Opinion: Pharmacy is in a much better place. Really.

To be honest, pharmacy was an after-thought in the 2007 Darzi review. Towards the end of the work, I was asked to get the views of the profession on the future of the NHS, which was a bit of a pharmacy box ticking exercise. Yet things moved on quickly and the following year saw the publication of Pharmacy in England: Building on Strengths, Delivering the Future. 

This 2008 White Paper set out a clinical vision for pharmacy practice and the reforms necessary to get there. It was well-received by the pharmacy world which, given that I led the development of it, was a nice surprise. 

Back then, pharmacy was not a particularly influential player – and for good reason – but now the profession is in a totally different place. Remember those were the days when the BMA cried “over my dead body” at the thought of vaccinations in community pharmacy. 

So what has changed to give the Government more confidence in pharmacy? 

It starts with the basics. In 2007 pharmacy had a conflicted professional regulator – the joined-up professional leadership and regulatory body known as the Royal Pharmaceutical Society of Great Britain – which could not be trusted to underpin clinical services to patients when commercial influences were at the fore. That is now fixed! The GPhC is an experienced, independent, patient and public-focused professional regulator.

Following on from that, a patient and public focus on professional leadership was needed to champion excellence in pharmacy practice. After a couple of false starts, this is now heading in the right direction with the recent proposals to form a Royal College of Pharmacy with charitable status.

Clinical training

Professional education was, and rightly still is, science-based – but back then clinical training was, to say the least, insufficient. Fixed! 

Continuing education and development has been invested in (and is a revalidation requirement) and fundamental education reforms are being implemented, culminating in all new pharmacists becoming prescribers at registration. 

In 2007 probably the most common clinical service in community pharmacy was the provision of medicines use reviews. Gone! And replaced with a range of new services over the years including the NMS, vaccinations and, of course, Pharmacy First.  

In general practice, pharmaceutical skills were largely employed to control the drugs bill. Fixed! Thousands of pharmacists with enhanced clinical skills, including prescribing, are leading the charge on reducing overprescribing. Compared with 2007, pharmacy is in a much stronger clinical position. 

Strong position despite the pain

Let’s now turn to infrastructure that frees up pharmacists to deliver even more of these clinical services. 

In 2007 I don’t recall any robotics placed in community pharmacy. Work in progress! Now it is much more common to see automated dispensing and prescription collection technology. 

More fundamentally, at some point in the hopefully near future, the legislation will be in place to accelerate deployment of large scale (hub) centralised dispensing. And not only that, there is light at the end of the very long tunnel known as supervision, such that pharmacy technicians in community pharmacy will finally be able to play their part in enhancing clinical care for patients. 

There have been some painful, rocky patches along the pathway to reform – in particular the decision in 2016/17 to reduce community pharmacy funding – but overall pharmacy is in a very strong clinical and infrastructure position to play its part in repairing the broken NHS. 

Building blocks in place

So what might pharmacy do now that it has got the right building blocks in place? 

I’ll start with perhaps the least obvious but, in some ways, one of the most important steps. Pharmacy now has the bedrock of capability to deliver clinical research. Sure, more specialist training is needed for most, but pharmacy could play a major part in economic growth by leading, not just supporting, clinical trials. 

Secondly, long-term condition management in community pharmacy should become routine, alongside pharmacy-led access to diagnostics. Gaps between sectors in the profession will disappear as technology brings them all closer together, meaning ‘one pharmacy service’ across a locality should be how care is delivered. And community pharmacy will be a leader in preventative healthcare and advice. 

Of course, all of this will be within a multiprofessional team, but pharmacy must no longer underplay either its capability or the scale of reform (and sometimes, pain) of the last decade-and-a-half.

Do not underplay scale of change

The argument to deploy is one that educates policymakers about the significant and fundamental reforms pharmacy has undergone over the last two decades and the new capability available. Pharmacy must not underplay the major reforms that have put it where it is today and will underpin the future. 

Pharmacy can now confidently explain why it can be trusted to deliver. Do that and not only will future policy documents set out in depth how the profession will be central to a revitalised NHS (unlike the traditional couple of paragraphs we have seen again in the latest Darzi review), but the right amount of resource is much more likely to flow.