key people in delivering this tailored medication. There will be many others vying to do this. However the scientific and broad nature of the pharmacy degree marks out the pharmacist as best person for this exciting new role. We must not allow our natural caution and conservatism to block our way and prevent us from meeting the challenges of a New Age.
The Society has recognised that meeting these challenges requires a review of its organisation and the way it works. At Lambeth, we have made some significant changes and we are tackling the corporate responsibilities of the Council to bring greater probity and transparency in the way we work. One of the major issues, which the membership flagged up, was a desire to raise to public profile of pharmacy.
To achieve this we now have a Public Affairs Directorate whose job it is to influence policy makers so that our vision can be implemented. The Public Affairs Directorate is currently co-ordinating a programme of political and parliamentary contact, including the formation of a parliamentary pharmacy group and the formation of a patient liaison group. All this is in addition to the day-to-day public relations work that ensures that the voice of pharmacy reaches the widest possible audience. In addition we are continuing to build better relationships with other health professionals and with patient groups that are essential to improving pharmacy’s position as a health care provider.
The services that the Society provides to the membership are also set to improve and we are confident that within the next couple of years the membership will clearly see the benefits of planned upgrades to our communication and information systems at Lambeth.
There have never been more opportunities for pharmacy and we are standing at the threshold of a new millennium which will offer new and exciting challenges. Ours is a past that we can truly be proud of and the future is ours to shape.