An aspirational vision for pharmacy

What would community pharmacylook like in Wonderland?  Join me as we tumbledown the rabbit hole...

You'll find that a pharmacist'sonly involvement with the dispensing process is the clinical screening ofprescriptions.  Dispensers and ACTs handlethe remainder.  Comprehensive screeningis possible thanks to access to a patient's medical history.  Paper prescriptions are a distant memory,their impracticality chuckled at in hindsight.

The relationship between GP andpharmacist is no longer distant and unbalanced. The job of practice prescribing advisors is integrated in the role ofevery community pharmacist.  Changes to apatient's prescription aren't something for patients to talk to their GPabout.  They are instead explained by thepharmacist who contributed to the prescribing decision through the writing ofjoint guidelines and policies. Pharmacists are able to make unrestricted amendments to prescriptions,their professional judgement being trusted.

Pharmacists are ‘experts inmedicines' in a way that has practical effect, rather than being a mereself-congratulatory motto.  It now seemsbizarre that asthma management, warfarin monitoring and minor ailment treatmentwas ever conducted by anyone other than pharmacists.  We wonder how GPs ever coped with theworkload, then remember how difficult it once was to get appointments.

Funding is a non-issue.  The process of piloting new services,analysing resulting data and forming compelling funding arguments is the norm.  The onus has shifted from pharmacy tocommissioners in justifying which alternative ‘willing provider' can deliverthe service better without pharmacists and their unparalleled integration inthe community.

There is a clearly defined careerpath which recognises and rewards advanced practice.  Community pharmacists - now referred to asgeneralists - are no longer career nomads. They progress through stages of practice, graduating from servicedelivery to taking increasing responsibility for service design and management.Local practice committees arestrengthened as a result and have formidable influence over local healthcare agendas.

A pharmacist isn't defined by wherethey work but their area of practice.  Specialistpharmacists move fluidly between hospital and community, with an expectationthat they practice in both.  Specialistsconduct outpatient clinics in the premises of their generalist colleagues.  The primary-secondary care interface ceasesto exist.

In all, it's a vision that willscare some but excite many others, particularly those recently qualified whofeel most acutely a disturbing and soul-sapping discord between what theythought they'd been trained to do and the realities of the role.

The direction of change is thankfullyin favour of this vision.  I'm not alonein hoping it comes sooner rather than later.

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