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

Pharmaceutical Care

16. Community pharmacists are generalists in their knowledge of medicines. Each pharmacy has a very mixed case load of patients for whom they provide professional care. Some twenty years ago it was estimated that a 'typical' pharmacy served, for example, up to 500 patients on antihypertensives, 150 asthmatics, 50 diabetics and 20 cancer patients - we would expect these figures to be higher now¹⁸ . Their care should be delivered as 'pharmaceutical care', a philosophy which emphasises the pharmacist's responsibility for the outcome of the treatment, not just its supply. Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. It involves cooperation with the patient, and other professionals, in designing, implementing and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient.¹⁹ This approach is a particularly effective way of (amongst other areas of care) managing long term conditions.

17. Many of the problems associated with medicines and outlined in the previous section are addressed by this approach, including detecting prescribing and monitoring errors, involving patients in decision making, improving adherence and reducing waste. Pharmacists working with GP practices can significantly increase the quality of their prescribing²⁰ . To be effective pharmaceutical care requires good communication and shared understanding with patients and local prescribers. Additionally, the approach of being focussed on the outcome of interventions rather than the nature of them can be applied to self-care, and health promotion and prevention. In the case of self-care, the pharmacist will distinguish the complaints that require referral to a doctor and those that can be dealt with by self-medication, and provide appropriate advice and follow up. Targeted public health activities involving treatment and behaviour change, such as smoking cessation, are also a key part of pharmaceutical care. In Scotland, the main elements of the current Community Pharmacy contract - the Chronic Medication Service (CMS), the Minor Ailment Service (MAS) and the Public Health Service (PHS) - have underpinned this approach to pharmaceutical care.

18. But, importantly, to be most effective pharmaceutical care must be delivered within a framework of multi-disciplinary co-operation, which means that the pharmacist works in partnership with the GP, the nurse, the social care worker and any other professional involved to arrive at optimal treatment for the patient. And that therapeutic partnership also extends to the patient and any carers involved.