The future of community pharmacy in Northern Ireland was revealed this week by the publication of the province’s new pharmacy strategy. When compared to the English, Welsh and Scottish pharmacy strategies, the approach taken in Northern Ireland’s “Making it better: a strategy for pharmacy in the community” appears to be closest to that in Scotland.
“We will have a core service that probably will not differ much from that in England, Scotland and Wales. However, the additional services will take a different approach to respond to local needs in Northern Ireland,” says a spokesman for the Department of Health, Social Services and Public Safety. “For example we have a higher level of deprivation here than in much of England and we have a different profile of disease, such as higher rates of coronary heart disease and teenage pregnancy.” Some of these issues are more similar to those faced in Scotland than either England or Wales.
The Northern Ireland community pharmacy strategy is based on three layers. At the bottom is public health, next is self-care and at the top is managing medicines.
Public health One of the stronger themes in the strategy is the role that community pharmacists can play in improving public health. Certainly the emphasis on public health seems greater than in any of the other home countries’ pharmacy strategies. “The strategy has been heavily influenced by ‘Investing for health’, Northern Ireland’s public health policy document,” explains the spokesman. “We need to make better use of the pharmacy network in public health.” He adds: “Through ‘Building the community-pharmacy partnership’ [a public health initiative to develop pharmacies as a community health resource] we had a good understanding of public health before we started.” This, along with the fact that understanding of public health has developed since the earlier strategies were published, could explain this greater emphasis on public health, he says.
One of the public health concepts to be introduced this year is “Health promoting pharmacies”. These will be accredited pharmacies that provide advice on health promotion and lifestyle management. Pharmacists will refer patients to other health and social care professionals and offer a service to “signpost” people to other relevant community groups. Other extended health promotion roles for pharmacists outlined in the strategy include roles in smoking cessation, immunisation campaigns, drug misuse services and falls prevention. Another plan is for pharmacists to carry out health surveillance.
Self-care The pharmacist’s role in self-care will follow the Scottish model of allowing pharmacists to treat common ailments on the Health Service. The strategy says that this is an important area for development: “It is widely accepted that the role of pharmacists in helping people deal with common ailments could be utilised more fully.” The spokesman adds: “We have got schemes testing this up and running. The Department supports this development.” It plans to implement the scheme across Northern Ireland in 2005.
Managing medicines A “Managing your medicines” scheme has been in place in some parts of Northern Ireland for several years. Through this scheme, pharmacists conduct medication reviews for people taking multiple medicines, people with poor compliance or those who have been recently discharged from hospital. The targets outlined in the strategy are about building on this scheme’s success: to ensure that the scheme becomes common practice throughout Northern Ireland and to formalise the referral process for medication review.
A greater role for pharmacists in medication review as a whole is also envisaged. They will undertake reviews in nursing homes and GP practices, and provide support for carers who are managing medicines for patients.
Introducing repeat dispensing will be one of the Department’s priorities this year. The success of a pilot study, and demand from the public, mean that the roll-out will begin this year and continue in 2005.
A framework for supplementary prescribing is currently being developed and a phased introduction should begin this year. “Due to additional changes in legislation required in Northern Ireland, it is likely that clinical pharmacists working within the hospital environment will be the first to be trained as supplementary prescribers. However, it is the intention that this will be an opportunity open to all pharmacists once the necessary changes to legislation have been effected,” the strategy states.
Alongside supplementary prescribing, specialist clinics in community pharmacy — such as for anticoagulant therapy, asthma or diabetes — are envisaged.
Promoting seamless care is another theme in the strategy with initiatives scheduled for this year. Part of this will involve the Department encouraging the introduction of integrated medicines management frameworks between different care sectors. This will include harmonising product supply between primary and secondary agencies so that patients do not have their medicines changed when moving between care sectors.
How will the changes in the framework be supported?
Like their counterparts in the rest of the UK, community pharmacists in Northern Ireland will soon have a new contract. The strategy says that a new system of remuneration linked to quality rather than volume should be introduced. “Changes should be designed to help ensure that the emphasis in community pharmacy continues to shift from products to patients, and from working in isolation to operating more fully as part of the primary care team,” it says. The Department spokesman explains: “The new contract will be built around the strategy.” It is expected to take a format of a core service with enhanced and additional services added on. Implementation of the new contract is scheduled to begin in 2005 and continue into 2006.
The Office of Fair Trading report is touched on in the strategy. The strategy confirms that simple deregulation is not the way forward for Northern Ireland but that some improvements of existing arrangements will be considered as part of the new contract. Another improvement needed relating to access to services is out-of-hours provision, although the strategy suggests that late opening of pharmacies might be a better option than 24-hour emergency on-call cover.
Community pharmacy premises in Northern Ireland look set to improve over the next three years. The spokesman explains: “Pharmacists will be able to apply for funding to improve their premises with a view to enhancing the services they provide.” Services should be provided in an environment that respects people’s dignity and promotes confidence to access the service. Therefore, premises improvements such as constructing consultation areas are needed to allow the greater privacy that patients want, the strategy states.
Access to electronic health records will be essential if community pharmacists are to contribute effectively to patient care. “Pharmacists will not only need to read them but will also be required to record relevant data such as interventions and recommendations,” the strategy says. A pilot project involving an integrated primary and secondary care IT network called the “Electronic prescription and eligibility system” is being tested in Northern Ireland and this will be continued over the next few years. Automated dispensing in community pharmacies will be piloted in 2005.
One of the Department’s top priorities for 2004 is quality. A clinical governance framework will be developed this year and will include standard operating procedures for common services. There are plans to reward pharmacists who have high standards of practice through a system of “charter marks” awarded for delivering particular services.