The Chief Pharmaceutical Officer for NHS England gave this clear message to the Royal Pharmaceutical Society (RPS) Annual Conference 2015:
Over the years, pharmacy across all sectors has contributed much to society. From its apothecary roots enabling anyone to have access to healthcare, to scientific endeavour that underpins much of pharmaceutical discovery and development, to innovating to deliver best care for patients.
In recent years, the development of pharmacy as a clinical profession has come more to the fore.
Starting in hospitals, but now moving to primary care and community pharmacy too, clinical pharmacy has made its mark. Indeed the demand for clinical pharmacy has never been greater, including for pharmacist prescribers.
The RPS is to be congratulated in grabbing this agenda, in the form of medicines optimisation. A patient centred, value driven, outcome based approach to medicines use.
But the journey towards optimal medicines use in all patients through the deployment of clinical pharmacy has only just begun, and still we hear far too many cases of poor outcomes from sub optimal medicines use.
At the same time, we find ourselves with a set of challenges that people like me continue to talk about: aging population, increasing public expectation, the opportunity of technology, and of course the financial situation.
In England, the Five Year Forward View sets out the challenges and opportunities very well: our NHS has to be redesigned, to rebalance effort towards prevention, whilst improving quality of healthcare generally, and at the same time close a funding gap of the scale never seen before. This will all need a huge improvement in efficiency and productivity if our NHS is to survive.
So what will pharmacy’s contribution be?
People being admitted to hospital because of avoidable medicines issues simply cannot go on. Nor can the level of wastage of medicines use. Nor can over use of medicines, and medicines use has to get much safer. Add poor adherence and it’s nothing short of a scandal. So a dead cert is expansion of clinical pharmacy in all settings to deliver the patient benefits, and system efficiencies, of using medicines optimally.
At the same time, technology progresses. I was at the NHS Expo recently and saw first-hand some of the fantastic technology with us right now to support patients and better care. Set alongside improved diagnostics, genomics and personalised medicine, we can expect radical change to patient care in the not too distant future.
Pharmacy has started adapting to this new and challenging context. For example, robotic dispensing in hospitals is now commonplace – helping – a little – to free up clinical staff to deliver more direct patient care and medicines optimisation.
In community pharmacy, this is starting too. Not just using robotics in pharmacies, but there are now large centralised dispensing facilities in England. It could be that such facilities will be capable of dealing with two thirds of dispensing volume in community pharmacy.
Large scale centralised dispensing. We knew it was coming – well now it’s here.
If implemented well, not only will dispensing be more efficient and safer, but it will free up highly trained staff to work closer with patients – to deliver clinical pharmacy and medicines optimisation, and helping people live healthier lives. And whilst we are at it, let’s make the whole patient experience more convenient through click and collect, more home delivery and generally digitising a good chunk of traditional pharmacy practice.
And let’s not forget the deployment of clinical pharmacists into GP practices. A key development for collaborative, cross sector pharmacy practice, that’s focused on getting best outcomes for patients.
This is a real opportunity for the pharmacy profession, but let’s not pretend there won’t be other consequences. Any tax payer wants their money to be spent well. So those who spend tax payers’ money have a duty to get the best value.
In the context of the financial challenges, all across the public sector, and not just NHS and health, the emphasis is on transforming service design and delivery, to deliver better and more efficient services. So expect a much closer examination of how tax payers’ money is spent on pharmacy as new models of practice roll out.
Put all this into the context of the New Models of Care being piloted across England, and it’s easy to see how clinical pharmacy will, and must, quickly dominate pharmacy practice.
Please don’t think this focus is on community pharmacy practice alone. It’s not. The work I am sponsoring on pharmacy and medicines optimisation in hospitals is a central part of the NHS Procurement and Efficiency Programme. The work is examining how best to modernise the infrastructure and metrics that support hospital pharmacy in order to focus even more on clinical pharmacy and medicines optimisation.
So the future is clinical, underpinned by efficient and effective use of technology.
What else can be done to deliver this efficient and clinical future?
As we know pharmacy practice is surrounded by regulation. The rebalancing medicines legislation and pharmacy regulation programme seeks to promote, not hinder, future practice. If we are to improve patient safety in medicines use we must be free to report and learn from our mistakes. So the progress made in providing a defence to dispensing errors is a great step forward, and part of making healthcare more human-centred, not system centred.
But more has to be done to ensure legislation and regulation supports improvement in care.
There’s more to be done on supervision. There is now significant infrastructure designed to underpin patient safety in pharmacy practice. The GPhC, it’s standards, the RP and so on. We now have pharmacy technicians as a registered profession who, like registered pharmacists, have to face the expectations of such status. But there is still some way to go until uniformity of practice by pharmacy technicians is guaranteed.
If we are to free up pharmacists in community pharmacy to provide more clinical services, including through utilising pharmacy technicians much more, then we must ensure if there are any risks, they are identified, and are mitigated – just as has happened already in hospitals. So the four CPhOs are looking at how best to do that.
And if the benefits of centralised dispensing are to be fully delivered, then all community pharmacies must be able to access them. That’s not possible at present because medicines legislation does not permit it, so that must change as soon as possible.
And finally we must make progress on the pharmacist educational reforms, promised for too long. We are already seeing signs of the pharmacy education system creaking. Neither I, nor my fellow CPhOs, nor the GPhC can simply stand by and let that happen.
For too long the reforms have been blocked by some doubting but powerful universities. This must stop if we are to produce a sustainable supply of the type of clinical pharmacists the NHS wants.
The pharmacy world has been calling for change for years. The stars are lining up, and firmly pointing towards a clinical and digital future. The next few months and years are going to be a fundamental period for the profession.
Some will embrace change more readily than others, and some will be able to adapt more quickly, but throughout we must ensure patients and the public are nothing but beneficiaries.
Dr Keith Ridge CBE is the Chief Pharmaceutical Officer for England, employed by NHS England, but also supporting the Department of Health and Health Education England. He is head of the pharmacy profession with a workforce of some 150,000 people.
He is based within the Medical Directorate and leads on various work-streams including getting better outcomes and value through optimising medicines use.
Keith works with Bruce Keogh and across the organisation on the implementation of the Pharmaceutical Price Regulation Scheme. This involves close working across the organisation to make the most of community pharmacy.
He leads on reform of specialist pharmacy services and supports HEE on reform of pharmacy education and training.
Keith is working across the system on reducing the threat of antimicrobial resistance and working with DH on rebalancing medicines legislation and professional regulation. He also holds the general role of being the systems’ principal advisor on pharmacy and medicines use.
He was previously Chief Pharmaceutical Officer for DH where he led the development of a well-regarded pharmacy White Paper setting out a clinical vision for pharmacy. He led the reform of pharmacy professional regulation including the establishment of the General Pharmaceutical Council and established and led the Modernising Pharmacy Careers programme aimed at reforming pharmacy pre and post registration education and training. He also held the senior role in pandemic and seasonal influenza planning.
Before that Keith was the chief pharmacist at University Hospital Birmingham FT, and prior to that Chief Pharmacist at North Glasgow University Hospital Trust. He has practiced in hospital, community and industrial pharmacy.
Keith qualified as a pharmacist 1988 with a PhD in pharmacy practice, University of Manchester. He holds the University of Manchester Outstanding Alumni Award and is a Fellow of the Royal Pharmaceutical Society, a Fellow of UCL School of Pharmacy and honorary Professor in Infectious Disease and Immunity Section of Imperial College Medical School. He was awarded the CBE in the 2014 New Year Honours List for services to pharmacy and patients.