Three reasons why Prescription For Excellence could become an overinflated failure

In just under a decade from now, the daily tasks of a community pharmacist in Scotland could be radically different to today. The bulk of a day in a pharmacy could be spent on consulting with patients, prescribing and playing a majorly integrated role within the NHS rather than just checking and filling prescriptions much of the time.

Yet despite the ambitions of the Scottish Government, there are many ways in which failure could easily prevail if the proposals within Prescription For Excellence (PfE) do not get the adequate support that it requires in order for the identified aspirations to be fully achieved. Fundamental reforms and a radically different mindset are needed to make way for the new working environment for pharmacists to flourish.

The whole ethos of the reforms proposed for the provision of pharmaceutical care in Scotland is to increase the professional autonomy of pharmacists and other practitioners providing such care and to bring this framework of healthcare in line with the overall 2020 vision. But it seems to me that with just five years to go until the next decade, time is not on anyone’s side. 

I’m entering this issue from the perspective of a community pharmacist so please bare with me if you see things from a different perspective. There are three main reasons why Prescription For Excellence could end up becoming nothing more than a hypothetical wish list. 

Firstly, a lack of investment and financial support. It is likely that the working structure and infrastructure of community pharmacies will have to radically change in order to facilitate the new working environment. With that must come a suitable financial package in order to support contractors and other care settings who stand to be affected. In the current political climate, Scotland is receiving less and less money from Westminster through the block grant and regardless of who wins the Westminster election in May, I do not anticipate things changing any time soon. Funding pressures will apply to many of the areas the Scottish Government have responsibility for such as health, social care and education so the case needs to be continuously made for a significant chunk of investment into pharmacy services in Scotland. I’m not suggesting that the administration in Edinburgh will not provide an ounce of capital to make PfE work, but one of the alarming aspects of the PfE document was the lack of clarification over how much it would cost to make the changes needed – this needs to be spelt out urgently.

And what’s more, community pharmacy must not be short changed at the end of the day – whilst community pharmacies run as businesses and need to be efficient and profitable, it cannot afford to shy away from stretching it’s arm to the fullest extent when it comes to getting the maximum amount of money needed to make PfE work. New computer systems and IT infrastructure will cost millions to set up. Suitable training for pharmacists to update their skills necessary to facilitate PfE – investment will be needed there as well. And financial support to contractors to invest in new staff and personnel will need to be looked into too, although this is something I will talk about later. 

Secondly, will every pharmacist in Scotland have enough time between now and next decade to become qualified as prescribers when it is intended then for the proposals in PfE to become live? One of the objectives or proposals of the overall plan is to make pharmacists as independent prescribers, accredited by the NHS, by 2023 – it alarms me that with just eight years until then that there doesn’t seem to be an urgency around facilitating for this ambition to be truly achieved. Eight years will rush past like Lewis Hamilton going at 190mph at Silverstone. And it’s worth noting that a pharmacist has to complete a separate course to become a prescriber long after graduating with an MPharm degree – if I rightly remember, I believe you need to have been qualified for two years before embarking on a prescribers course. To put things into other words, the current MPharm course will not provide within it a qualification as a prescriber.

Maybe the Scottish Government is being too ambitious. However, is it worth exploring the idea of training pharmacy students to become prescribers prior to completing the MPharm degree? I think the General Pharmaceutical Council will have to accredit such a proposal before it becomes reality and I think many arguments can be made against such an idea – for example, a newly qualified pharmacist’s lack of working experience. If pharmacy students were trained up as prescribers as well as pharmacists then the 2023 target could well be achievable, but in the current state of affairs I don’t think this is possible.

And thirdly, the working environment of pharmacists – specifically, how it will have to be completely overhauled when PfE comes into force. Pharmacists like to have as much control as possible when it comes to the running of the dispensary as they are normally the responsible pharmacist. But devolving tasks also works and I can safely say that had it not been for the support and contribution of Accuracy Checking Technicians (ACT’s), I think I would have really felt stuck repeating the same job again and again of checking and filling prescriptions solely on my own – that is not necessarily a good thing, because if a pharmacist like me is expected to be carrying out more clinically based services then having an ACT in the dispensary won’t just become desirable, it will become essential. And that applies to every dispensary with no exceptions. Contractors who don’t employ or include an ACT in their pharmacy, must ask themselves why and consider the fact that they provide a great help to pharmacists. Pharmacists are as human as everyone else and they can only do so much. And if the role of an ACT wasn’t seen as mandatory now in the dispensary, then it sure will be in the future. ACT’s and other pharmacy technicians must be registered with the General Pharmaceutical Council, just like pharmacists, and it is therefore in everyone’s interests that things run smoothingly in the interests of quality patient care and safety. Also, pharmacies need to project a different impression of themselves to the public – a one stop hub for healthcare rather than just a commercialised entity. As I stated earlier, pharmacy contractors obviously need to be profitable, but the balance needs to shift towards the clinical aspect of matters, especially in the context of PfE.

When PfE was revealed, many people within pharmacy got themselves into an excitable frenzy and understandbly so. But the plans are not perfect and there is a very long way to go until significant progress can be truly made. And with all that, many questions remain to be asked.

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