Jonathan Sheppard: A frontline role for community pharmacists

Jonathan Sheppard is Editor of ToryRadio.

> Policy summary

The Health Service, and in particular primary care is coming under increased pressure to deliver. An untapped resource - in the shape of the local pharmacist - can and should be used to relieve pressure on an under-delivering NHS.

> Policy explanation

NHS resources are stretched to breaking point. The Government claims that funding is at record levels yet actual health outcomes are failing to show improvements. Money continues to be wasted on bureaucracy and isn't targeted to the areas where it will achieve the best results for healthcare.

People still use NHS services inappropriately. For example, hospital A&E departments are full of people who could be dealt with by their GP in a primary care setting. At the same time, GPs are unable to spend quality time with people who need more specialist care because their surgeries are filled with people who have minor ailments that can be dealt with elsewhere.

People need to take responsibility for their own health to prevent or delay long term illnesses in the future. The under utilised resource is community pharmacy.

Pharmacists are highly skilled professionals - they go through five years of training - they are experts in medicines and have far more knowledge on the subject than any other health professional including GPs. Pharmacists are accessible where people live, shop and work 24/7 and should be the first port of call and entry point to the NHS.  It is estimated that six million people visit pharmacies daily.

With the new pharmacy contract, pharmacists are helping people manage their illnesses and providing support and advice to those with chronic diseases like diabetes, asthma and heart disease. They are already prescribing repeat medicines for patients instead of them visiting the GP every time. Additionally two thirds of patients do not understand their medicines, half of patients stop preventative medication within 1 year, 60% patients forget to take medication regularly and 82% of patients want to know more.

Using pharmacists, patients can be enabled to understand their medicines better - it will save lives, improve health outcomes, empower patients to look after their health better and prevent ill health.

Demands on the NHS are only going to increase over time, It is imperative to use the skills and resources in the NHS as effectively as possible and that means there is the need to get the right professional for the right job.  Pharmacists are an untapped resource in the NHS.

One of their key roles would be to ensure that medicines are being used properly, reducing wastage, increase effectiveness and thereby improve health outcomes.  This would deliver Win for Govt a Win for NHS and most importantly a Win for patients.

> Questions for ConservativeHome readers

• Is there a specific financial cost given to a patient visiting their GP?
• How many GP visits are there per year?
• How many could be equated as unnecessary and dealt with by a pharmacist?

> Costs

There should be no overall cost as any additional spend, could be redistributed resources and money from secondary care to primary care as improvements to health flow through. 

Comments

[malcolm]

Seems a good idea in principle.But isn't there a danger that some unscrupulous pharmacists will prescribe unnecessary medicines because they want the revenue these medicines will bring?

[BorisforPM]

Fabulous! I had almost finished writing my own proposal for 100policies which was based on this exact idea. In answer to malcolm: pharmacists are bound by similar codes of practice [and similar consequences for breaking them] as doctors. The risk is no greater than the one that a doctor might prescribe the cheaper but less effective treatment, so that he can keep the rest of the money.

Pharmacists are trained well beyond what we currently have them doing. This is an excellent way to deliver a greater quality of care without great extra spending. It fundamentally conforms to our most central principles, too; we can bring about an improvement in a public service by devolving some of that service closer to the communities it serves, not spending any further money, and introducing an element of competitive enterprise on the part of the pharmacists. All this while the service itself [in the form of prescriptions] remains largely state-subsidised.

The role of a doctor really is to identify disease and identify the best *form* of treatment; once a drug treatment is chosen, it is the pharmacist who knows most about those drugs, and who should decide how much of what drug should be prescribed.

It is worth noting also that in other countries - France being an instructive example - almost everyone considers their pharmacist as their first port of call if they are ill. Only serious problems merit a visit to the [in our case massively overworked and under-resourced] doctor.

This proposal is exactly the sort of thing we should be recommending - please do vote to approve it!

[Matthew]

Excellent, throughly excellent! Not much more to say!

There's obviously a small scope for 'corruption' as malcolm points out, but as Conservatives we have to base what we do on trust as far as possible. Corruption can never be entirely stamped out, unless you don't trust anyone with anything! I'd think the risk is no greater than, say, GPs billing PCTs for out-of-hours work they haven't done, which has happened.

[Kevin Davis]

This is a good idea. In part this is formalising what the best "independent" pharmacists already do.

