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

Safe and Effective Services

30. Pharmacy is often described as a risk averse and rule bound profession, contrasted, for example, with the medical profession's approach to dealing with uncertainty. There is, however, strength in that complementarity, and the ability of pharmacists, for example, to detect errors in their scrutiny of prescriptions, to advise on interactions, and to assure the safe dispensing of medicines provides important protection to patients. But it is important that the pharmacist's contribution to safety is integrated with the wider health and social care system.

31. Access to and sharing of relevant clinical, including medication, information between professionals is fundamental to safe and effective care. This is particularly important where patients move from one care setting to another. And yet pharmacists in the community, unlike their counterparts in hospital, have generally not been included in the exchange of information, although they are regulated professionals bound by the same standards of confidentiality as other professions. The full benefits to patient care will not be realised until pharmacists are part of the NHS system of sharing information, and that in turn relies on the building of trust from patients and fellow professionals. It is only at this point that patients in the community will be able to benefit from the additional safety practices and clinical input that pharmacists deliver to patients in hospital.

32. Within community based care, there is a significant opportunity for pharmacists to be full partners in the relevant parts of the Patient Safety in Primary Care Programme. A shared agenda focusing on high risk medicines and high risk prescribing can demonstrate the complementary roles of the professions and the measurable benefits to patients. Inclusion of community pharmacy in medicines reconciliation, when patients enter and return from other care settings (hospital, care home etc), will provide more complete information for other professionals and additional safeguards and improved care for patients.

33. Within pharmacy in other parts of the UK, separate services for particular aspects of pharmaceutical care such as the reviews of medicines use and of new medicines have been established. While these have value in themselves, we support the approach in Scotland where they are part of a single, co-ordinated service for individual patients, building on the approach of CMS. This can be complemented by the use of risk prediction tools to target the identification of and support to those patients most at risk. This would also underline the importance of working with other care staff and the patients themselves to deliver mutually agreed outcomes.

34. For some services, e.g. drug misuse and end of life care, the development of particular expertise, including pharmacist prescribing, and networks of professional support, together with a multi-disciplinary and multi-agency approach, is essential. It is important that this specialist care is co-ordinated with mainstream provision, and relevant information exchanged. These are also areas where a co-ordinated national approach to standards and specification of services would ensure equitable provision across the country, while recognising the specific needs of local areas.

35. In recent years pharmacists who have gained the appropriate qualification have been able to prescribe. However, in practice, little prescribing is done, because it needs to be part of a system in collaboration with others. We believe that, given the increasing workload on GPs, working with prescribing pharmacists in a structured way could be mutually beneficial. Pharmacists could reduce the calls on GPs by acting as an accessible, drop in triage centre with the ability to treat minor ailments (as has been shown in some of the Pharmore+ projects). Pharmacists could also work in agreed ways with patients to find the best formulation and medicine for them to improve patient experience and hence adherence. Any such developments would have to ensure they did not introduce a serious risk of moral hazard, in which the pharmacist would gain significant financial benefit from certain prescribing decisions. There may also be the opportunity to align more closely the training and future qualifications of doctors and pharmacists in prescribing to promote common standards across the professions, as happens already in some other countries.