Opinion: Looking forward. Charting a course for pharmacy

At the time of writing, I have just had word of a much-needed advance payment being granted to support contractor cashflow in Scotland as costs rise and margins are squeezed, something I have only ever seen done once before. 

However, unlike the last advance we were given to help us ride out the disruption to the generics market due to manufacturing issues, this particular ray of light is just a temporary measure, with further action required to keep our services running for the people of Scotland. 

At the same time, every conversation I am having with our members paints a picture of a network under extreme pressure, with workforce challenges that will not be resolved quickly affecting our ability to deliver and a creaking NHS directing more work our way.

Yet through the dark skies I can clearly see a bright future for our sector on the horizon. Also, for the first time, others from outside the profession are slowly coming to realise that the community pharmacy network is effectively propping up the rest of the healthcare system and could do so much more to support the wider NHS. 

In the words of our former chief pharmaceutical officer, Rose Marie Parr: “Community pharmacy is the new black”. This is evident in the sharp increase in use of our clinical services over the last year – clearly shown in the over 5.5 million recorded NHS Pharmacy First Scotland interventions and particularly high demand on sites running the prescribing-led extension to the service. 

Remodel care

I believe this is symptomatic of a NHS that is struggling to meet the healthcare needs of the population. As a network, it is essential not just to respond to this pressure but to remodel care to address health concerns further upstream with preventative interventions. 

We find ourselves in a tricky yet not unsolvable position. As the health service comes to ask whether we can meet critical needs, for example by handling hospital discharges or expanding our women’s health service, our answer at this moment is that, while our colleagues in the network have proven time and time again that they have the capability to deliver first-class care, our available resource and therefore capacity to deliver is what would stop us from taking on more.

It is important to stress that we deliver care to citizens and not just medicines.

When making this assertion in public, I’m often challenged on whether the supply of medicines is getting in the way of delivering clinical services – and have heard more than once that dispensing would be better done elsewhere, centralised, nationalised… I’ve heard it all.

I can understand where this thinking comes from, but for me it is fundamentally flawed. Dispensing is a clinical service in and of itself, with the potential to drastically improve outcomes if we choose to view it not through the lens of a process that ensures accuracy, but one that ensures safety and maximises benefit.

Yes, accuracy is important – but we have decades of experience and ever-improving systems, training and technology that can give us comfort in this respect, and the confidence to “let go” of what is at times an obsession of our profession.

For me, the main take away from this introductory article is that the community pharmacy network needs to shift its focus from accuracy of supply to safety of supply – and the two are subtly different.

New obsession

Our new obsession must be making the most of every interaction with our patients and the public. Community Pharmacy Scotland’s research shows that we hold a privileged position in terms of the volume of face-to-face conversations that happen up and down the country every day. 

This same research described the special trust people place in their local pharmacy teams, with seven out of 10 people saying this is the major driver behind their choice of which pharmacy to use. 

Nine out of 10 respondents said that they had confidence in pharmacy teams’ ability to manage their long-term condition – adding to my view that it is really only the resources and capacity to deliver on this support that we need to develop. 

Accepting that there is no “silver bullet” for our current issues, the question that I and my colleagues have been working on is how we navigate from where we are today to where we want to be in terms of positioning and delivery.

Over the next five months, I’ll be exploring a different aspect of the future of community pharmacy in turn:

• In March, I will look at the clinical focus, including independent prescribing, of our services moving into the future – demonstrating how supply and supportive pharmaceutical care interventions are inextricably linked
• In April, I’ll give an overview of how initial and ongoing education and training is increasingly being designed to equip pharmacists with the skills and behaviours required to deliver these services
• In May, we will tackle how to make dispensing a “background” activity – with a particular focus on IT and support teams
• Finally, in June, I hope to add to the debate around supervision and how this needs to change to empower pharmacy teams to work differently and more efficiently.

I have worked in my current role for 16 years and in community pharmacy practice for a further 18 years. Even in Scotland, where we enjoy a world-leading contract, I have never experienced such trying times. Equally, I have never seen such an opportunity for evolutionary change as we have now – necessity being the mother of all invention. 

I hope that through this series we can begin the debate and all come to agree that change is required and by working together with a shared focus, a bold and bright future is entirely within our reach.