Our correspondent enviously eyes developments north of the border

I wonder how many of our pharmacist colleagues in Scotland are looking askance over their shoulders and asking themselves “what on earth is happening in community pharmacy in England?”

If I were pharmacist in England working near the border, I would certainly be looking with envious eyes at Scotland. The NHS in Scotland has recently published its vision for pharmacy - all pharmacy, hospital and community: Achieving Excellence in Pharmaceutical Care. It’s available in full at http://bit. ly/2yxbFR2. It’s worth reading.

In stark contrast to the attitude of the chief pharmaceutical officer in England, Rose Marie Parr, the chief pharmaceutical officer in Scotland, is an enthusiastic advocate of community pharmacy. In her introduction to the document she says: “We need to work together with the wider multidisciplinary health and social care team, to ensure that this specialist knowledge in medicines is utilised to best effect for the health and well-being of the people of Scotland.”

Wow! It’s a bit different from her counterpart in England, Keith Ridge, who recently announced that NHS England will not publish a response to the Murray review of community pharmacy services despite an earlier commitment to do so. On top of that, English pharmacy minister, Steve Brine, recently admitted that minor ailments schemes in England were being scrapped: “Things have moved on,” he said, responding to a question at a hearing of the all-party pharmacy group.

Dr Ridge, who was also present at the meeting, added: “We are in a transition phase from the traditional minor ailments scheme, to something that is much more digitally-led.” I’ve complained before about the obtuseness and lack of transparency from the pharmaceutical division at NHS England, but it seems to me that Dr Ridge has reached new heights with this. Digitally-led minor-ailments? What on earth does that mean?

But let’s go back to what’s happening in Scotland. There, the Scottish government has identified nine commitment areas and a programme of supporting actions including: improved and increased use of community pharmacy services; pharmacy teams integrated into GP practices; support for the safe use of medicines; better care at home or in a care home; a better-skilled pharmacy workforce to enhance both clinical capability and capacity; better use of information technologies; and enhanced access to pharmaceutical care in remote communities.

For community pharmacy, the document states: “We want more people to use their community pharmacy as a first port of call.” Central to this will be the enhancement of the minor ailment service, the chronic medication service, the public health service, and more independent pharmacist prescribers with advanced clinical skills. “It is through making full use of the clinical capacity in community pharmacy that real gains in clinical care can be made.”

Music to my ears
Its heady stuff isn’t it? Regular readers of my column will know immediately that this is music to my ears. It should be music to all ears. It is so different from the expectations of community pharmacists in England that I’m tempted to point to it as evidence that we no longer have a truly “national” health service.

How can it be that the vision for the contribution that communitypharmacy could make is so much more advanced in Scotland? Are the health needs so different? Is the NHS infrastructure so different? Is the set-up of community pharmacy so different? The answer to these questions is no, no, and no. We must ask the question, insistently, and repeatedly: why has community pharmacy in England fallen so far behind?

My suspicion is that the answer to this is in two parts. On the one hand we have a pharmacy division in NHS England that obdurately refuses to share its vision for the future of community pharmacy or even to admit whether it has one. On the other, we have a negotiation body that seems to be out of touch with how pharmacy practice has advanced over decades and stubbornly insists on clinging on to the fee-per-item dispensing fee as the dominant element of our remuneration package. It would appear to be a classic coming together of the irresistible force and the immovable object.

As Einstein said: the difference between genius and stupidity is that genius has its limits. It is perhaps an exaggeration to describe the Scottish proposals as genius, but there is so much merit in them that they are impossible to ignore. Our colleagues north of the border have given them a very warm welcome. Harry McQuillan, chief executive of Community Pharmacy Scotland, has said that pharmacists “look forward to working in partnership with the chief pharmaceutical officer and her team to enact the changes necessary to facilitate our network’s contribution to this vision.”

It’s not rocket science, and bar the quote from Einstein, it doesn’t take a genius to know what needs to be done. As a start, PSNC and NHS England need to draw a line under past difficulties and start afresh with meaningful and constructive discussions. Our Scottish colleagues have ably demonstrated that where there is goodwill a great deal can be accomplished. Let’s get to it.

 

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