1.1 Introduction
The pharmacy sector in the UK plays a crucial role in the British healthcare system. Pharmaceutical care helps promote the wellbeing of patients and reduces the likelihood of misuse of drugs. In the past decade, pharmacists in the UK are allowed to prescribe across a number of therapeutic areas. Pharmacy can be traced to prehistoric times, to the Sumerian era. There were separate people for diagnosing sickness and others who prepared medication. During the 17th century, the pharmacy sector became more defined in Britain. Physicians wrote out bills, which were then prepared by pharmacists.
The role of a pharmacist has evolved over the years and involves a number of responsibilities, including customer interaction and computer expertise for managing stocks - and so on. A pharmacy assistant works in a team environment and is expected to perform a number of duties.
The pharmacy sector has been earmarked for improvements and the UK government plans to maximise its potential. The pharmacy workforce can contribute to the maximisation of patient outcomes, by reducing the workload on GPs and clinics. The Minor Ailment Treatment option will allow pharmacy workers to treat minor ailments, such as allergies, asthma, eczema and so on.
Optimisation of the pharmacy sector will also help to reduce misuse and wastage of medication. Although there has been a signiicant growth in the number of physicians, the pharmacy sector needs to keep pace. There is a lot of potential to improve the distribution of medication and medical supplies to rural areas. A career in pharmacy can prove to be an exciting and fulfilling choice.
1.2 Brief History of Pharmacy
The roots of pharmacy or treatment of disease can be traced back nearly 4,000 years. The pharmacy profession can be traced back to the Sumerian Era, where special medicine people used substances such as mustard, liquorice and opium. Right from the ancient times, there were separate people who carried out diagnostics and treatment and a different set of people who prepared medication. In fact, the earliest prescriptions were written as far back as 2,700 BC. Similarly, shops and stalls dedicated to selling medicinal goods and products can be traced back to 1900 BC. In London, the earliest medical shop was opened in the year 1345 by apothecaries. The shop sold medicines and
treatments for the plague.
In 1632, physicians forbade apothecaries from selling medicine and patients were exclusively treated by the physicians - they wrote out “bills”, which were then prepared by apothecaries. The word “pharmacist” was first used in the 18th century and referred to someone who prepared and dispensed medications. However, they were more commonly referred to as a chemist or druggist.
Apothecaries and chemists were seen in competitive roles around the 18th centuries. In 1941, the Pharmacy and Medicines Act stipulated for the first time that drug manufacturers had to list the ingredients used in the drug. The National Health Service made prescription drugs available to all, in 1948.
1.3 Role and Importance of the Pharmacy Sector in the UK
Pharmacy can be an exciting and meaningful career. It is a unique and challenging profession, which enables you to provide correct dispensation of medication, helps improve the healthcare system in important ways and facilitates collaboration with other health professionals. Your role as a pharmacist is crucial to the wellbeing of patients and pharmacy, as a profession, can be described as a dynamic career choice.
Let's look at the issue in simpler terms. A doctor examines a patient, makes a diagnosis of the symptoms and prescribes treatment (medication). However, the treatment will not be effective if the medications are not dispensed to the patient along with clear instructions and advice from the pharmacist. Pharmaceutical care involves extreme care and vigilance, as misuse or wrong dispensation of drugs can result in severe health implications and even death. Medication is instrumental in promoting recovery and this can only be dispensed in a pharmacy.
1.4 Patient Care
The spectrum of patient care is broad and encompasses acute care, chronic care and self- care - and so on. The different needs of patient care increase the complexity of medication delivery. The majority of pharmacy practices serve communities, hospitals, ambulatory care facilities, long term care facilities (including elder care homes) and home care.
Pharmacy assistants play an active role in the dispensing of drugs. However, in recent times, robotic or digital dispensation of drugs has enabled pharmacy assistants to play a more expanded and active role in patient care. Pharmacy assistants in general report to the supervising pharmacist, who is legally accountable for the services offered at the pharmacy.
However, regardless of the pharmacy practice settings, pharmaceutical care emphasises communication, information exchange and education with healthcare professionals, patients and caregivers. Pharmaceutical services also include optimal usage of systems and resources, efficient distribution of medication, implementation of technological advances (such as robotic dispensation of medication) and integration of information systems. Moreover, the listed goals of the pharmacy sector have to be achieved in changing healthcare technologies and environment.
1.5 Pharmaceutical Practices
The broad scope of pharmaceutical practices and the complexity of responsibilities require a trained, skilled and knowledgeable workforce.
