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Models of care: winning back professional autonomy

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It’s always nice to do number exercises when big reports arepublished. This week, pharmacists will be hearing a lot about “Now or never: shapingpharmacy for the future” , the long-awaited report of the Royal PharmaceuticalSociety’s Commission on Future Models of Care delivered through pharmacy, whichwas chaired by Judith Smith, director of policy at the Nuffield Trust.

Dr Smith’s report sums up the world of pharmacy spot on, ie,the lack of recognition, its fragmented voice, how it is competing for the samepot of money, and how it could make a difference if itsbusiness model were to change from being a supplier of medicines to a provider ofpatient care. It is great to hear this from an outsider.

What struck me foremost about the report was the number of recommendationsassigned to different pharmacy actors.

Recommendations to pharmacists number five; to localcommissioners, two; to the Royal Pharmaceutical Society and leaders of theprofession, four; and, crucially, to the Government (NHS England, Public HealthEngland and the Department of Health), a substantial nine.

The report is absolutely right to give government bodies themost recommendations.  For years now,pharmacy has been a forgotten contributor to the English healthcare landscape.Policy-makers may occasionally reference pharmacy in some report, but generallypharmacy has been a sideshow.

Now Dr Smith says these Government bodies must includepharmacy in plans for the future of out-of-hours and urgent care, publichealth, and the management of long-term conditions. They must also take accountof the role that pharmacy can play when planning initiatives.

The most exciting recommendation, which, in my opinion, shouldhelp give pharmacists their professional autonomy and status, as well aidingpatient care, relates to how NHS England should use its national commissioningrole for pharmacy in the future.

The report says it wants NHS England to consider includingthe possibility of community pharmacy having separate core contracts for dispensingand supply on the one hand, and for service provision in a broader primary carecontext on the other. “There should be openness by NHS England to pharmacistsholding these contracts as professionals, perhaps through networks or chambers,rather than through their employers,” it says.

The future, it says, may see two “tiers” of pharmacists,those who focus on the supply and dispensing of medicines, and those  who take on additional care-giving roles, includingprescribing, public health work, and management of long-term conditions andcommon ailments.

Contracts being held by pharmacists themselves may prove abit radical for the current holders of pharmacy contracts, especially the multiples, which will be worried about how this will affect their revenue streams. Therecommendation might also not have the backing of some pharmacists,  who may be concerned that “dispensing”pharmacists are placed in a different sort of bracket to others.  But it’s happening already, some  pharmacists have already attained skills to go beyond dispensing and a new landscapehas to recognise this.

So far there has been little political will in darkgovernment circles to move the pharmacy agenda forward, but possibly this reportmay just be the bright spark pharmacy needs.   

Elizabeth Sukkar is asenior news and features writer for The Pharmaceutical Journal

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