The Covid-19 pandemic changed the healthcare landscape in many ways – and a number of those changes were beneficial. High up on the list of positive changes was an increased public recognition of the value of community pharmacists and the vital role they could play in reducing pressure on primary care and hospital services and providing a faster resolution to minor health issues.
We have just witnessed the introduction of Pharmacy First, a significant initiative that we welcome and are pleased with the opportunity it gives for community pharmacy to start to work more closely with general practice, and indeed with other parts of the health and care system, moving forward their involvement in integrated neighbourhood teams.
We know community pharmacy colleagues have a wide range of under-utilised skills. Pharmacy First is the first step towards them being facilitated to effectively deliver the prevention and long-term conditions services, which would support our belief in the need to move away from a purely biomedical model of delivery towards one of patient activation in which people are encouraged to take steps in improving their health and wellbeing.
Public perceptions have changed for good
Professor Ash Soni OBE, President of the National Association of Primary Care (NAPC) and a practising community pharmacist, is in no doubt that public perceptions of the value of community pharmacy have changed for good.
‘During the pandemic the front face of the NHS to a great extent, apart from hospital A&E departments, was community pharmacy, with people suddenly realising that it was a place they could go to get some advice, some help and some idea of whether they should be worrying about something and needed to see a doctor.
‘I think that recognition of the value of community pharmacy has been retained post-pandemic, but my fear is that the system will lose it by not retaining the opportunity to use community pharmacy more effectively as part of what happens within Integrated Care Systems.’
In a recent NAPC podcast Prof Ash Soni, NAPC President, outlined a number of key ways in which the expertise of community pharmacists and their desire to put it to effective use could be harnessed by health care systems.
Better integration and a greater role for Community Pharmacy was mentioned in both ‘Delivery plan for recovering access to Primary Care’ and ‘NHS Long-Term Workforce Plan’ published by NHS England earlier this year.
Ability to enter data directly into patient records
As far back as 2015, the Royal Pharmaceutical Society recommended that, with patient consent, all pharmacists directly involved in patient care should have full read and write access to the patient health record in the interests of high quality, safe and effective patient care.
But while pharmacists were granted read access to summary care records the following year, discussions about write access have become mired in legal considerations.
‘Our work could be so much more effective if, after talking to you as a patient and working out what is needed, I could record this into your common patient record’, says Prof Soni.
Protected time to attend meetings
Although GPs and their teams have protected learning time for training, development and attending team meetings, the same does not apply to community pharmacy teams.
‘If I am working in my pharmacy, I am there all day because people are coming in all day’, explains Prof Soni. ‘The GPs may have some time out during the day for clinical meetings, but I can’t go because I am too busy working in the pharmacy.
‘We need to find some way to create that protected space and some of that is how we work with our populations to get them to understand that they can’t have constant access to certain things.
‘If we can’t achieve this we will continue going round in circles, with us unable to meet in the daytime because we are too busy in the pharmacy and GPs unwilling to meet in the evenings because they have spent all day at work.’
Greater linkage between pharmacies
Alongside finding time to attend multidisciplinary team meetings, pharmacists need time to talk to each other ‘to better understand what we can each do and how that can be made to work most effectively for our local population.’
‘Research has shown that the single biggest indicator of outcomes is the relationship and trust that exists within team. We have to find the time for this because it is the thing that is most going to affect outcomes for patients and populations.’
A crucial aspect of better communication between pharmacies would be improved IT linkage to enhance information flow.
‘As well as thinking about some of the digital work we are involved in as organisations, we need to use digital to help build some of the time for us to meet together’, says Prof Soni. ‘It’s useful to be in the same physical space but sometimes just having a common environment will make that happen.’
Abolishing unhelpful distinctions between pharmacists roles
What is the difference between clinical and non-clinical pharmacists? Vanishingly small, according to Prof Soni.
‘Although there are some variations in terms of what they can do, all pharmacists are clinicians, wherever they work, and the use of differential language undermines perceptions of their skills and capabilities along with their relationship with patients.
‘It is a continuum and a blending of care we should be aiming to achieve rather than creating more silos. As a community pharmacist I am a generalist and that is a specialism in its own right and should be recognised as such.
‘One of the things I have talked about in the past is pharmacist-to-pharmacist referral. I may not have the depth of knowledge that some of my more specialist colleagues have but it is about putting my knowledge to use and then referring on through pathways to someone who has the skills and knowledge to be able to provide what is needed for a particular patient.’
Getting the ‘business’ issue out of the way
One of the perceived barriers to a perception of community pharmacists as patient-focused clinicians is their status as independent business people, whose premises are often owned by profit-motivated commercial conglomerates.
This is an issue Ash Soni feels passionate about. ‘I might work in a private pharmacy, whether it is my own or owned by a big company,’ he explains, ‘but I am a pharmacist and I am there with my professional head on to provide the best care to individuals, regardless of anything else.
‘I am not going to turn round and say: “I don’t care what’s wrong with you – I am going to sell you this because my company tells me I have got to.” That is not the way I operate – none of us do because we are professionals.
‘One of the positive things that came out of the pandemic was a changing perception of pharmacies from somewhere that sells me something, to someone that provides me with professional advice.
‘I think that we within the health system still hang on to some of the language and behaviours around pharmacy that the public themselves have started to move away from.’
The value of pharmacists in integrated neighbourhood teams
A key distinction between community pharmacies and other healthcare settings, according to Prof Soni, is this: you don’t walk into a doctor’s surgery and say: ‘I am well today, what are you going to do for me?’
‘Whereas’ says Prof Soni ‘you can walk into a pharmacy for something completely unassociated with health and end up having a conversation about your health.
‘You might be walking into what is considered a retail space, but you are going to see a clinician who can provide you with help and support and direct you to the most appropriate place to meet your health needs.
‘The ultimate goal is to have community pharmacies recognised as part of fully integrated teams that work together to serve the needs of a local population, delivering the best quality care and supporting their health and wellbeing.’
You can hear a longer interview with Professor Soni here: – https://napc.co.uk/the-future-of-community-pharmacy/
