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Rx for 2020: policy, please

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Rx for 2020: policy, please

By Rob Darracott

The New Medicine Service (NMS) squeaked through a second evaluation recently as researchers from Manchester, Nottingham and UCL found patients supported by the NMS were 9 per cent more likely to be adhering to treatment at six months than those not, although the subject drop out rate meant the result was not statistically significant.

The NMS is the only community pharmacy service built as a result of a published evidence base, yet its history since its introduction in 2011 is an object lesson in how not to do it. One that should be studied by the review team led by UEA’s David Wright looking at how community pharmacy representation and support might be improved in the future.

I should declare my interests: I was a member of the team that did the original research into support for new prescription medicine taking. I also took the team that sold what became the NMS into the Department of Health in 2008. So, I’m biased. But something has to be badly wrong when an experienced community pharmacist, running a great pharmacy, can tell me, as one did early in 2019, that he hoped the contract review would abolish NMS because then he would have “avoided it entirely”. That’s eight years of not delivering. 

As a newly registered pharmacist in the early 80s, my ethical framework was built around keeping people safe. Making sure that prescribers were genuine, prescriptions made sense, medicines were sourced appropriately, and those prepared on the dispensing bench were made to a professional standard. The law stopped others from doing these things because they required a certain expertise. There was a philosophical basis to the role: part art, part science.

Fast forward to now. What’s the philosophical basis underpinning modern day community pharmacy? Electronic prescribing, mass manufactured GMP medicines and automated dispensing solutions have torn holes in the old framework. The role of the health professional is more likely to be described these days as patient advocate, expert navigator, counsellor and/or decision supporter. Unless I’ve missed something, understanding how pharmacists should think about themselves and the work they do now has never been properly addressed. The implications for practice are left for people to work out for themselves. Or not. 

The NMS was one opportunity to work some of this through. The evidence said that one in 10 patients would, after a chat with a pharmacist, benefit more from a new treatment at four weeks than would otherwise be the case. The corollary: not following the evidence would, therefore, represent poorer care. But as “improving care” joined “keeping people safe” as a fundamental in the profession’s rationale, pharmacists needed the channels to input into their own future if they were not to go the way of the chandlers, the knocker uppers and the ironmongers. 

Top down, derivative approaches might be expedient, but without effective local implementation, where it may requiring fundamental changes to how people think about themselves and what they do, it’s asking for trouble. Ask the NHS. 

The challenge to role boundaries has been coming for years: in the workforce literature, in psychological, behavioural and sociological research. The impact of technology is all around us. That pharmacy nationally has no policy function worthy of the name doesn’t help. You can’t shape what you don’t see coming, and you won’t see it coming if you’re not looking for it. 

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