To: Gery McLaughlin
2^nd Floor East (Rear)
St Andrew’s House
Regent Road
Edinburgh
EH1 3DG

15th November 2002

Dear Ms. McLaughlin,

Thank you for the opportunity to contribute to the creation of this document. The Guild represents the majority of NHS hospital pharmacists and an increasing number of pharmacists employed by PCTs.

The letter from Godfrey Robson requested views on three themes so our response deals with each of the themes in turn. Many of the points have already been made in the Strategy for Pharmaceutical Care in Scotland – "The Right Medicine". However, there is considerable frustration within the hospital pharmacy service at the difficulties experienced trying to achieve some of these goals.

Community pharmacists have long been involved in health improvement. From needle exchange schemes to the more recent supply of emergency hormonal contraception, community pharmacists have been in the front line. It has been shown that the involvement of community pharmacists in smoking cessation counselling almost doubles the quit rate but funding is required to support this. It is also well known that community pharmacists are often patients’ first point of contact with the health system. At the moment, it is not possible to direct patients to health professionals other than their GP. The ability to directly refer to other members of the multidisciplinary team would make better use of the pharmacists expertise and would also alleviate pressure on GPs. Routinely, pharmacists in both hospitals and the community are helping patients make best use of their medication and proper medicines management remains the goal for both the Health Department and Pharmacy.

One of the targets for "The Right Medicine" is that all NHS Boards and LHCCs should have access to Pharmaceutical Public health advice by the end of 2002 and proper involvement of pharmacists in public health initiatives can only benefit patients.

Many examples of how pharmacy can integrate into the health system are given in "The Right Medicine", including near patient testing, direct care and instalment dispensing. Repeat dispensing models are in operation in several locations. Medicines management and the dispensing of a 28-day supply in hospitals would reduce the number of patients, discharged from hospital, running out of their medication before being able to get a prescription from their GP. It is widely recognised that this is the direction in which the profession should be proceeding, but attempts to introduce such schemes are being hampered by haggling over resource transfer between primary and secondary care. Any scheme which results in a reduction in drug wastage from the estimated £15m/year should be welcome.

Pharmacists within hospitals are usually well-integrated members of the multidisciplinary teams charged with patient care. Community Pharmacists are rarely as closely linked with prescribers or the other members of the team and there is considerable anecdotal evidence of the difficulty of contacting GPs for clarification of prescriptions.

The use of a common electronic health record is facilitated by the NHS providing computer equipment to GP practices, but no such incentives have been offered to community pharmacy contractors to ensure their ability to access and contribute to the health record.

There is a finite core of pharmacy managers with the expertise and experience to deliver the current agenda. It would therefore be a backward step at this point to try to streamline the current pharmacy management arrangements and in so doing lose some of this scarce resource. England has recently seen some of its most experienced senior pharmacy managers leave the NHS for the pharmaceutical industry. The loss to the service is significant and should not be allowed to happen within Scotland. Instead they should be mobilised by providing the resource required to create an infrastructure which will speed up the process of change and service improvement. If change is to happen quickly, those in the front line who will make the changes need to have the support and the freedom to implement them.

Frustration over the difficulties encountered in implementing systems which improve patient care has a negative impact on the service and demotivates staff. Although NHSScotland has stated on numerous occasions that communication must be improved to prevent wheel reinvention, this is not happening in practice. Most Trusts in Scotland are repeating the same arguments in an effort to achieve dispensing of a 28-day supply of medication to patients. This was agreed in NHS Ayrshire & Arran some time ago, but there appears to have been no communication of this to other NHS Boards so a tremendous amount of time, effort and resource is being expended reinventing this particular wheel. This resource can ill be afforded given the current restrictions on budgets and staff.

Lack of resources is the biggest challenge to achieving the goals of "The Right Medicine". Finances are always tight, but pharmacy has the added problem of finding it increasingly difficult to recruit staff to, or retain them within, the hospital service. The disparity between hospital and community salaries often forces graduates to opt for the higher financial rewards of community pharmacy in order to pay off student debts. The uncertainty surrounding the pay modernisation negotiations, "Agenda for Change" and how pharmacists fare in the process is causing serious concern and unrest. Pharmacy is almost unique in that a higher percentage of pharmacists work outside the NHS as contractors (or employees of contractors) than in hospitals. As the salary differential widens, more staff decide to leave the managed service for positions providing more money and less hassles.

We hope that you will find these comments helpful.

Yours sincerely