It’s tough out there in community pharmacy. To deny this fact is absurd. That said there is a ray of hope for the sector.
Once again, these green shoots and genuine leadership are emerging from Scotland.
For eight years of my career, I was a community pharmacist in Scotland. That time was spent running a community pharmacy in a rural location. The contract sustaining said community pharmacy, and all the others in Scotland at that time, was based largely on dispensing revenue. My paymasters at the time were not much fussed on remuneration from activities too far removed from the dispensing process.
More was more.
The perpetual conundrum for community pharmacy.
How to withdraw gently from a growingly inhibitive dispensing volume-driven contractual arrangement?
Interestingly the pinch point for the community pharmacy network in Scotland of late has not been funding, which has remained relatively flat but instead pressures on their workforce. The challenge has pivoted from one of funding to one of creating an attractive career option for young pharmacists entering the profession and of course unleashing the talent of the pharmacists in our community pharmacy network.
In January this year, the Chief Pharmaceutical Officer for Scotland Rose Marie Parr wrote a letter referring to the new NHS Pharmacy First service which is to be implemented from April 2020.
The Scottish Government’s Programme for Government 2018/19 committed to increase access to community pharmacy services by developing and implementing a redesigned minor ailment and common conditions service available to all. Our focus was on increasing access to community pharmacy as the first port of call for managing self-limiting illnesses and supporting self-management of stable long term conditions in and out of hours and to improve pharmaceutical care and contribute to the multi-disciplinary team.
It is intended that the redesigned service will replace the current Minor Ailment Service and current Pharmacy First services and will commence in all community pharmacies from April 2020. Implementation of the service will be supported by a range of materials and approaches to raise awareness amongst members of the public, pharmacy staff and other healthcare professionals.
A new remuneration model will be introduced from April 2020. This will replace the existing capitation model and will move to an activity based model, where the pharmacy team will be remunerated for the activity undertaken and reimbursed for dispensed items.
The activity will be based on Advice: Referral: Supply. There will be increased eligibility and access to the service which, together with the remuneration model changes, will necessitate changes to operational practices and how pharmacy teams interact with members of the public.
And there it is. Just like that the future beckoned.
The exciting element of the Pharmacy First service for me is not the initial setup phase, which has been executed brilliantly so far by Community Pharmacy Scotland colleagues, but rather the opportunities that now will emerge. Namely the prospect of making it the norm that pharmacist independent prescribers will operate ubiquitously across the Scottish community pharmacy network.
Moves have already been made by the Scottish Government to prepare the workforce for these changes but the work of Sam Falconer demonstrates that the innovators in Scotland are impatient to get going.
That’s the pot of gold at the end of the rainbow.
And many will sniff and ask:
Where’s the money?
Well, the short answer is that the money will come to deliver the service and the emerging model of payment looks as good if not better than the minor ailments deal. The existing capitation model will be replaced and will move to an activity-based model. In this model, the community pharmacy team will be remunerated for the activity undertaken and reimbursed for dispensed items. The activity will be based on:
Advice: Referral: Supply.
But the real gold is the fact that community pharmacy in Scotland has the potential to develop and embed a compelling pharmaceutical care driven value proposition with the patient and pharmacist at the centre. If we get this right the value proposition offered to Government on one side of the market and people accessing the service on the other is so compelling that it would be daft not to invest and build further for years to come.
The bottom line ethos behind this new Pharmacy First endeavour will be the chance to harness the clinical expertise of community pharmacists. For years this work has gone unrecorded and therefore largely politically unnoticed. I think the pressure to gain widespread read/write access to the patient record will shortly become inevitable. The safe and effective delivery of a service like Pharmacy First needs a joined-up technology solution.
So we have the prospect of a joined-up, simplified and universally accessible community pharmacy service to enable pharmacists to make the most of the environment within which they exist, our local communities.
And what of the future. Well here is where colleagues at Community Pharmacy Scotland have shown some genuine vision and leadership. I’ll give the last word to them:
It is our intention that, in the long term, every pharmacy in Scotland will be able to offer a common clinical conditions service utilising the IP skillset and advanced clinical training. This offering would sit ‘on top’ of the Pharmacy First service, and in time will negate the need for any PGDs.
Pretty cool I reckon.
Johnathan Laird is a pharmacist who has said that if any PIP reader can find a better community pharmacy initiative than Pharmacy First in the world he will eat his BNF.