Review of NHS Pharmaceutical Care of Patients in the Community in Scotland

Working Together

51. A number of pharmacists working in the community highlighted their professional isolation and a wish to work more closely with colleagues in the same discipline and with other professionals. We recommend that NHS Boards to take the lead in creating professional networks and support for community based pharmacists, and to extend these to include the whole of the local pharmacy workforce. A practical approach would be to focus on particular clinical areas such as polypharmacy in the elderly or the implementation of services such as CMS, building on the approaches which have already proved successful in areas such as end of life care and drug misuse. This would also have the advantage of creating an obvious bridge to the involvement of other professional groups.

52. The pharmacist in the community will be the member of a number of teams - the team within the pharmacy, the wider primary care team, and the network of pharmacists in area wherever they work. The role of these teams will change as the service needs and the locus of care change, from hospital to community, from GP practice to pharmacy and from professional to self care. In all of this the NHS Board has a key role to play in providing professional leadership and support. But the increasing pressures in the community and the need to provide pharmaceutical care to a larger number of dependent patients brings into sharp focus the sustainability of the traditional single handed pharmacist. Just as medical practices and other some professional groups have sought ways to work together and provide a wider range of services, we recommend that a similar approach may be needed in pharmacy. Part of this may be to incentivise individual pharmacy practices working together, sharing support and premises, while at the same time preserving the accessibility so valued by the public. And, as has happened in hospital pharmacy, there is the opportunity to make greater and better use of pharmacy technicians in the community which will also help to free up a pharmacist's time.

53. A number of pharmacists working in the community are not based in community pharmacies. Some are working in GP premises, others in specific clinical areas, e.g. drug misuse, or in other settings such as care homes. Not all pharmaceutical care services have to have a community pharmacy as a base, and those which do have that base may still require the pharmacist or other team member to leave the pharmacy to work in other settings. It is important that the most effective and efficient use is made of all the pharmacy professionals in an area, and the NHS Board needs to consider how that is best achieved in its own local circumstances. Whatever the arrangements, the individual patient is key, and the communication and information exchange has to ensure that a co-ordinated pharmaceutical care service is provided.