The NHS has declining resources in real terms so pharmacy could be the answer, says Chris Martin

Pharmaceutical care services based around the community pharmacy network have been on pharmacy’s service development agenda since around 2005. In the almost 10 years since then, this concept has developed to a greater or lesser extent, depending on the attitudes of local commissioners – and in some cases, on which side of Hadrian’s Wall or Offa’s Dyke you are located.

Today the NHS across Britain faces the task of meeting increasing demand for services with declining resources in real terms. As a result, pharmaceutical care and its potential to release the underutilised resource of the community pharmacy network has once again become the currency of negotiation and lobby. You just need to read strategy documents, such as Scotland’s Prescription for Excellence or Wales’ public health consultation document ‘Listening to You’ or to digest the minutes of the Rebalancing Medicines Legislation and Pharmacy Regulation Programme and its work on rethinking the supervision legislation in pharmacy, to see that the country’s health departments all have developing pharmacy very much on their minds.

It is more than likely that pharmacy’s track record in delivering pharmaceutical care will come under scrutiny during this process, which is why I am heartened to see services such as the Discharge Medicines Review service pilot in Wales promoted to a nationally commissioned service. I also hope that pharmacists in England will be eager to receive a similarly positive evaluation of the New Medicine Service.

I say ‘hope’ because sometimes the aspiration of the contract services negotiators is not matched by the reality of the output from community pharmacy. Immediately springing to my mind are the less than optimum numbers of Medicines Use Reviews and the tiny number of community pharmacist independent prescribers currently actively prescribing.

A recent estimate has put the proportion of community pharmacy prescriber scripts at less than one per cent of all scripts dispensed in England. This compares to the two per cent of scripts dispensed by community nurses, and this includes independent and supplementary prescribers. In total, the General Pharmaceutical Council register records around 3,270 pharmacist prescribers, of which 11 per cent are said to be working in the community.

Of course, community pharmacy is not solely to blame for this. Rising prescription volumes and the increasing complexity of long term condition management are a reality. Restrictive legislation and bureaucracy, not to mention professional territorialism and reluctance to change – these all play their part. I also agree with the General Pharmaceutical Council when it says that outputs in pharmacy – of which activity figures (MUR and NMS volume statistics) are, perhaps, one – do not equate to outcomes. In MUR and NMS terms this would be the benefit that patients and the NHS accrue from the service.

Nevertheless, neither is community pharmacy entirely blameless for its less than perfect record of service delivery. On the national platform, the clarion call of Pharmacy PLC is muted by vested interests. You only have to look at the recent Health and Sport Committee deliberations on Prescription for Excellence to see Community Pharmacy Scotland coming in to bat strongly for services delivered through and by the bricks and mortar network of contractor pharmacies, while the Royal Pharmaceutical Society in Scotland talks of developing pharmacists and pharmacy in a much more holistic and pan-sectoral sense. Is it any wonder that health politicians hear these mixed messages and manage to miss the potential that is inherent in all pharmacists?

How many pharmacists take the time to find out what their customers – the area teams, GPs, local authorities and patients – actually want from the local expert in medicines?

On a local scale, how many pharmacies are struggling with workload issues, yet fail to employ an Accredited Checking Technician or sessional pharmacist support? Do they maximise the existing skill mix through training and commercial support services to enable them to expand their service delivery or develop new business streams? If relationships with a local GP seem testing, how many pharmacists actually know why? How many pharmacists take the time to find out what their customers – the area teams, GPs, local authorities and patients – actually want from the local expert in medicines?

The answers to these questions require some serious thought – and almost certainly, some serious commitment to delivering the necessary change. But the winners in the new race for pharmaceutical care can only be those who are prepared to roll up their sleeves and make the necessary effort.

Chris Martin is non-executive advisor and national chairman of customer forums at Alliance Healthcare.