Every member of the pharmacy workforce needs to be able to demonstrate important qualities, including values, attitude, ethics, discernment and professional judgement. The healthcare system in the UK is currently facing several challenges, due to escalating costs and because resources are stretched. As patients move through the healthcare system, they encounter multiple levels of healthcare from multiple providers. Consistency in pharmaceutical care ensures continuity in the patient's medication therapy, in order to maximise outcomes and minimise errors.
Commercial environment and rising consumer expectations also play a major role in adding to the complexity of the pharmacy sector. Pharmaceutical preparations play a vital role in the life of a patient, by improving the quality of life. This is because medications are used in diagnosis, treatment, recovery, prevention and elimination of disease. The National Health Service (NHS) in the UK expects the pharmaceutical industry to play a broader role in healthcare compared to earlier years and it is expected to meet multiple healthcare needs of patients.
FACT
According to NHS statistics, 92% of the UK's population can gain access to a pharmacy within 20 minutes by car.
Source: psnc.org.uk
1.6 Managing Interactions
With increasing globalisation, pharmacies are now managing interactions with patients from different cultural backgrounds. The interactions involve clear communications when dealing with different perceptions, beliefs and behaviours. Inadequate knowledge of English, for example, may reduce the quality of communication between a pharmacist assistant and patient or the pharmacist and the caregiver.
In addition, pharmacist assistants must be able to see beyond the language barrier. It is important to be able to assess if the caregiver or patient has understood instructions, advice or recommendations regarding medication and dosage and so on. Pharmacists often have to deal with health literacy issues on a daily basis, when communicating information or dispensing medication to patients.
Inadequate health literacy or misunderstood communication can prevent a patient from achieving desired health outcomes. Hence, it is important for pharmacists and assistants to improve in the field of cultural competencies. Comprehensive training programmes help to improve the efβicacy of pharmaceutical care, by eliminating cross-cultural barriers. Similarly, the UK has seen a growing number of patients who are unable to afford medical care, or are associated with straightened means.
The pharmacy workforce needs to be able to help such patients to access indigent medication therapy (for example, help them to access drug manufacturer medication programmes). Pharmacies and pharmacists help impart education, information and guidance regarding medication management. This is referred to as Medication Therapy Management or MTM and it plays a crucial role in helping the healthcare system to achieve desired patient outcomes. One of the core responsibilities of a pharmacist involves understanding the implications of the medication regimen of a patient and examining inter-drug reactions, in case of multiple medication therapy.
The pharmacy workforce has assumed an expanded role in the safety of medications, promotion of wellness and prevention of disease. There has also been a corresponding increase in pharmacies that specialise in a niche area of healthcare, such as asthma, diabetes and other chronic conditions. The patient or caregiver is able to avail of specific treatment and care. Research indicates that community based pharmacy initiatives achieve a number of benefits, including improved patient health outcomes, improved health literacy, reduced healthcare costs and decreased absenteeism from work due to “sick days”.
Activity 1
Estimated time 10-15 minutes
How do you think pharmacy initiatives can help in improving healthcare in communities? How will this help on a broader scale?
1.7 Community Education
After training under a supervisor, pharmacist assistants are being increasingly coached in community education programs and this in turn has helped to reinforce self-help programmes. Pharmacist intervention can prove to be extremely beneficial, if performed under strict adherence to prescription drugs and instructions and this helps to minimise medication errors.
The pharmacy sector in the UK is expected to offer the following benefits:-
-The availability of medication therapy management to all patients.
-Desired patients outcomes should be more easily and more frequently achieved.
-Minimisation of under-use, overuse and misuse of medications.
-Public health goals are more readily achieved.
-Optimisation of cost effectiveness of medication.
Whilst there are different roles within pharmaceutical care, the bottom line is that all the areas have one objective in general - helping the patient to recover and regain wellbeing. Advancing technology has enabled improvements in outpatient facilities. Although the number of physicians has increased, there has not been a corresponding increase in allied health professions, such as pharmacy. The UK healthcare system requires an increasing number of pharmacies (and pharmacy professionals), in order to ensure an equitable distribution of healthcare services. In general, the pharmacy sector is dedicated to the preservation and enhancement of public health care.
Crucial role
Pharmacists play a crucial role in nearly all facets of the healthcare industry. They may not always operate on the frontline, but their expertise plays a pivotal role in helping a patient heal. We generally perceive a pharmacist as a faceless individual, who solemnly stands behind a counter and mysteriously hands us our medication.
However, in reality, pharmacists possess in-depth knowledge of drugs and how they work. The duty of a pharmacist is not restricted to making up prescriptions provided by a general practitioner or other certified health professionals. The duties of the pharmacy sector extend to assessing the suitability of a medication, as well as taking into account side-effects of the medication, as well as interactions with other medications.
