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After a long wait for something substantive to happen in pharmacy, we have witnessed three big developments in a very short period of time — the OFT response, the proposed framework for a new community pharmacy contract and the Vision for Pharmacy — all courtesy of the DoH. All three documents are interrelated and likely to impact heavily on the future direction of pharmacy. However it is the Vision document which I am going to comment on, because on first reading, it seems short on substance and specifics.
For example, there is no fixed timetable, it is not clear where the funding will come from and it is vague on IT infrastructure and access to medical records, premise upgrades and the rational distribution of pharmacies. Take, for example:
• Jim Smith’s 10 key roles for pharmacy: these lack innovation and seem dated, while woeful omissions include the management of minor ailments on the NHS by pharmacists and provision of compliance aids to susceptible patient groups.
• Barriers and factors for pharmacists to undertake future roles: I am dumbfounded by this question as it is abundantly clear both to Government and pharmacy what these issues are. Some are even alluded to in the consultation document! A better question would have been: how can these barriers and factors be overcome?
• Integration of community pharmacy into the NHS: this is another question, the presence of which in the document defies logic. Factors to be considered range from IT infrastructure to adequate NHS remuneration — all of which are within the control of the Government which seems to procrastinate on these issues every year.
• Closer working partnerships:professional relationships at grass roots between healthcare professionals are generally good but the professional leadership at national level is sadly lacking, with no overall unified strategy for pharmacy Since a lot of other professionals don’t know what pharmacists do, there is an education issue here.
• Consultant pharmacists: the only novel idea proposed in the whole document is that of consultant pharmacists. This may even help define a career structure for pharmacists, the apparent lack of which is often a cause of much disillusionment in the profession. However consultant pharmacists must be recognised as being on a par with doctors and be remunerated accordingly.
• Supplementary prescribing:I feel there is an over-emphasis on supplementary prescribing that doesn’t fully realise the true potential of pharmacists. Why must pharmacists undertake the same training as nurse prescribers? Most pharmacists will feel the challenge lies in independent rather than supplementary prescribing — so why is detail on this lacking in the document? Is it because they expect us to compete with nurses?
• Skill mix: this is another issue where I feel the document is quite positive in its approach. If a clinical check/intervention has been undertaken bya pharmacist at some stage of the dispensing process, then why can’t the rest of the dispensing process/counselling not be delegated to appropriately trained support staff? That said, SOPs, competence, clinical governance and referral criteria need to be robust.
Although the Vision for Pharmacy is a vast improvement on previous Government documents, it still lacks specifics and details on manyof the important issues. I hope these are forthcoming during the consultation process.
All three documents issued by the DoH have the chance to shape positively the future of pharmacy, consistent with pharmacists’ own aspirations — but only if the Government commits the necessary investment and puts ‘flesh’ on a lot of rather vague statements. Only then can the Vision become a Reality.
(With acknowledgement to CIG and Pharmacy magazine - 6/10/03)
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