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

Person Centred Care and Services

21. Person centred care and services fall into main three areas -

• care for patients with prescribed medicines
• diagnosis, treatment and advice for those requesting it
• public health services to change behaviour and promote healthy living

22. In our discussions, patients described what they wanted from their pharmacist and pharmacy in the community -

• continuity and consistency of professional input and care from an individual pharmacist
• easily understood information about their medicines adapted to the needs of the individual
• appropriate support and advice
• greater ownership of their own care
• accessible services
• a suitable environment, which allowed privacy and confidentiality when required.

They also wanted to know that the relevant information needed to deliver high quality care would be shared between the professionals involved including when they used hospital services. Some form of patient held information (paper or electronic) about diagnoses, medication, allergies etc would be welcomed by many. They said that they would often ask a pharmacist questions about their medication which they were unwilling to ask of their GP. They also expected the overall system to be safe and error free, and that their pharmacist would act as the "guardian" of their medicines.

23. The arrangements already being put in place in Scotland for community pharmacy provide a good foundation to meet those needs. As indicated earlier, this could be reinforced by a stronger focus on the individual pharmacist and the personal and continuing relationship with patients and, where relevant, their carers. The term "named pharmacist" was used by many patients to describe that relationship, supported by a system of registration. This also means in some cases redefining the relationship between the pharmacy owner and the individual pharmacist to ensure that the latter has the freedom and is supported to exercise professional judgement for the benefit of patients. This is a fundamental principle and we recommend that this should also be reflected in the future arrangements for pharmaceutical care in Scotland.

24. Where medicines are prescribed, the supply of those medicines, important though it is, instead of being seen as the prime function of community pharmacy, becomes a trigger point for the establishment of a more meaningful clinical encounter between patient and pharmacist. This brings the opportunity for greater patient involvement in their own care and improved understanding of what the medicines are intended to achieve, how and when they should be taken, and how to resolve any concerns. In some circumstances the supply of a medicine can be separated from the provision of pharmaceutical care e.g. assessing risk factors in medication before treatment with medicines.

25. The professional relationship between pharmacist and GP also ensures a consistency of message and clinical regimen. This in turn leads to improved adherence, reduced waste and better patient outcomes. While this is most clearly demonstrated in relation to patients with chronic disease and multiple conditions, as exemplified by the development of CMS, it is also an important part of the service to acutely ill patients. Over 200,000 patients are now registered with CMS with numbers continuing to increase each month. A number of GP practices and community pharmacies are engaged in the Early Adopters phase of the serial prescribing and dispensing element of the service. The focus now should be to build on the experience and lessons learnt from these Early Adopter sites whose pioneering work will help to embed and mainstream the serial prescribing and dispensing element of CMS so that the service can realise its full potential for patients.

26. But the pharmacy and its professional staff also provide the focus for a wider range of services than just those related to prescription medicines. Readily accessible advice on self-care and appropriate treatment of common conditions is an important part of the role of the pharmacist in the community. This has been demonstrated by MAS, but there is a need for this role to be more widely understood by the public and by other professionals. We recommend that Scottish Government should consider how the underlying principles might be extended more widely and suggest that this could usefully be taken forward under the umbrella of the joint initiatives supported by RCGP and RPS to ensure common standards and expectations of the two roles.

27. The Public Health Service has also shown where specific targeted initiatives such as smoking cessation and EHC can have a direct and measurable impact on behaviour change and responsive care and treatment²³ . The pharmacy profession is keen to see further services included, but it is important that these are of high priority and evidence based, and that the time and resources committed provide value. A currently relevant example is in relation to alcohol misuse, where a review by Public Health Wales²⁴ found that community pharmacists trained in brief intervention techniques were able to screen for and provide advice to individuals who would benefit from reducing their alcohol consumption. We recommend that the evidence for the contribution of pharmacists should be considered further within the Scotland wide strategy for tackling alcohol misuse.

28. We recognise the major improvements to many pharmacy premises which have taken place over recent years, and the support provided by Scottish Government. We also welcome the approach by the General Pharmaceutical Council in its proposals for the standards of registered pharmacy premises, particularly the emphasis on safeguarding the health, safety and wellbeing of patients and the public, and on supporting professionalism which we see as consistent with the emphasis in this review. We believe that an important part of the relationship with patients is to ensure that their privacy and confidentiality is safeguarded, and that pharmacy owners should actively consider how this can be achieved in their premises. The design of premises can be an important factor in emphasising the nature of the professional services being delivered and the relationship with patients.

29. In all of these services, it is not just the pharmacist who is key to effective and efficient provision, but the whole pharmacy team, involving professionally registered technicians and counter assistants. We return to this in the section on workforce and education.