December 2019 Blog: My Reflections on Community Pharmacy
Christmas and the New Year have traditionally been times for reflection; thoughts of the past, what’s happening now and whatever the future holds. This year there will never be a better time to reflect on my 41+ years in pharmacy because I will be retiring at the end of December.
Today, pharmacy is a world away from what it used to be, but the ethos is still the same and patients are still at the heart of everything we do. There may be computers, a vast array of potent medicines, electronic prescriptions, and summary care record access, but we are still dispensing medicines to the local community as we have always done. Everyday interactions and conversations with patients are still a key part of the ‘day job’ and help to ensure that the profession is trusted and well thought of.
I no doubt view the way pharmacy used to be through ‘rose tinted spectacles’, but I do think that we had more time. Time to get things done without the frantic rushing and pressure that feels common place today.
There was certainly very little original pack dispensing and everything had to be either counted or made up from scratch using ancient skills that are no longer required. I remember making gallons of Kaolin and Morphine Mixture and then pouring it into 200ml bottles for sale over the counter – you should have seen the mess on the bench!
New therapies and new medicines have transformed people’s lives making it possible for people to live longer and to have a better quality of life for longer. The choice of medicine was very limited compared to what we have available today. In the past labels were handwritten and ‘lick and stick’ was the order of the day. Self-adhesive computer generated labels are one innovation I wouldn’t want to do without…
Year’s ago we didn’t say too much to the patient when we handed over their dispensed medicine. This was just in case we dared to say something that might have been contrary to what the doctor had told them. Fortunately, this unwritten rule has long gone and now all pharmacists proactively and routinely advise patients on how best to take their medicines. One thing that has not changed is the “It’s only tablets!” cry from patients who usually have a single-item prescription, but don’t notice the queue of patients already besieging the dispensary or the people waiting in line behind them.
There has been a lot of innovation and undoubtedly there will be more. Flu vaccination, malaria and travel advice services, and national services such as the new Community Pharmacist Consultation Service (CPCS) are just the current iterations. The new Community Contractual Framework (CPCF) means that once more community pharmacy is ‘at a crossroads’. This has been said many times before, but this time I think it’s actually true. The Government does not value the traditional dispensing process and they believe it could be done more easily (i.e. cheaply) if done at scale in remote locations (e.g. Hub and Spoke dispensing). The new contract is an attempt to change what we do in pharmacy and to give us a more expansive clinical role.
Nowadays the emphasis is more about delivering services which promote population health and wellbeing through improved health outcomes. Another key priority of course is integrating community pharmacy into an increasingly under pressure primary care arena. The LPC has supported the identification of lead Primary Care Network (PCN) pharmacists. It is important that all pharmacists and their staffs get actively involved in their local PCN to shape and develop local services.
What of the future? Well, the pathway for the next five years at least is known – the 5-year CPCF deal has seen to that. There will be annual reviews that will look at capacity, costs, pressures (workload) and delivery. How well pharmacy delivers its contractual obligations will be key to the future success of the sector. Currently, more than 80% of Derbyshire contractors have signed up to the new CPCS service, so we have made a great start. However, how well this service lands will be key to what is offered to us in the future. There may not be many CPCS consultations initially, but if the pilot studies are a success and GP referrals through CPCS become the norm then we will have proved that we can deliver clinical services.
I’ve had 41+ years of ‘life long learning’ and continuing professional development. The new generation of pharmacists will have to innovate and keep up to date just like I did. Who knows what pharmacy will look like in 40 years time? I didn’t have a crystal ball when I started and I couldn’t have imagined where we have got to today. The speed of change is accelerating all of the time with new technologies continuingly being developed, so whoever looks back in 40 years’ time will again be amazed by the developments and changes they have witnessed.
In the meantime, I would like to wish you all the very best wishes for the future!