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

Changing Relationships

19. If we are to see the full benefits of pharmaceutical care, pharmacists in the community need to be seen by the public and fellow professionals as full members of the wider primary care team and a core part of the NHS. Community pharmacy is seen to act as a commercial enterprise with a focus on the supply function. Concerns about lack of continuity through changes in staff and use of locums get in the way of building continuing relationships. For the public, trust is a crucial factor in healthcare settings, and a recent study in the West of Scotland²¹ demonstrated that participants' trust in pharmacists was less than it was for their GPs. The authors cited factors which reinforced trust and confidence in GPs such as registration, appointment systems, gatekeeper role, practice environments, and the nature of the interactions. They suggested that health systems had to change in a way that promotes trust in pharmacists, for example by increasing the quality and quantity of patient interactions with pharmacists and gaining GP support for extended pharmacy services. This is reinforced by a study of patient evaluation of a community pharmacy medicines management service which demonstrated that pharmacist intervention was associated with significant and positive changes in patient satisfaction, and that experiencing a community pharmacist-led service resulted in an attitudinal shift toward the pharmacist²² .

20. Thirty years ago there were tensions between pharmacists and doctors in the hospital setting; these have been resolved over time and we now have, generally, good team working, with important benefits for patient care. In the same way, the relationship between pharmacists in the community and fellow health and social care professionals needs to establish that parity of esteem as reflected in the recent joint statement by RCGP Scotland and RPS Scotland "Breaking down the barriers - how pharmacists and GPs can work together to improve patient care". This emphasises the complementary roles of pharmacists and GPs in patient care, the value of collaborative partnership, and the importance of professional learning together. It identifies a number of key areas of activity, e.g. managing long-term conditions, services to care homes, and supporting self-care and re-enablement, where improved working between the professions would bring benefits to patients. We welcome this initiative and recommend that Scottish Government and NHS Scotland should use the opportunity of the policy changes already being implemented in community based care to work with these and the other professionals involved to reap the practical benefits of the proposals in the Statement. We also recommend that continuity and consistency of care, underpinned by patient registration, should be a key element in any future contractual arrangements for pharmaceutical care, to support the changing and positive role of the pharmacist in the community. We believe that Scottish Government should also take the opportunity of a move towards a more Scottish focused contract for general medical practice to reinforce joint working between the professions.