Having two pharmacists in every pharmacy could transform patient outcomes and optimise a post-Covid healthcare landscape, says the Pharmacists’ Defence Association. Report by Sasa Jankovic

A new report from the Pharmacists’ Defence Association (PDA) has called on policymakers to use learnings from the pandemic to reconfigure primary and secondary healthcare into a more collaborative and integrated multidisciplinary system.

‘Lessons from the Covid-19 Pandemic’, which is based on feedback from PDA members, aligns with other policy papers from the PDA proposing ways to better utilise the skills of pharmacists. According to the report, having community pharmacy as the first port of call in the primary care system “would result in a move away from an expensive, increasingly challenged, medically-led model of the NHS”. 

Improved collaboration then “reduces the likelihood of A&E attendances and unnecessary hospital admissions and creates benefits for the healthcare team, the NHS, the taxpayer and improves the patient’s journey”.

To do this, the PDA proposes a change to the way services and patient pathways are developed.

Additional service tiers

The report suggests the existing pharmacy contracting arrangements could be supplemented by additional tiers of more clinical services integrated within primary care and delivered by “individual pharmacist practitioners possibly through group practices of pharmacists” in a similar operating model to barristers’ chambers. 

In addition, it says contracts should be “complementary across primary care to incentivise collaboration and integration, partnership working and sharing of health outcome measures”.

As well as providing improved care for patients, the report claims the integrated nature of these new services would release significant GP capacity, although the PDA recognises that such proposals could only succeed in the long-term if “delivered within a locally managed and co- ordinated framework”.

The PDA says many of these proposals could be provided through arrangements independent of the current pharmacy contract for medicines supply, giving pharmacies the opportunity to create “more of a health centre offering and move away from the appearance of being a shop”.

Pharmacists would be responsible for clinical checks on prescriptions “but no longer for their assembly” under the arrangements envisaged by the PDA, with pharmacy technicians managing the “technical aspects of dispensing”. 

Other recommendations include allowing community pharmacies to make local nursing referrals for ‘frequent flyer’ patients through new formal pathways, having a ‘social care champion’ in every pharmacy, and using pharmacy as a means of helping “digitally disenfranchised” patients navigate the increasingly interconnected health service.

Transformative?

While the PDA says the reimagining of the model for pharmacy could be “transformative to the health and pharmaceutical care of patients”, it acknowledges that the current “model, funding and workforce structure” does not facilitate this.

These proposals are also predicated on a model where at least two pharmacists are working in a pharmacy – one in an opportunistic patient- facing role, and one leading clinic activity in the consultation room with planned caseloads, both supported by full access to patient records.

“The presence of two pharmacists should certainly be one of the options when looking at skill mix and technology adoption across pharmacy to enable the sector to deliver the right standards of care and meet patient needs,” says Ade Williams, director and superintendent pharmacist of Bedminster Pharmacy in Bristol.

“It is a visionary intent, the sort of direction that – with a proper implementable road map, [and] sustainable and sufficient funding alongside a coherent policy commitment – should enable community pharmacy to deliver even more for the population and ease the NHS burden.”

 ...but funding a stumbling block

Visionary or not, the obvious stumbling block remains funding.

“How will you fund two pharmacists in every store?” asks James Rotherham, superintendent pharmacist at Higginbottom Pharmacy in Ferryhill, County Durham.

“[In] smaller pharmacies it is impossible with the current structure, rising costs, reduced margins and increased wages. [It is a] lovely idea and a vision I support but is not realistic without a dramatic change in funding.”