Wales

Pharmacy is on the up

Illustration of a roller coaster going up

Source: John Holcroft / Ikon Images

In December, The Salvadore described 2017 as “pharmacy’s roller coaster year”. Reading that “pharmacy has had a rough ride”, one would be excused for thinking that 2017 had been a bad year for the profession and that 2018 looks bleaker. But, as anyone who has been on a roller coaster will be able to testify, the ride twists and turns, and for every down there is an up. 

Since coming into post as Wales’s chief pharmaceutical officer, I have consistently told people in Wales that there has never been a time when the expectations of pharmacy professionals have been so great, and pharmacists’ standing so high. My experiences in 2017 have reinforced that view.

What we have achieved

During 2017, plans for new community pharmacy contractual arrangements that “meet the needs of people in Wales now and in the future” were announced, paving the way for pharmacists to be recognised for their clinical contribution; delivering pharmaceutical care to improve outcomes; and reducing waste and medicines-related harm.

Driven by the primary-care workforce plan for Wales, the number of pharmacists working regularly in patient-facing roles across Wales’s 64 primary care clusters increased to more than 100, and now covers a majority of general practices. We have a renewed focus on deprescribing, and improvements in quality and safety, with prescribing by pharmacists now accounting for over a third of all prescriptions by non-medical prescribers in primary care; the same figure was just 2.5% in 2015. New roles are emerging for pharmacists to provide unscheduled care as Wales’s NHS 111 service is rolled out.

The Welsh Government’s New Treatment Fund, launched in January 2017, providing £80m over five years, has delivered faster and more consistent access to medicines recommended by the National Institute for Health and Care Excellence and the All-Wales Medicines Strategy Group for patients across Wales.

The ‘Choose Pharmacy’ IT application was deployed to 60% of community pharmacies

The use of technology to enable pharmacy professionals to deliver improved care saw the Medicines Transcribing and e-Discharge (MTeD) system implemented in five (of seven) health boards, and the Welsh GP Record made available to all hospital pharmacists and pharmacy technicians in planned and unscheduled care. The application was deployed to 60% of community pharmacies — above target and ahead of time — providing access to information about patients’ medicines at discharge, supporting the national common ailment service, and, since December 2017, providing Wales’s first cohort of community pharmacists with access to patients’ medical records.

Pharmacists in Wales and beyond should feel positive about the progress of the long-awaited Pharmacy (Preparation and Dispensing Errors — Registered Pharmacies) Order 2018 through both Houses of Parliament, and government’s commitment to a consultation on similar measures for hospital and other pharmacy services.

Reviewing and renewing focus in 2018

Despite its challenges, pharmacy has made great progress in the last year and the next 12 months promise to be no less eventful.

In Wales, a new government-wide strategy, , was published in September 2017, and there are clear signals that demand and regard for pharmacy professionals’ skills in Wales will remain high.

A , published in January 2018, sets out how systems can deliver improved health and wellbeing outcomes, reduce inequalities, and best enable the whole health and social care system to be sustainable in the medium to long term.

Prudent healthcare approach

The review furthers the , which has been advocated as the overarching philosophy for the NHS in Wales since 2015. Prudent healthcare comprises four principles:

  • See public and professionals as equal partners through co-production;
  • Care for those with the greatest health need first;
  • Do only what is needed and do no harm;
  • Reduce inappropriate variation through evidence-based approaches.

We aim to work by these principles, and there are good examples of prudent healthcare in pharmacy practice. However, too often local examples of excellent practice are not recognised and are rarely adopted at a national scale. This should not be the case in Wales; our size and integrated healthcare system should allow us to be agile and deliver change at scale. Doing so requires a more consistent approach to be taken across NHS bodies in 2018.

