Community pharmacies could be NHS ‘third tier’

18 January 2013

School of Pharmacy

At the 2013 UCL School of Pharmacy annual lecture, Sue Sharpe, the Chief Executive of the Pharmaceutical Services Negotiating Committee (PSNC), presented a blue‐print for community pharmacies to serve as a ‘third tier’ in the NHS, alongside GP practices and hospitals.

During her lecture, entitled From Making Medicines to Optimising Health – Pharmacists in the 21st Century, she suggested that innovations like Healthy Living Pharmacies can provide better and more affordable care in areas ranging from the prevention and early detection of obesity and smoking related problems such as cancers, strokes and heart disease through to ensuring good treatment for people with raised blood pressure, type 2 diabetes and some emergency needs.

She called on Ministers and new health service bodies such as the NHS Commissioning Board to champion ways of enabling community pharmacists to contribute more to the economic provision of well integrated, easy‐to‐access health services for people at all stages of life.

“The primary care progress the NHS needs to survive through the next decade of austerity can only happen through strong partnerships between community pharmacists and professionals like GPs, community nurses and social care providers. Building on the good relationships that already exist between doctors and pharmacists is vital, although when patient and public interests can be better served by extending service users’ choices or closer working across traditional boundaries we should not be afraid of radical change. Better medicines taking alone will generate £100s of millions of benefit and saving.”

The primary care progress the NHS needs to survive through the next decade of austerity can only happen through strong partnerships between community pharmacists and professionals like GPs, community nurses and social care providers.

Sue Sharpe, CEO of the Pharmaceutical Services Negotiating Committee

Other key messages from contributors to a UCL School of Pharmacy meeting held at the Royal Society today to discuss Sue Sharpe’s analysis and promote the achievement of better pharmaceutical care following the implementation of this year’s NHS reforms in April 2013 include:

More effective medicines taking support for vulnerable people living in their own homes will save lives and preserve independence

Leading independent pharmacist and NHS Future Forum member Ash Soni said: “There are risks of ‘back ward’ neglect in the community, and failures to help people take their medicines to best effect. This causes needless illness and waste. The new Clinical Commissioning Groups should work to extend the primary care role of community pharmacists, and more effectively combine social care provision with help

in medicines taking.”

The importance of professionalism in the twenty first century

Helen Gordon, the Chief Executive of the Royal Pharmaceutical Society, argued that: “Recent events at Mid Staffordshire NHS Trust and elsewhere in the NHS have shown that professionalism – putting the patient at the heart of decisions ‐ isn’t a “nice to do”, it is a prerequisite for safe and effective healthcare. Pharmacists contribute through applying not only their knowledge of medicines, but also compassionate insight into how and why individuals behave as they do. They are striving to achieve excellence through professionalism in the face of unprecedented demand and at a time of financial constrain within the NHS. The lesson from other high risk industries is that the system and culture in which people operate must allow professionalism to flourish. “Organisational professionalism”, making sure that boards and managers prioritise the quality and safety of care above everything else, is also essential.”

Public health programmes to curb problems like excessive drinking, obesity and the consequences of physical inactivity and poor diet need to be complemented by support for individuals

Professor Richard Parish of the Royal Society for Public Health, who chairs the DH’s Pharmacy and Public Health Forum, noted

that ‘community pharmacy has led the way in smoking cessation, and encouraging the use of medicines that help people who want to change their behaviour to stop using tobacco. Members of bodies such as the new Health and Wellbeing Boards should support pharmacy service developments across the spectrum of public health activities. I also believe that community pharmacists should be able to refer people directly to diagnostic services, as and when they have reason to believe this could bring benefit.’

Wider and more cost effective use of medicines that can prevent disease would save thousands of lives and disabling events every year

‘Providing more convenient, less costly, population access to medicines that can prevent strokes, heart attacks and conditions such as colon cancer will become an increasingly important NHS and global goal’, noted polypill pioneer and Royal Society Fellow Professor Sir Nicholas Wald. ‘Community pharmacists have a key role to play in achieving this, and promoting future health gains in ways that avoid harmful medicalisation, and are consistent with free and informed individual choice.’

Better ways of predicting non‐adherence in medicines taking and enabling patients to use medicines as effectively as possible will also save lives

UCL School of Pharmacy researcher and specialist HIV physician Dr David Pao said: “Today’s medicines can allow people with HIV to live long and fulfilled lives, and stop disease transmission. But they do not work if they are not taken properly, and we need to be able to predict this problem. The same is true in other areas, like cancer treatment. Pharmacy is at the cutting edge of helping to optimise the nation’s health through better medicine taking – it is a key area for research and better practice.”

Dr Devyn Smith of Pfizer presented new information about the development of treatments by the research based pharmaceutical industry and universities such as UCL. He described current progress in molecular and regenerative medicine in the UK and elsewhere that promises better treatments for conditions ranging from lung cancers (over 10 per cent of which happen in non‐smokers) to ulcerative colitis and macular degeneration, a leading cause of blindness.

Professor David Taylor of the UCL School of Pharmacy said: “Austerity or not, continuing to invest in new and more effective treatments is a vital public interest. So too is improving access to medicines and the professional care needed to use them to optimal effect, nationally and globally. Pharmacy and pharmaceuticals have important roles to play in the twenty first century, as integrated parts of care systems aimed at meeting human need and helping individuals achieve their goals.”