However, I would be worried about the pharmacists employed by the chains!

[Alison Anne Smith]

Great idea.

[Peter Coe]

Yes, good idea - here's the "but": we're producing nowhere near enough UK pharmacists, and one of the areas that migration from accession countries is benefitting us in is pharmacy.

And following yesterday's little-Englander outbursts from both Labour and Conservative politicians on putting restrictions on inward migration from future accession countries, we're not going to be able to square the circle.

So either we need to train more home grown pharmacists (fine, but if it's so easy why aren't we already? - part answer: because we don't have enough scientifically-qualified, inspiring Science teachers in schools), or we need to have a much more nuanced policy on immigration than Damian Green articulated yesterday. Or, of course, we can do both - something I'd support.

[Denis Cooper]

Peter, importing skilled people from abroad should never be used as a substitute for properly educating and training our own people. We'll still be stuck with the uneducated and untrained indigenes, unless you propose deporting them. As a short term expedient, on fixed term contracts with a clear commitment that they would make no attempt to stay beyond the period of the contract or extend that period, and that they absolutely waived any right to claim asylum on the pretence that they dared not return home, bringing in people from abroad could sometimes be useful, but not as a substitute for sorting out our own educational system. The only exception should be those with the very highest skills or expertise or ability - ie comparable to say the top 0.1% of the indigenous population - in which case they really would be a longterm asset with little downside. We have loads of our own people who are a bit below or a bit above average, and we have no need to import more. But those who are exceptionally talented would be a real acquisition for us, although possibly also a loss for their home countries.

[Richard]

"And following yesterday's little-Englander outbursts"

Can we please resist throwing names around, especially as that so-called little-Englander attitude is actually very popular.

Regarding the policy suggested, sounds like a good idea to me. It also strikes me as one that the Tories, having seen it, might actually adopt (which isn't to criticise previous suggestions, it's just that they might fall foul of being perceived as too radical (controlling the Mayor) or too controversial (passenger profiling).

[Pete X here]

Six million people can't be wrong - how many of them would vote the right way if the policy was adopted and their local pharmacy's future was assured (and it safeguards local community services)

[BorisforPM]

Peter Coe, I agree that we have not produced enough pharmacists in the UK. I would hope that, in the medium-term at least, raising the level of trust we place in pharmacists, and the impact of their role, will make the career a much more attractive one. The problem of science teaching in our schools is one that I don't suppose anyone could quibble with.

I do think that part of the reason why many able teenagers are turned off the idea of pharmacy is their perception of pharmacists as mere "pill-counters." Hopefully, once teenagers have visited our newly-empowered pharmacists a few times and seen the great difference they can make, the career will become a more attractive one.

In the short-term, skilled immigrants may well be part of the solution. Our party does indeed have a problem with the public's perception of a "Little Englander" wing, but I don't think that yesterday's comments are really part of that at all. It stands to reason - whatever your views on the cultural benefits of different levels of immigration - that we can't cater for an infinite number. Our own interests apart, we couldn't possibly hope to take care of any immigrants properly if we didn't have sensible talk of short-term limits to the immigration flow.

The very fact that both parties are now engaged in a sensible debate about such limits, without resorting to "racist"/"little-Englander" mud-slinging every time the topic is mentioned, should be a great source of comfort and relief to us all.

[Peter Coe]

I think we're at risk from diverting this discussion away from giving pharmacists more responsibility to immigration - apologies if I've been responsible for that, but the two can't be separated.

As I said, we should both work to boost pharmacy as a profession and continue building our advantage over our major European competitors by making Britain attractive to migrants from "new Europe".

But I repeat: it's not a straightforward matter: we have a lack of home-grown pharmacists because we have a lack of science graduates; because the sciences are not inspiring people at school: so we need more, qualified, inspirational science teachers first: by the time they're identified, trained, out teaching and the graduates they've taught graduated we're talking a minimum of a decade.

On the comments about immigration, well if we don't want to be perceived as Little Englanders then we need to get away from the sort of language that's splashed across the Sun today. Damian Green did not achieve that, in my opinion, yesterday, when the immigration stats were published.

All I saw was a knee-jerk "we're being flooded" reaction to a *positive* revelation that Britain has a head-start in building a strong, skilled, affordable workforce, contributing to tax revenue, impacting on the welfare state hardly at all.

