TUESDAY 5TH NOVEMBER 2013:
Now or Never: shaping pharmacy for the future envisages pharmacists across England expanding their role by treating many common illnesses, supporting people with long-term conditions and challenging wasteful, dangerous or inefficient use of medicines.
The authors warn that unless this shift takes place, the NHS will be letting down taxpayers and patients by missing opportunities to do more for less, and many community pharmacists risk being forced out of business as austerity and technological change drive down income.
The report, from the Commission into Future Models of Care delivered through Pharmacy chaired by Nuffield Trust Director of Policy Dr Judith Smith, finds that pharmacists have a marginalised position in the NHS and in health policy. It warns NHS England, the Department of Health and pharmacy leaders including the Royal Pharmaceutical Society that a united effort must be made to change this.
People across England should expect pharmacists to offer far more than just medicines. The report shows case studies of pharmacists providing vital health services ranging from vaccination, to the management of anticoagulation for people at risk of stroke. In some areas, pharmacists are working with other health professionals to visit frail elderly people after they are discharged from hospital, helping them manage their conditions and keeping them from needing to go back into hospital.
The authors conclude that re-focusing pharmacists as care-givers could reduce demand on GPs, out-of-hours and hospital services improve access and care for patients and free up capacity within these NHS services. This could play a major role in enabling the health service to cope with the unprecedented financial squeeze it faces, while still providing care free at the point of use, and improving access and dignity for patients.
They warn that pharmacists need to step up locally and nationally to lead in improving the use of medicines and the NHS must be ready to take advantage of their expertise. It is unacceptable that while the NHS spends £12 billion a year on medicines, between 30-50% of patients do not take them as prescribed, and 6% of emergency admissions to hospital are caused by avoidable reactions to medicines.
The report’s recommendations are summarised in an Executive Summary, and include:
- Pharmacists and their employers must shift their focus away from dispensing and supply of medicines towards providing a broader range of services
- They must drive change at a local level, proving to decision makers in the NHS and local government that they should be doing more
- The pharmacy profession should appreciate that there will be no new money: change will come from using existing funding better
- Pharmacists should work with other professionals in joint teams, and should come together in networks, or chambers like barristers, to provide large-scale new services
- The Department of Health (DH) and NHS England (NHSE) must include pharmacy in plans for the future of out-of-hours and urgent care, public health and the management of long-term conditions
- DH and NHSE should be open to pharmacists holding contracts individually or as groups rather than through employers, and should use their positions to shift funding from dispensing and supply towards new services
- DH and NHSE should work with leaders of pharmacy to create a united narrative about the future of the profession
- The Royal Pharmaceutical Society and other groups representing pharmacy should take responsibility for making these changes happen, and should work in a coordinated way to improve professional leadership. This should include the creation of a Leaders' Forum where innovative pharmacists can spread and improve best practice.