Priority 3: Empowering the pharmacy profession to transform patient care
Pharmacy has collaborated with other healthcare professionals to better support patient care. Lessons must be learned from COVID-19 to ensure patients benefit from more innovative and efficient ways of working across the NHS. It has also been an opportunity to challenge traditional bureaucratic issues that have held back progress for pharmacy.
Principle 12: All patient-facing pharmacists must be supported to become independent prescribers.
Principle 13: The infrastructure must be established to support and facilitate the use of independent prescribers in all care settings.
Principle 14: Ongoing support must be available to all independent prescribers including peer reviews and mentorship.
|
Patient benefit
|
NHS benefit
|
Increased access to prescribers closer to home who can support their care
|
Improve access to prescribing services
Make the most of pharmacist expertise to deliver patient care and provide better outcomes from medicines
|
Pharmacists have a unique set of skills and knowledge. Trained as scientists and clinicians, with an in-depth understanding of medicines, pharmacists are the ideal practitioners to prescribe medicines. Pharmacist independent prescribers can prescribe autonomously for any condition within their clinical competence. They provide opportunities for new ways of working and increasing capacity and access for patients to high quality care.
We are committed to having pharmacist independent prescribers in all care settings to support person-centred care, ensure better outcomes from medicines and increase capacity in the system. To achieve the widespread benefit from this the infrastructure must be in place to enable pharmacist prescribing in practice as part of the multi-disciplinary team.
Principle 15: Changes in medicines legislation must empower pharmacists to use their professional judgment to improve patient care.
|
Patient benefit
|
Benefit to NHS
|
Patients are more readily available to access appropriate treatment, when a medicine as prescribed is unavailable
|
Reduces requirement for Serious Shortage Protocols which are time consuming.
Better flow within system and reduces burden on prescribers
|
Pharmacists could amend prescriptions in the event of a medicine being unavailable, such as: the quantity, strength, formulation or generic versions of the same medicine (generic substitution). These substitutions are already standard practice for pharmacists in secondary care and across all care settings in Scotland.Enabling community pharmacists to make these simple changes would address this imbalance and improve access to medicines. Find out more about our proposals to mitigate the risks of medicines shortages here.
Principle 16: Pharmacists and their teams must be enabled to contribute to solutions for reducing health inequalities - including tailored communications to local populations.
|
Patient benefit
|
NHS benefit
|
People have local access to professional health care and advice tailored to their needs which should result in healthier populations
|
Reduce health inequalities in the system by: Earlier identification and treatment of high-risk conditions
Better public health and prevention reducing pressure on other parts of the system
|
The concept of the Inverse Care Law proposed thirty years ago by Julian Tudor Hart, describes a perverse relationship between the need for health care and its actual utilisation. COVID-19 has exacerbated and exposed the health inequalities gap. The network of community pharmacies helps to buck the trend of the inverse care law as there are a greater number of pharmacies in socio-economically deprived areas. This ensures that the people across the UK have access to healthcare and advice within their localities wherever they live.
Local pharmacy teams can act as champions and play an active role in breaking down the invisible barriers of tradition, religion and culture, and engaging with their communities. There is an opportunity to bulid on existing examples where pharmacists provide outreach services into the communities they serve. This local leadership should be utilised and built upon to help reduce health inequalities.1
Principle 17: The community pharmacy network must be fully utilised when providing vaccination and testing services whilst ensuring it is a safe environment to do so.
|
Patient benefit
|
NHS benefit
|
People have access to professional health care and advice tailored to their needs
Accessible care, close to home, sometimes less intimidating than other health care settings
|
Reduce health inequalities in the system
Access to hard to reach communities and individuals
|
There is huge potential for community pharmacy teams to be further developed as healthcare providers and public health hubs. Community pharmacists already provide NHS flu vaccinations in England and Wales. This should be extended to Scotland to increase uptake throughout the population.
The current flu vaccination programme could then be further resourced to provide access to other vaccines, such as childhood immunisation and travel vaccinations, safely and efficiently using trained pharmacists and pharmacy teams.
