By Clare Thomson, CPhO Clinical Fellow at RPS
At the Great North Museum in Newcastle, before an audience of pharmacists from across the North East, the RPS hosted a lively debate between Dr Fadi Khalil, a GP and Sunderland CCG clinical lead, and Dr James Davies, pharmacist and RPS Director for England.
Under the watchful eye of chair Ewan Maule, Director of Medicines and Pharmacy for North East and North Cumbria Integrated Care Board and member of the English Pharmacy Board, the two discussed the expected impact of prescribing in community pharmacy.
James began with the three Ps – patients, pharmacists, and practitioners. There is, he asserted, huge potential for prescribing in community pharmacy: patients are struggling to access General Practice, and A&E and out-of-hours attendance have both increased. To help patients access care in community pharmacy settings increasing numbers of pharmacists are already becoming prescribers, and prescribing pharmacists in community pharmacies provide many treatments for patients.
Community pharmacist prescribers can help to reduce pressures across healthcare, not just general practice. There is an opportunity for pharmacists to prescribe in high volume, low acuity conditions, as well as supporting patients with long-term conditions.
But, on the other side of the argument might this opportunity to improve access be simply a political football? With all parts of the healthcare system under financial pressure, pushing patients from general practice to pharmacies could just fragment care.
For pharmacists to prescribe in community pharmacy settings significant changes would be needed in infrastructure, such as ordering and taking bloods, and read/write access to records across the system. Making a diagnosis, pointed out Fadi, was challenging even for experienced GPs, and telling the difference between heartburn and heart attack, for example, would not be easy in a pharmacy. Even with training and support for pharmacists, diagnosing every condition in a pharmacy would not be feasible.
Fadi continued that prescribing in community pharmacy is a solution to a non-existent problem, one which primary care has not been consulted on. Would it not be better, he asked, to support the embedding of more prescribers within GP practices and community teams, as part of the multi-disciplinary team? We do not want to create “mini GP practices” within a community pharmacy. Integration is key and, with more support and funding, GPs would be able to do this.
Both James and Fadi agreed that healthcare faces financial challenges, and there are real difficulties accessing patient records. Also, how would prescribing be governed when so many pharmacists work in isolation? Peer support networks might be the answer, providing pharmacists with advice and guidance in their prescribing decisions. And what about managing risk? Pharmacists have a different risk profile to that of GPs.
Audience members began to describe the pressures they faced today, and noted that without an increase in workforce numbers, capacity constraints in community pharmacy would only get worse.
The debate ended with both sides acknowledging the other’s points. Each agreed better integration was needed in primary care, allowing everyone to be part of a multidisciplinary team. Primary care networks have made great progress in this. To further strengthen our fragile healthcare system commissioning bodies must help primary care teams and community pharmacists work together, autonomously but not independently, and of course there is a clear role for the RPS in supporting the future role of prescribing.
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