Getting the balance right
03 March 2008
As the only full-line pharmaceutical wholesaler serving every country within the UK, it is fascinating to see how each nation is developing its primary healthcare strategy and engaging with community pharmacy to deliver patient services.
Take for example the Keep Well projects which exist in certain parts of Scotland. As many of you will no doubt be aware these projects provide a voluntary health check for those aged 45-64.
The underlying driver for Keep Well is the clear and pressing need to tackle the unacceptable health inequalities which currently exist in many of our communities and to provide early interventions to prevent the escalation of health care needs. From both patient and financial perspectives there are clear advantages in preventing ill health arising in the first place or tackling conditions early before they progress to a more serious stage.
Although Keep Well was initially established as a GP led service, it strikes me that community pharmacy is arguably in a better position to deliver the direct and targeted interventions which the initiative envisages. I believe some Health Boards have recognised the potential contribution which community pharmacy could make and are now engaging with local pharmacists. However, surely this is exactly the kind of service which should be available at local pharmacies across the nation, not just in certain areas?
The Minister for Public Health, Shona Robison, has talked about the need to provide services such as Keep Well which are aimed at those with high risk factors such as high cholesterol, high blood pressure, poor diet, smoking, alcohol misuse and inactive lifestyles.
Throughout the country you will find best practice examples of community pharmacies providing those kinds of patient services. They make a unique contribution to meeting local primary healthcare needs. They do so in a manner which is effective in reaching target groups and in a way which offers value for money.
Arguably, in several ways the public health role of community pharmacy is more developed in Scotland than in England, but there are areas where further progress could be made. For example, take smoking cessation: one of the risk factors listed by the Minister. Some Health Boards have local negotiated services with pharmacies, but others do not. Important services such as this ought to be available from every pharmacy. This, of course, would require adequate and appropriate funding to be made available from the SEHD.
The wider context is, in my view, the need to achieve a better workload balance between primary healthcare professionals.
Leaving aside the current debate over opening hours and pay, we know GP practices have a heavy workload to deal with. However, we also know that a sizeable chunk of that work could be addressed outside of the GP surgery thereby creating more time for, and less pressure on, GPs and nurses. That would allow them to focus on those patients whose clinical needs mean they need to see a doctor or nurse.
Checking for excessive cholesterol levels or diabetes or providing advice on weight management or smoking cessation are roles ideally suited to community pharmacy. Indeed, some of these services have already been negotiated and agreed between community pharmacy and local Health Boards.
We know that pharmacies are open longer than GP surgeries, are visited more often by patients than surgeries and many are situated in deprived areas. As a result of the successful implementation of the Minor Ailments Scheme patients are now more accustomed to seeking advice and support from their local pharmacist. Therefore, the potential contribution which community pharmacy could make is huge.
I think great progress has been made in Scotland to provide patients with improved access to primary healthcare services through community pharmacies. However, I think more needs to be done to develop better care pathways with GPs and pharmacists working together at a local level to agree how best to direct patients to and from each other depending upon their clinical need.
That, in turn, will require adequate and appropriate funding to be made available for community pharmacies to provide new services. However, that would in my view be one of the wisest and most cost-effective investments in public health which the SEHD could make.
In future, I hope that when initiatives such as Keep Well are in the process of being designed, the potential role which community pharmacy could play is built in at the outset.
Mark James
Group Managing Director, AAH Pharmaceuticals Ltd
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