I'm all for sensible debates, not sure we're having one yet.

[NigelC]

I am in favour of the policy but we need to fund the training places and make sure the skills are in place (Wasn't there a story some weeks back that you did not need maths A level to get on a pharmacy degree course- quite worrying)

[Paul Staines]

Legalising online pharmacies would be a complementary policy. As would delivering on paperless e-prescriptions. That would save the NHS millions in paperwork. It was due to be implemented nationally in 2001.

So only 5 years overdue.

[Patsy Sergeant]

I agree with Malcolm @ 9.21 - that in principle this is a great idea, but that it needs safe-guards built into it. To draw a parallel story for comparison - I used to interview GP's for a job, and I remember one GP that I interviewed quite a few times who worked in a surgery in a 'deprived' (whatever that means!) area of Portsmouth, told me how patients would come and demand perscriptions for sleeping pills, so that they could sell them on (he believed), and patients would also come and demand letters that they could take to the council, saying that they needed a ground floor flat, or such like!

So a pharmacy with more power would need to be adequately protected from that kind of customer who was prepared to threaten to get what they wanted, rather like small GPO's, unfortunately, nowadays there are many more unscrupulous people out there!!

[Gildas]

A cautious 'yes' from me. I agree with the principle, but what must not happen is pharmacists be subsumed by the state - i.e. in the wake of this new responsibility they wind up saddled with extra regulation and targets imposed on them.

In terms of your questions:

1. No idea

2/3. My family (2 adults and a 2 year old) have been to see the GP perhaps 5 times over the past couple of years. Probably 3/4 of those could comfortably have been handled by a pharmacist - IF we felt that they knew what they were doing to be able to answer our question.

If you go to the GP, and it turns out to be something more serious than you first thought they can refer you to hospital. Perhaps pharmacists would need some kind of expedited way of getting in touch with a local doctor if they felt the issue was out of their area of expertise.

Finally, this would need a public information programme to make the public more aware of using pharmacists and not GPs.

[Matt Wright]

Good idea. I will approve,

Matt Wright

[aristeides]

I actually do not know which way to vote on this one. I am not sure there is quite enough detail in the policy proposal and this is evident in the statement that pharmacists should "ensure that medicines are being used properly, reducing wastage, increase effectiveness and thereby improve health outcomes." How exactly would they do this and is it just a case of dispensing stern lectures along with the drugs?

The policy does not seem to permit the pharmacist to prescribe drugs and, although I agree with that, it doesn't leave them with a lot to offer except worthy advice and sympathy.

NHS Direct was set up with the same intention: to reduce the burden on GPs and casualty departments. I think that experiment could be said to have failed. It was very expensive and they basically ended up telling you to go to your GP for anything but the most basic of ailments. I wonder whether this policy could be construed as an attempt to shift that slightly uninspiring role to the next available line of defence?

That is not to say that pharmacists are not underused and there may be some point in a public education campaign to increase "awareness" of their use. But then there are good reasons for speanding taxpayers' money on many things... Maybe an equivalent amount of money could be just as well spent on having a self-diagnostic public triage website?

[BorisforPM]

Aristeides, the beauty of this idea is that it - unlike NHS Direct - requires very little additional outlay. Our pharmacists are already sufficiently trained to undertake the majority of these tasks, and the prescription of many drugs for minor ailments. It's just that we don't trust them as much as we ought to.

In other countries, such as France, use of the pharmacist for routine ailments is entirely standard, and works very well as a first, community-based level of healthcare.

[BorisforPM]

Aristeides, the beauty of this idea is that it - unlike NHS Direct - requires very little additional outlay. Our pharmacists are already sufficiently trained to undertake the majority of these tasks, and the prescription of many drugs for minor ailments. It's just that we don't trust them as much as we ought to.

In other countries, such as France, use of the pharmacist for routine ailments is entirely standard, and works very well as a first, community-based level of healthcare.

[NigelC]

Paul 3pm
Legalising on-line pharmacy is fraught with problems around drug safety and security. I would not go there

[Paul Charlson]

Good idea. Pharmmacists are under utilised.
They do need more training in managing minor ailments first and when to refer on to other serivces. Pharmacies are generally not set up to properly examine patients and this needs addressing.
All pharmacists should become independent prescribers.

Nurses have successfully extended their roles but pharmacists have been slow to realise the opportunities which their qualification brings

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