Madame,
I have the good fortune to be a member of the local PEC and the Clinical Leaders Network in our part of the world. For some time I have been "talking up" the opportunities to commissioners of using pharmacies to deliver services closer to patients homes. In late 2007 I, with many other pharmacists, attended a meeting of the All Party Pharmacy Group at the House of Commons to hear Dawn Primarolo asking for ideas about how to deliver care to patients with long term conditions(LTCs) without choking general practice. I detailed a scheme we have where we have trained two community pharmacists on "doctor free" housing estates to prescribe and to manage substance misuse patients including prescribing for them, from their pharmacies. I volunteered that it was a good template for managing all long term relapsing conditions. Someone from the DOH made contact as I am sure they did to others with similar schemes they were developing. There followed, the Pharmacy White Paper which temptingly dangled the carrot of what could, if the will was there, be done for patients to manage long term illness starting with cardio vascular screening. On Thursday I had a discussion with a secondary care physician who has been given a lead role in looking at new pathways to deliver care for patients with LTCs. He had only just heard what pharmacies could contribute and was excited. However.......I have just learned that Scotland is to roll out a national "Chronic Disease Management Service" as a core role in the pharmacy contract. Clearly much work has gone into it's preparation and the fuse has already been lit.
The White Paper detailed a national scheme for dealing with minor ailments in pharmacies. Locally, nearly 3 years ago our PCT merged with two adjacent PCTs. We had a minor ailments scheme offered from all pharmacies but the other two PCTs had a) a scheme limited to a few pharmacies and b) a scheme that was set to start but which never did. Now, nearly 3 years later we are close to a single scheme for all patients in the 3 PCTs........Scotland has had a national scheme for years as a core service.
The recent announcement that emergency supplies will be allowed for quantities of medicines allowing up to 30 days of treatment was welcome. However there is no mechanism apart from local courtesy where a GP could be informed of the supply which is a private transaction where the patient pays for the medicine. This is a source of everyday friction when patients exempt from prescription charges present requesting such supplies. In Scotland a core scheme allows 30 day supplies that patients exempt from prescription charges receive free of charge and the GP records are updated as a condition of the scheme.
In England we chase prescription volume, in Scotland payments are made on a per capita basis which is a much more orderly process and I could go on about how pharmacy in Scotland is developing at a sensible pace into the professional occupation many employees in English prescription factories can only dream about. More to the point Scottish patients have pharmacists delivering high quality care constituting a bigger network of health providers which gives them vastly improved access and choice. This can only be good for patients who can be assured that when they are referred to GPs that they will face shorter waiting lists than their English bretheren.
English LPC members are obliged to waste massive amounts of time doing business cases and fighting like dogs over scraps with PCT minnions for relatively trivial services whilst in Scotland innovation and genuine will is demonstrated nationally.
How has this happened? Do DOH officials from the two countries never speak to each other? In these cash strapped times may I politely suggest that the Chancellor, whilst searching for economies to fund the bank bail out and it's awful consequences, closes the English arm of DOH and subcontracts, albeit for a modest fee, such work to his Scottish counterparts (it is a separate country after all). Yes resource would be freed up but the English public would then have the benefit of a much bigger resource. A properly funded, properly motivated pharmaceutical service that was truly fit for purpose.
Win win I believe they say in "managementspeak".
