Community pharmacy services

Is it time for community pharmacy to let go of dispensing?

Perhaps it is time for pharmacy to give up dispensing, a professor in health economics argued at the FIP Congress in September 2018 — an idea that was strongly contested by colleagues from across the globe.

It was the most polarising debate of the conference. A panel of pharmacists at the 2018 International Pharmaceutical Federation (FIP) Congress in Glasgow, Scotland, was asked to discuss whether the days of pharmacists handing out white bags will soon be over.

Darrin Baines, professor in health economics at Bournemouth University, argued that in order to keep its place in the healthcare system, community pharmacy needs to be the “go-to place for health technology” and should give up dispensing.

He reasoned that health technology was the biggest area for growth in pharmacy and, using pharmacists’ origins as compounders as an example, he explained that pharmacists were originally experimenters and only became dispensers in the past 70 years. With dispensing potentially becoming automated, he argued that clinical work was the future because “no one else in the healthcare system has the time or access to patients”.

But he was largely alone in his extreme assessment. Eeva Teräsalmi, a community pharmacist and pharmacy owner from Finland, argued that dispensing is the core function of community pharmacy and all services are based on it — although she conceded that “we can discuss how we define dispensing”.

Similarly, Paul Sinclair, a community pharmacist from Australia, argued that since dispensing is pharmacy’s main link to the patient, community pharmacy should retain dispensing and “leverage it to greater benefit for the patient, and greater professional opportunity and satisfaction for the pharmacist”.

But perhaps there is a middle ground. Bernadette Brown is a pharmacist owner in Glenrothes, Scotland, and her community pharmacy, Cadham Pharmacy Health Centre, has been transformed by the installation of a dispensing robot, which has been funded by the Scottish government as part of its strategy to develop community pharmacy in the country. Brown and her team are able to set up the machine to dispense medicines, including from a 24-hour ATM-style prescription collection point. This frees up the pharmacy team to concentrate on patient consultations — both walk-in triage and long-term condition management. But it’s not the end of pharmacy dispensing: far from it.

The FIP debate on letting go of dispensing was perhaps a straw man argument, but it revealed the direction pharmacy could take by focusing on clinical care and the real difference that could make.

Also announced at the FIP Congress was the largest ever review of evidence into the effect of non-dispensing services provided by community pharmacy. The authors reviewed 111 trials covering 40,000 non-hospital patients and found that pharmacy services can significantly improve management of blood pressure and physical function. They said that services delivered by pharmacists “produced similar effects on patient health, compared with services delivered by other healthcare professionals”, and could prove cheaper than doctor-led services; however, they added that the results should be viewed “cautiously because there was major heterogeneity in study populations”.

The data are not perfect, but they do show a clear direction. Community pharmacy can achieve clinically significant outcomes for patients if it is allowed to expand and provide services to patients with long-term conditions. Automation is part of the solution, but it is not the only goal.

For full coverage of the FIP Congress, visit the special report page.

Citation: The Salvadore DOI: 10.1211/PJ.2018.20205452

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