TERRY MAGUIRE OUTLINES HIS EFFORTS TO BRING ABOUT CHANGE AND ENHANCE THE SOCIETAL BENEFITS THAT CAN BE GAINED BY USING PHARMACISTS’ SKILLS PROPERLY
About 30 years ago, I latched onto the idea that the practice of community pharmacy must change. It became my religion, but I was profoundly naïve. In spite of overwhelming evidence that few, if any, pharmacists really wanted change, I have continued to cling, mostly desperately and sometimes sanctimoniously, to this idea and, as I enter ‘senior grade’, it seems I will continue to hold onto this vision, because of stubbornness of course, but also because I feel that the future should have a healthcare professional with a specialist knowledge and expertise of medicines and that should be a pharmacist, ideally working in the community.
Yet in most countries, without a shift from a supply function to a clinical function, the community pharmacy network is facing inevitable Amazonisation. Transformation in the UK is government policy, so it should be easy. It could be argued that it is also a professional ambition and must happen so that the inherent societal benefits of this valuable public resource can be fully realised. But also remember that Jeff Bozos can always get medicines to your patients more efficiently than you can.
Work is progressing in N Ireland, albeit slowly; government might be less convinced of pharmacists’ appetite for change. As part of a new pharmacy contract last year, the Department of Health (DoH) set up a Service Development Group with an aim of identifying services that can, after positive assessment, be commissioned across the network. Commissioned services identify a possible future model of community pharmacy, allowing a greater emphasis on clinical and public health, yet with retention of a medicines supply function within an efficient and robust governance framework.
The challenges to transformation are many. Identifying how the strategies attempted over the last 30 years have largely failed might go somewhere to help success now. Covid-19 has changed everything and there really is now an opportunity to bring about change producing a pharmacy network focused on medicine optimisation, supported self-care, and improved public health. There is a window of opportunity and a government willing to make the investment so this can be done. Will the network rise to the challenge? One little-known group is rising to the challenge.
Northern Pharmacies Ltd (NPL) is a small N Ireland-based company consisting of six pharmacies and committed to supporting this transformation. I am proud to be one of its six directors. NPL is unique, in that the profits generated by the company are ploughed back into the profession who set up the company in 1969. NPL was designed to keep dispensing doctors in check in locations where a pharmacy would not normally be viable. NPL’s first pharmacy was in the then-new town of Craigavon and that risk paid off, as this is now one of our biggest dispensing pharmacies.
To date, NPL’s support for transformation is impressive and is through investments in projects designed to develop and evaluate new services for roll-out across the network. But NPL also realises that simply developing new services, even when these services are demonstrably of public benefit, is a waste of time and resources if the services fail to get commissioned. Equally, it would be a waste if services were commissioned but were not delivered due to significant workforce challenges within the network. There are therefore two elements to the current NPL work: The development and assessment of new services, and the identification of barriers to new service delivery.
NPL met with the Chief Pharmaceutical Officer (CPO) recently to bring attention to our projects and our concerns about how these successful services can be delivered. It was clear from the CPO meeting that NPL’s strategy of undertaking service development projects with a view of wider roll-out might not always be successful.
Our Cough, Cold and Flu project was successful in identifying a potential reduction in the use of antibiotics for common respiratory conditions. It was peer-reviewed and published in the Pharmaceutical Journal in 2021, but is yet to get commissioned.1
Our UTI pilot project was brought to the Service Development Group and was modified to become a displacement project — from general practice into pharmacy — rather than a service focused on antibiotic stewardship. This project will now be rolled-out as there is good evidence that pharmacists can safely manage UTIs as well as GPs. NPL would also like to see it used to improve use of antibiotics.
We are seeking support for a NPL obesity project and will invest in it over the next few years. This project aims to assist people lose weight safely and sustainably and to use IT in delivering this support. The obesity project is fully aligned with key DoH priorities.
We are also providing funding for other groups to develop their ideas for network transformation and have data from an AgeWell project that demonstrates the valuable role pharmacies can have in supporting frail elderly patients. Our work with a cancer hospice has created a vital support role for medicine optimisation of cancer patients by a pharmacist based in the community.
NPL will continue its collaboration with the Service Development Group. But simply having a menu of paid-for services is only the first part of the challenge. We must understand how community pharmacists and their support staff can
create the time to deliver these new services. The Covid-19 pandemic altered the way community pharmacies in N Ireland worked. In a pandemic, this would be expected. However, it would also be expected that the workforce activity would return to normal afterwards. Perhaps because we remain in the pandemic, this has not happened, and due to a combination of changes to the way GPs issue prescriptions and the public demand their medicines, the pharmacy workforce has lost a lot of efficiency in medicine supply and appears to have little control in re-establishing this. There is, however, huge resilience within the network, demonstrated by the response to Covid-19 vaccination services delivered since March 2021, where an impressive capacity was created within the sector. We want to understand how this was done.
Even before the pandemic, pharmacists had a list of concerns which presented clear evidence of a highly-stressed workforce and which I have already addressed previously in this column.2
NPL is continuing to apply its resources and work in partnership with other organisations to address the challenges. In addressing the barriers, it is clear we need additional time and that can only happen by better use of technicians, robotics, improved IT, training and funding. There is always a danger, however, that these efficiencies will be pocketed by contractors and government before they manifest in the vision of a transformed network.
Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University Belfast. His research interests include the contribution of community pharmacy to improving public health.