Pharmacy must Seize the Opportunities in Healthcare says Lord C-J
I was recently asked to make the introduction and welcome for delegates to the the Pharmaceutical Group of the European Union Symposium hosted by the Royal Pharmacy Society and the National Pharmaceutical Association. This is what I said.
Leading the Change
Ladies and gentlemen can I first of all say how delighted I am to be able, thanks to the National Pharmacy Association and the PGEU, to join in your President Raj Patel’s welcome to London and this important conference today. It is an awesome thought that the PGEU represents 400,000 pharmacists across the European Union and in my remarks today you will not be mistaken to find more than a tinge of sadness about the UK’s exit from the EU.
As a former health spokesman for my party, then Chair of Council of the School of Pharmacy University of London, now part of University College London and coming up to its 175th year, and an active Vice Chair of the UK’s All Party Parliamentary Pharmacy Group, I have been a supporter of community pharmacy and pharmacists for many years taken a strong interest in the development and resourcing of community pharmacy services and the necessary education and training of young pharmacists.
My plan this morning is set out the current policy and political context and challenges for Community Pharmacy in the UK and what I believe it can achieve if gets its act together in a manner which is really credible to your external audiences and I am delighted that my good friend and long term collaborator -not least over the years in the annual School of Pharmacy lecture-Emeritus Professor of Pharmaceutical and Public Health Policy David Taylor, who with his colleagues at the School has done so much to critique and develop public policy in this area, including the important area of medicines management, is joining me on the the platform today too.
He will be highlighting some of the difficult questions that need to be answered by pharmacy leaders in the face of the demands of change and wider health and political institutions.
Let me say right from the start that I firmly believe that community pharmacy has much more to look to in its future than its past.
For several years now there has been a common vision- expressed in a succession of reports both by pharmacists themselves, such as 20 years ago The Royal Pharmaceutical Society’s Pharmacy In A New Age initiative and more recently in in Now or Never: Shaping Pharmacy For the Future; Government White Papers such as “Pharmacy in England: Building on Strengths and Delivering the Future” in 2008 and more recently the package of the package of reforms, including changes to the community pharmacy contractual framework announced last October; numerous supportive and insightful reports from my own All Party Parliamentary Pharmacy Group, and the Murray Review for NHS England into Community Pharmacy Clinical Services, particularly important in the light of the new Sustainability and Transformation Plans and the NHS 5-Year Forward Plan. Finally, of course, contributions from the European Pharmacists Forum such as the role of pharmacy in supporting the Public’s Health, in 2015.
All conclude that community pharmacy should not just be able to keep its medicines supply role but should and is able to offer an extended range of health care services in fields ranging from prevention and early diagnosis through to the management of chronic conditions and supporting self care.
And successive governments in a piecemeal way have tried to respond to this variously through legislation.
The essence of the vision is that pharmacies and pharmacists are able to:
- offer professional support for self-care and speed access to diagnosis and early stage treatments; and
- make optimal use of new IT based capacities in areas ranging from locally managed dispensing to the implementation of national public health programmes like smoking cessation support and the prevention and control of cardiovascular diseases and conditions such as type 2 diabetes.
This reflects the fact that since the start of the 20th Century there has already been a profound change in pharmacy – in essence, from making medicines to safely supplying the products of the pharmaceutical revolution. The focus of the latter has moved from antibiotics like the sulphonamides and penicillin to targeted anti-cancer treatments like Imatinib, as well as the provision of medicines like anti-hypertensive and lipid lowering products.
However, since the 1960s, ie during the last half century, another change has been put on the public policy table - from pharmaceutical supply to providing clinical pharmacy services – health care provided directly by pharmacists in a community setting.
The fact is however that this vision and these good intentions have not produced speedy outcomes, there has been a gap between rhetoric and reality.
Frustratingly, progress in making the best use of the valuable resource represented by community pharmacy in the UK has been slow for a whole range of reasons some external to healthcare some internal:
- Inappropriately constructed commissioning and funding mechanisms and constant change in those mechanisms,
- misallocation of resources;
- attitudes and culture in other health professionals patrolling boundaries;
- frequency of changes in Ministerial responsibility inconsistency in policy and lack of understanding by politicians of the clinical potential of community pharmacy;
- but significantly also because of a lack of self-confidence and assertiveness in the pharmacy profession itself and this includes over read and write access to patient records.
It could be argued that the slow pace of change means that many of our young pharmacists are over educated for what in many cases they do. We must use our community pharmacists to better clinical effect.
So given over a long period of time that we have a great deal of agreement on a common vision what needs to be done to drive desirable change?
David and I do not pretend to know the answers but hope our opening questions can help make the day a successful way of taking your plans forward.
Across Europe important issues currently relate to implementing the Falsified Medicines Directive and ensuring the proposed Proportionality Directive is appropriately drafted, plus from the UK point of view accommodating the challenge of Brexit and the future of the NHS which - it is no secret - is facing a funding challenge.
But key point I want to make today is that the intellectual case for a change in the direction of providing clinical care in the community pharmacy setting - and when appropriate in partnership with other primary and secondary care providers - is in large part won.
Few now oppose pharmacists doing more to improve health outcomes in areas such as, say, contraception provision and use or the management of vascular disease risks and relieving doctor’s workloads while providing many people with more convenient access to medicines when they need it.
So given we have this great resource and the necessary demand why is there a danger in countries like Britain of community pharmacy being cut back to little more than a minimal cost supply function involving large scale mechanised dispensing and lowest possible cost medicines delivery systems?
My key message is framed from a political perspective. It is:
Politicians, irritating though they are, and I’m not going to absolve them from responsibility from where we are, by and large want to help, but to help you they need across party to achieve consistency in having:-
- a clear picture of the public interest related problem helping community pharmacists will help to resolve and;
- a really clear and credible explanation of how community pharmacy will cost effectively solve the problem for the people we mutually seek to serve.
- A clear understanding of the barriers to the realisation of this vision
The bottom line is that it is no use coming to politicians just saying help us for the sake of the profession itself. As a lawyer I know that, I am in short order replaceable by Artificial Intelligence for example!
Community pharmacists need to keep developing their clinical case more powerfully saying that together they can help patients and the public and resolve some of the key problems facing us in health care delivery and resourcing. Pan European events like today are in my view crucial in that task.
