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Roses are red, Outsider is blue

By Outsider

February: the shortest month. The most romantic month. Snuggling under blankets knowing that Spring is around the corner and soon Matt Hancock will have, by himself, vaccinated every single person in the four most vulnerable groups, all from his cupboard under the stairs. I suspect no-one will need to prepare Piers Morgan a romantic Valentine’s Day dinner: at the rate he’s going on Good Morning Britain, he’ll still be full from eating most of the Cabinet for breakfast each day.

Talking of TV, I was surprised the other night, during the post-insurrection-pre-inauguration news feeding frenzy, to see on CNN the same arguments that the Royal Pharmaceutical Society, PSNC and others had been using to prove that community pharmacies should provide coronavirus mass vaccinations. Well, no plan survives first contact with the enemy, and the enemy in the situation we find ourselves in is a very constrained vaccine supply.

There are now, finally, people apart from medics providing PCN-designated vaccination centres – some of them in community pharmacies. Having been on the periphery of colleagues attempting to set these up, I commend the tenacity of all who are engaged in this effort: it’s not easy and those who succeed will do so in spite of, rather than because of, the commissioning process. All whilst quietly losing their sanity, I suspect.

Across the world, coronavirus vaccine supplies are precarious and the media is full of conflicting stories of vaccination centres sat idle, with no-one to vaccinate, whilst elsewhere they are only just starting on the earliest of the eligible cohorts. This is no surprise: it was always going to be like this, and then you factor in the storage requirements that single stranded mRNA in a lipid envelope demands.

There will likely be a place for community pharmacy (and indeed general practice) vaccination on a model similar to seasonal flu, but it is not now, with vaccine supply seemingly more imperilled every day. 

No plan survives first contact with the enemy, and the enemy is a very constrained vaccine supply

Now, it’s not quite a romantic anniversary, but having conducted a second advice audit in under a year for PSNC, I cannot help but get frustrated about why we are even having to do this. It’s not the need to gather evidence to demonstrate our worth – that may be annoying, but it isn’t what riles me. 

In the early 2000s, I was working for a certain vertically integrated international multiple when it rolled out its fancy new EPOS systems. Shiny. I remember going on the training and asking about linking to the (still slightly shiny) PMR to be able to record all the essential service interventions in the (so shiny it hadn’t even started) new pharmacy contract. After being scoffed at, 15 years later, we’re double working and having to waste time transposing paper tick sheets onto a webform. I love pharmacy, but we do need to stop and ask ourselves if sometimes we are our own worst enemy.

Questions, questions

Of course, the first thing we’ll all be doing after Valentine’s Day is the Discharge Medicines Service (DMS). Assuming your hospital trust is TCAM (transfer of care around medicines) capable, this will represent a significant shift in the relationship, not just between community and hospital pharmacy teams, but right across primary and secondary care. 

In preparing for this service, I am confused about the patchwork quilt of chaos that is pharmacy postgraduate education and training. Why, when reviewing the declaration of competence for this service, do I need to be asked if I’ve completed safeguarding training, a basic professional requirement and part of the Pharmacy Quality Scheme and every other service pharmacies provide? 

The declaration of competence framework is a huge advance on where we were 10 years ago. But how can it be that at the same time as we appear to be on the verge of post-registration prescribing rights by default, we’re being made to jump over bureaucratic hurdles for the most basic of things?

Finally, there are many reservations about the fee structure for DMS, but it must be better to get paid for something with an evidence base built out of real bricks, than rely on monies from a service that has a poor evidence base and has done nothing over 15 years to shore up its foundations. 

So, while February should see serious momentum from GP referrals into the Community Pharmacist Consultation Service, this can only be a good thing as there is a big MUR-sized hole in services income that rapidly needs filling. 

Outsider is a community pharmacist




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