Time to act together
Margaret lives alone. Following the death of her husband she has become increasingly frail. Carol, a pharmacy technician from the local pharmacy, visits Margaret at home to undertake a review of her medicines as requested by Mark, the community pharmacist. Margaret tells Carol that she finds no benefit from omeprazole and amitriptyline and does not want to continue them. Carol and Mark discuss Margaret’s concerns with her GP, who agrees that the medicines can be stopped.
Edith was admitted to hospital after having a fall and is now going home. Dominic is a clinical pharmacist for older people. He calls Mark, the local community pharmacist, to discuss the transfer of Edith’s care. There have been some changes to her medicines and tramadol has been stopped. Edith’s pain control will need to be reviewed when she returns home. Mark and Dominic agree that the hospital outreach team will visit Edith at home and hand over to Mark for further follow-up. Dominic notes that while in hospital Edith had indicated a willingness to stop smoking and Mark agrees that he will make sure that she has the right support to do this.
Do these stories ring true or are we fantasising? Both are examples of the type of practice espoused in the Royal Pharmaceutical Society-commissioned report for England “Now or never: shaping pharmacy for the future”. But in reality this is not standard practice.
The current pharmacy model — where community pharmacy and hospital pharmacy use their expertise independently — does not facilitate this vision. Although both sectors have achieved great things individually, imagine how much better it would be for patients like Margaret and Edith if all sectors of pharmacy were to step out of their silos and use their expertise synergistically.
Many vulnerable, housebound patients never set foot in their local pharmacy; nor do they discuss their medicines with a pharmacist or pharmacy technician. Despite the introduction of the new medicine service and targeted medicines use reviews, the only contact that these patients have with pharmacy are the drivers who drop off their medicines. It is the exception, rather than the norm, that colleagues from hospital and community pharmacy get together to discuss cases and agree pharmacy care plans.
These are longstanding issues and we do not suggest that resolving them will be easy. Indeed, increasing pressures in NHS funding and a new community pharmacy contract in England will certainly bring further challenges. However, as the third largest healthcare profession and key members of the health and social care team, we all must work differently to ensure we can deliver the best possible patient care.
There will be difficulties in getting the funding to match service delivery, but these are not insuperable. This is your profession: what changes can you bring about locally to improve the care of your patients? It is time to act together.
Richard Copeland is chairman of the Northumberland, Tyne and Wear Local Professional Network (pharmacy), Mike Maguire is chairman of the Durham, Darlington and Tees Local Professional Network (pharmacy), Wasim Baqir is research and development pharmacist and David Campbell is chief pharmacist, both at Northumbria Healthcare NHS Foundation Trust.
Citation: Clinical Pharmacist DOI: 10.1211/CP.2014.11134781
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