With proposals announced for a new GP GMS contract in Scotland (jointly designed and agreed between British Medical Association and the Scottish Government), we are delighted to see a recognition of pharmacy and how they can be utilised in a more clinical role, delivering care to patients and releasing pressure on GPs and their workload.
The proposals set out to focus the role of the GP on activities that require their skill and expertise. To enable this, the workload will need to be redistributed to a wider primary care multi-disciplinary team, of which pharmacy is a key part. A re-design of services will take place over a agree period of time from 2018 to 2021. A number of agreed services will be focused on including:
- Vaccination services
- Pharmacotherapy services
- Community treatment and care services
- Urgent care services
- Additional professional clinical and non-clinical services
Each of the 31 HSCPs (Health and Social Care Partnerships) in Scotland will develop a Primary Care Improvement Plan to outline how these services will be introduced before the end of 2021. In particular there are 2 areas in which pharmacy could play an important role:
1. Vaccination services
It has been agreed that vaccinations would move away from a model based on GP delivery to one based on NHS Board delivery through dedicated teams. The Vaccination Transformation Programme will take 3 years to complete and will have the following work streams:
- Pre-school programme
- School based programme
- Travel vaccinations and travel health advice
- Influenza programme
- At risk and age group programme (shingles, pneumococcal, hepatitis B)
Pharmacy has already proven its ability to deliver vaccinations (as evidenced by the provision of private services via PGDs and the success of the NHS influenza advanced service in England) and we would be keen to see pharmacists fully utilised to support this vaccination plan.
2. Pharmacotherapy services
The proposed contract includes an agreement that every GP practice will receive pharmacy and prescribing support. To date the GP Pharmacy fund has enabled 160 pharmacists and 34 pharmacy technicians to be appointed in over one third of GP practices in Scotland. In order to expand this further, additional funding has been secured to increase the number of pharmacist training posts from 170 to 200 per year from 2018/19
The contract proposes further development with the introduction of a new pharmacotherapy service. This will take the shape of core, additional (advanced) and additional (specialist) services. By 2021 every practice in Scotland will benefit from the core elements which include:
- Authorising/auctioning of all acute and repeat prescribing requests and hospital immediate discharge letters
- Medicines reconciliation
- Medicines safety reviews/recalls
- Monitoring of high risk medicines
- Non-clinical medication reviews
Additional advanced specialist services will initially be available in different areas (subject to workforce availability) but will build up throughout the three years. These include:
- Medication reviews (5 or more medicines)
- Resolving high risk medicine problems
- Polypharmacy reviews
- Specialist clinics e.g. chronic pain, heart failure
These services recognise the pharmacist expertise in medicines and also support the development of the Independent Prescriber role as detailed in the ‘Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland’ document published in August 2017. Importantly the proposal also makes reference to the role of all 3 areas of pharmacy – community, GP practise based and hospital and that they all link together into an integrated pharmacotherapy service.
As well as these areas we believe there are also further opportunities for pharmacy. For example for in community treatment and care services, we believe there are opportunities for pharmacy around other services such as ear syringing – there is already interest from some pharmacies to set up these services especially in England where they have been decommissioned from CCGs and with the right training this could be another opportunity for pharmacy in Scotland.
It is important that pharmacies now begin to develop the skills and confidence to adopt this clinical role and we as Numark will be looking at how we can support our members to make this change. Delegation and leadership will be key to help free up time and as will ensuring they utilise the expertise of the whole pharmacy team effectively.
Overall we believe this proposal is a positive step forward for expanding the role of pharmacy in Scotland.
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