Primary Care reforms and the role of Pharmacists

The London School of Pharmacy launched its New Year’s open discussion about the future of pharmacy in the midst of NHS reforms. This discussion featured a prominent panel of speakers including Professor Sir Nicholas Wald and Dr Panos Kanavos, chief author of 2020health’s report Implementing value based pricing for pharmaceuticals in the UK.

Amid recent news on flu vaccines shortages, descriptions of pharmacists have pitched them as a public health hazard.  The School of Pharmacy’s own Nicholas Barber argues the value of the pharmacist historically but also the profession’s own set of values. Alex Gourlay, Chief Executive of Alliance Boots noted that the vision for pharmacists was threefold – encompassing all the medical expert, public health guru and patient friend. From personal experience most will know that the queue at a local pharmacy is far more appealing than any GP surgery, and that the near immediate responsiveness from a pharmacist has the hallmark of that ever elusive patient centeredness.

This also recognises an ongoing cultural onus within the medical professions on hierarchy. In the absence of any “Royal College of Patients” (coined from Jeremy Taylor of National Voices) it continues to risk that one crucial group may not have been heard. We want to encourage empowerment through new information and technology frontiers, through self care, access, quality and safety. However a continued lack of integration between GPs and Pharmacists, Primary and secondary care often makes any attempt redundant before it even gets underway.

Wald, an expert in behavioral medicine, reiterated that we are always talking about people over patients (Royal College of People anyone?) and made several crucial points.

• Too much choice can be over-burdensome for those with little ability to choose.
• Age remains the single greatest determinant of disease.
• Prevention is not better than cure, but is better than measurement.
• Pharmacists and other health professionals in the community have a pivotal role to play.
• Something more substantial than “nudge” might be required to solve conflicts of interest between the realms of commercial and health sectors.

A major concern associated with the move towards GP Commissioning Consortia (GPCC), public health functions and all, is that GPs may not wish to fund enhanced pharmacy services. More broadly, in a roundtable that engaged the allied professions, held following the White Paper, 2020health found that forthcoming GPCC’s need to recognise the value that other allied health care professionals will bring to the table. It was also widely claimed that as contracts are renegotiated, there must be a level playing field between competing potential providers. This too correlates with the need for representatives at the GPCC board level to be present for much more than just a tick box exercise.