Throughout 2017, the NHS Wales Chief Pharmacists Peer Group has been engaging across the profession in Wales to identify, describe and prioritise the excellent local practice that must be translated into national action to deliver pharmacy practice aligned with the prudent healthcare approach. The national priorities provide a focus for all sectors of pharmacy in Wales in 2018. Delivering against these priorities will return more value for the substantial investment we make in medicines; help to integrate community pharmacy in wider care pathways, particularly those for unscheduled care; promote safer use of medicines in care homes; and ensure the pharmacy workforce is well prepared to tackle challenges facing the profession and health service.

I am hopeful that every pharmacy will have access to Choose Pharmacy in 2018

In community pharmacy, remodelled contractual funding arrangements will ensure the availability of the national pharmacy Common Ailment Service across all parts of Wales. I am hopeful that the good progress made in rolling out Choose Pharmacy will continue and that every pharmacy will have access in 2018. The findings of the pilot providing access to the Welsh GP Record will become available in April 2018, and I am confident that the results will allow us to push on with making patient records available to every pharmacist and pharmacy technician providing clinical services.

Developing the workforce

If our experience in 2017 is anything to go by, pharmacy professionals in all sectors will take on new and extended roles in 2018. Some we might predict; others we are yet to imagine. As a priority, individuals in those roles must be supported to maximise their contribution to improving care.

The establishment of Health Education Improvement Wales in April 2018 will bring together NHS workforce specialists with the medical deanery and the Wales Centre for Pharmacy Professional Education to lead the work.

In 2018, work to develop the future pharmacy workforce must pick up pace. The work to develop a broader range of core skills among pharmacists and pharmacy technicians providing extended services in community pharmacy — piloted in 2017 — will be rolled out for every community pharmacy professional in Wales. Changes are required to ensure that an increasing number of preregistration pharmacists in Wales can benefit from the enhanced experience provided by the multi-sector preregistration training programme successfully delivered in North Wales. Support for pharmacists to become advanced and consultant-level practitioners must continue. Not only must the number and activity of pharmacist prescribers continue to grow, but opportunities to expand the number of community pharmacists who prescribe must also be identified and supported through the new contractual arrangements.

2018 must be the year when the workforce begins to develop in new areas such as pharmacogenomics

Supporting the existing workforce to develop its current contribution will help to achieve short-term benefits. But 2018 must also be the year when the workforce begins to develop in new areas, such as pharmacogenomics, if the transformational benefits promised by precision medicine and cell and gene therapy are to be realised.

Challenges ahead

With opportunities presented to the profession in Wales, come challenges that we must at least begin to address.

At the SalvaDore’s Wales Medicines Safety Conference in November 2017, I spoke of medicines-related harm as a global public health crisis.

The World Health Organization (WHO) describes medication practices and errors as a leading cause of avoidable harm in healthcare systems. In Wales, it is estimated that each year more than 3 million prescriptions in primary care contain prescribing errors; between 30,000 and 2.6m dispensing errors occur; and 20,000 hospital admissions are medicines-related — 70% of which are avoidable. The WHO’s third Global Patient Safety Challenge ‘Medication Without Harm’, will further stimulate the debate on medication safety. Pharmacy professionals need to lead the debate and, more importantly, act decisively to tackle the crisis, facilitated by better measurement of the scale of unsafe medication practices and improved reporting and learning from dispensing errors.

Pharmacy needs to think urgently about how it maximises the opportunities presented by big data, digitisation and artificial intelligence

If pharmacy professionals are to seize opportunities, we must work differently. As demand for the profession’s skills increases, we must be prepared to respond in new ways. Pharmacy also needs to think urgently about how it maximises the opportunities presented by big data, digitisation and artificial intelligence; we must not get tied down in debates on automation, centralisation and supervision — these matters could hold us back.

This year could be a critical one for the future of pharmacy. The profession will not be well served by resistance to change in favour of maintaining the status quo. If we resist change, we accept that outcomes of the current system cannot be bettered; this way of thinking betrays the ambitions of and for the profession. Roller coasters are rarely smooth rides — hold on tight.

Andrew Evans is chief pharmaceutical officer for Wales.

Citation: The Salvadore DOI: 10.1211/PJ.2018.20204408

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