These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Pharmacy technicians may become prescribers

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Automation and Delegation in Pharmacy: Understanding the Moving Parts

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Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

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Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

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Scotland’s New Health Committee

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Comparison of Funds: New Medicines v Cancer Drugs

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New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

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Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Wednesday, April 04, 2018: Pharmacy and the New GP Contract

This interview is published in the latest edition of Scottish Pharmacist magazine http://www.scottishpharmacist.co.uk/magazines/

General Practitioners have voted to accept a new GMS Contract negotiated between the BMA and the Scottish Government. The contract is being introduced over a three-year period from April. It promises every practice access to pharmacist and pharmacy technician support to deliver a defined list of ‘pharmacotherapy services’. Meanwhile, responsibility for vaccination services will be taken from GPs and handed to NHS Boards. John Macgill asked the Chief Executive of Community Pharmacy Scotland, Professor Harry McQuillan, what the new deal for family doctors means for community pharmacists.

HM: My first reaction was that, while it’s good to see so much recognition of the pharmacy profession, I’m not quite sure who in the profession was consulted when they wrote so many pages about pharmacy. Certainly not me, nor any of my Community Pharmacy Scotland colleagues.

The contract clearly recognises the role for pharmacy in the management of patients’ medication. The question for community pharmacists is how they will fit in with the growing group of colleagues working in general practice? If we get it right, we could have proper peer-to-peer communication, pharmacist to pharmacist, creating a seamless transfer of information and, as a result, improving the pharmaceutical care of our patients.

You have to remember, though, that pharmacists in the community have benefited from working directly with local doctors. There was a lot to be said for what we used to see, when the GP would come into the pharmacy on a Friday and write up all the prescriptions that had been phoned through during the week, allowing us to talk about patients’ medicines and exchange ideas. That sort of interaction will stay in the past if every GP has their own pharmacist in the building.

JM: Do you believe those negotiating the GP contract were assuming that practice-based pharmacists would be the ones to deliver the pharmacotherapy services outlined in the document?

HM: I think that was the intention. But I would suggest we are missing a huge opportunity to use community pharmacy expertise properly, so long as we get the information transfer right. Looking at the pharmacotherapy services laid out in the GP Contract – defining ‘core’, ‘additional advanced’ and ‘additional specialist’ activities – I can’t help feeling that these lists were created in isolation. The list of so-called ‘core’ services seems very similar to the Chronic Medication Service. So there’s now the question of how to integrate the new GP contract with the CMS to stop a patient falling into a gap between the two – or being asked the same questions twice.

I’d like to see it becoming the norm that patients with long-term conditions are managed close to home by their community pharmacist. If, then, there is some sort of exacerbation or concern, he or she would be escalated up to a GP pharmacist with a particular in-depth knowledge of that condition, and then passed back to their community colleague when things had stabilised again. 

JM: Another chunk of the work that has been taken away from GPs is vaccination. What are your hopes in terms of the role for pharmacy in taking over responsibility for vaccination services? 

HM: It is now approaching a year and a half since we submitted a proposal to allow us to undertake travel vaccination, which is specifically highlighted in the new GP contract as being time-consuming for GPs. There is only a certain number of travel vaccines that the NHS will fund – the others can be supplied on a private basis. Community pharmacy is ideally placed to deliver that entire service, ensuring people have the right information and the right protection. We are still waiting for the outcome of our proposal. 

In terms of protecting vulnerable groups, we consistently fail to meet our targets in Scotland for vaccinating at-risk groups. These are the people who we work with all the time in community pharmacy. We are ideally placed to reach, for instance, the over-65s and, as these services change, it’s so important that none of these at-risk people get missed. But allowing us to achieve all this will require changes in the legislation that defines ‘medical practitioner’, which currently restricts so much of this work to doctors. 

So, I think a balanced reasonable progressive solution to filling the service gaps created by the new GP contract will be to include community pharmacy in many areas of vaccination; to have really good information flow between practices and community pharmacies; and allow us to play a much bigger role in helping, and protecting, those people whose working lives make it difficult for them to attend GP surgeries.