Any decision to implement population level COVID-19 vaccination and testing across the NHS should explore using the clinical expertise, knowledge and accessibility of community pharmacists and their teams to maximise access to these services.
Principle 18: Opportunities and support must be assured for practising pharmacists to participate in research to demonstrate value in existing services and products and lead future developments.
|
Patient benefit
|
NHS benefit
|
Patient care is improved as pharmacy roles and services are evaluated to demonstrate this
|
Evaluation of services will increase quality and ensure better value for money
Improves links between academia and the NHS
|
Relatively few pharmacists have opportunities to link academic careers with the provision of clinical care, and pharmacists at the front line of care are ideally positioned to improve knowledge, and outcomes for patients, through research and development. This could include clinical research on medicines and service evaluation.
The research skill of pharmacists should be developed to strengthen their ability to innovate and lead the development of new products and services.
Principle 19: Pharmacy teams must be fully integrated and utilised across primary and secondary care to support a seamless patient journey.
- Mobilise and utilise the whole of the pharmacy workforce, ensuring clinical expertise is used across the system
- Develop a national structure and strategy to increase the number and accessibility of consultant pharmacists
- Enable outpatient prescriptions to be accessed at the patient’s community pharmacy of choice for supply to the patient.
|
Patient benefit
|
NHS benefit
|
More integrated care with increased patient access to pharmacist expertise
Care is provided closer to home
There is handover of care between secondary and primary care settings
|
A flexible and adaptable workforce, able to respond to surges in demand during a pandemic, which maximises clinical expertise across settings
Efficiencies are realised across the system
Patients receive better, and more joined up, care
Improve medicines optimisation across the system
|
Pharmacists must be fully integrated into multi-disciplinary teams, with a 24/7 pharmacy operation, reflecting the needs of both patients and the wider multidisciplinary team. Pharmacy teams should lead on all aspects of medicines care from arrival, during in-patient stay, and through to discharge.
Hospital pharmacy teams must work closely with primary care services to ensure medicines and care plans are in place on discharge and coordinated through the patient’s nominated community pharmacy team. At the point of discharge there needs to be the ability to supply discharge medicines in the primary care setting.There should be a clinical handover of care so every patient is included, cared for and involved in their own healthcare journey.
Regulation must be amended to allow community pharmacists to supply hospital medicines prescribed and dispensed in secondary care.
Collaboration between pharmacy teams in different care settings is essential to enhance patient care. Specialised pharmacy teams in hospital should routinely work with community and primary care colleagues to provide ongoing input into care for their patients in the community.
Traditionally many pharmacy specialist roles have been based within the hospital sector. The skills and knowledge of specialist pharmacists must also be accessible to patients in the community. A centralised service with local outreach will provide people with direct and equitable access to specialised pharmacists.
There should be an increase in the number of consultant pharmacists working in the NHS.
These post holders will have specialist therapeutic knowledge and can provide clear strategic direction and leadership for use of medicines, reducing harm and increasing value. They will be an expert point of contact for their speciality, working across all healthcare sectors. They will support delivery of government priorities such as safer medicines management, frail elderly care, managing acute illness, transfers of care, mental health, prevention and end of life care.
During the pandemic regional procurement has been key to the delivery of safe care, it needs to become embedded into NHS structures and funded via a standard model. Procurement of medicines, available in a usable form, needs to be a fundamental part of the planning process and adequately resourced.
All hospital medicines should go through the hospital pharmacy, as the IT systems and stock control are better, and data can be amalgamated and used effectively. Pharmacy can help to raise standards and provide leadership across the sector.
Where feasible, patients should have equitable access to pharmacy services across each country.
Local system leadership is however important, to ensure that local systems can focus on the health issues that are most prevalent within their communities. To enable this, providers need to be empowered and enabled to respond flexibly to wider changes in the local healthcare system.
[1] Appleby, J. and Deeming, C. 2001. Inverse care law. Available at: www.kingsfund.org. uk/publications/articles/inverse-care-law