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An onlooker's notebook - October 2017

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An onlooker's notebook - October 2017

Someone from the British Medical Association has been having a go again at the pharmacy flu service. Dr Andrew Green, GP clinical and prescribing policy lead at the BMA, has reportedly said that it undermines good working relationships and that there is no evidence that it improves uptake. This only serves to prove what I have said many times in this column, namely, that doctors see pharmacists as business rivals. GPs, as contractors, are in business just as much as we are. I suspect that the only area where the pharmacy service does not improve uptake is in the fl u service offered by GPs, which they do not like one little bit.

Another one having a go at us is Dr Keith Ridge, the chief pharmaceutical offi cer for England. Speaking at the Royal Pharmaceutical Society’s annual conference last month he said that pharmacy must up its game in terms of quality. This struck me as a bit rich coming from the mouth of someone who has been party to a massive reduction in remuneration in England. It’s not just a question of wanting better performance from us from static pay but better performance for less. One wonders whether Dr Ridge is on the same kind of deal in terms of his departmental salary. The big problem that contractors in England face is that governments over the years have failed to provide the funding that would fi nance an improved quality of service on a consistent basis. The New Medicine Service is only limited in scope, and there is no cast iron guarantee that it will be continued. If experience with minor ailment schemes and smoking cessation services is anything to go by, pharmacists in England have every reason to have their doubts.

The Health Secretary Jeremy Hunt, I read, wants something to be done about reducing prescribing and medication errors. He is planning to work out how this might be achieved alongside the chief pharmaceutical offi cer, Keith Ridge. The truth is that a solution has already been worked out and it is called “pharmaceutical care”. This has been defi ned as the responsible provision of drug therapy for the purpose of achieving defi nite outcomes that improve a patient’s quality of life (Hepler and Strand, 1990). Key to the process is identifying potential and actual drug-related problems, resolving these problems and preventing them. There is a huge amount of literature on the subject and I’m sure that Dr Ridge will fi nd plenty of inspiration in it. A defi ned practice has been built around “pharmaceutical care” but the problem has always been fi nding funding for it. To practice such care takes time and costs money. There are elements of it in Medicines Use Reviews and the New Medicine Service, but they are miniscule. Medicines would undoubtedly be better used with pharmaceutical care but there would be a cost in terms of pharmacists’ time. We would need to be paid for this. Being shouted at to improve quality will not cut the mustard. Government will have to put their money where their mouth is. Contractors already provide unremunerated services like monitored dosage systems and deliveries. They are not in the mood for more.

I have read a lot about pharmaceutical care in my time, but I don’t recall it being suggested that we should run urine tests to see whether patients are taking their medicines properly. This might change. Researchers from Manchester and Leicester universities discovered that nearly one in three patients with high blood pressure were not taking their tablets regularly. Urine testing led to more than 80% compliance. This research is to be published in the journal Hypertension and, in the meantime, can be seen online. Something else for Dr Ridge’s reading list.

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