Active engagement
Pharmaceutical care also includes active engagement with the patient and communicating information regarding the medication(s). The pharmacist will also offer advice regarding dosage, benefits and adverse effects (if any) and so on. In the UK, some pharmacists also undertake to educate the community regarding disease prevention and general health.
In addition, some pharmacies specialise in certain areas of healthcare, such as diabetes or asthma and offer specific services and advice. However, the lack of adequate pharmacies has led to increased work pressure on UK based pharmacists and the industry has witnessed a growing lack of skilled manpower. This in turn has resulted in poor patient engagement and a fall in service levels. This is not related to competency levels, but pharmacists are continuously inundated with new products and information and the sector requires additional workforce. As overall medical care improves, improved longevity and better health have led to a shifting emphasis from the treatment of acute diseases, to the management of chronic conditions.
1.8 Pharmacy Integration with Community - Pharmacy Integration Fund
The NHS has proposed a fund to support the expanding services of pharmacies, consolidate clinical practices and develop digital platforms, in order to serve the public in a more efficient manner. The Contractual Framework of proposals for 2017 and 2018 has been introduced by the Department of Health. The objective of the Pharmacy Integration Fund (PhIF) is to expand the range of pharmacy services in primary care settings. This move is expected to improve the efficacy and integration of NHS healthcare services across the UK.
In particular, the PhIF lays emphasis on expanding the role of pharmacy workers, including pharmacy technicians and assistants in innovative and new local pharmaceutical care models. The move is expected to deliver a host of potential benefits, including reduced pressure on GPs and hospitals, better delivery and use of medication and drive better values. The overall effect should be to improve the patient's treatment outcomes.
Keith Ridge, Chief Pharmaceutical Ofβicer of England, has suggested that the pharmacy workforce in the UK is not expected to do more, but that the NHS would examine ways of doing things differently.There has been a general consensus on the fact that pharmacy workers are still being viewed in a traditional (although rather outdated) way, where they are seen as individuals at the back of the shop who dispense medications across the counter. The PhIF expects to educate the public on the role of the pharmacist, with respect to clinical expertise and disease prevention. The underlying aim is to spread awareness about the role of pharmacy, in being able to provide specialist advice and guidance.
1.9 Training
The pharmacist workforce in the UK is undergoing training, to ensure that they are able to issue prescriptions in their own right in various areas of healthcare. This step is expected to ease the pressure on GPs, whilst improving patient access to clinical services. The PhIF wishes to introduce innovation into community pharmacy practices, in order to improve patient outcomes and reduce the economic load related to healthcare. The NHS is preparing to work closely with the pharmacy sector, in order to improve health benefits to the public.
The main initiatives of the Pharmacy healthcare Fund are outlined below:-
-Integration of the pharmacy into the NHS main healthcare services.
-Deployment of pharmacists, pharmacy assistants and technicians in care homes and ensure that an increasing number of pharmacists have a prescribing qualification.
-Deployment of pharmacists, technicians and assistants in NHS urgent care hubs, again ensuring increased prescribing qualification.
-Development of pharmacy technicians, through a clinical leadership programme.
-Evaluate and identify the ways in which digital technologies in the pharmacy sector can improve and modernise healthcare system in the UK.
These steps are expected to accelerate the role of the pharmacy sector and transform the face of the pharmacy profession. The pharmacy sector in the UK has a proven track record of professionalism and efficiency and these attributes will be built upon, in order to maximise healthcare benefits.
Other valuable assets include accessibility and expertise and capitalising on these assets can help ease the high load on a stretched NHS system. In addition, UK pharmacies have played an active role in the provision of sexual health services. The community pharmacies are particularly better placed to do so, because they do not require appointments and are open in the late evenings and weekends. Many patients find themselves more comfortable with their local pharmacist, compared to visiting the GP or clinic (if the issue is not a major one). Pharmacy workers are able to educate patients on sexually transmitted diseases and the different contraception methods available.
Yet another important role of the pharmacy sector includes assistance and advice in cases of minor ailments.
For example
Patients can access medication, ointments, creams and gels, etc in case of a rash, hay fever or a sprained ankle (please note that for any major ailments, you should visit your GP). The convenience helps patients gain access to medical services at the earliest opportunity and also improves the cost effectiveness of healthcare services.
Research statistics indicate that a more active pharmacy role in the treatment of minor ailments can reduce the workload of a GP by as much as 16 consultations in a day. This helps to streamline medical services and also frees time and space for the GP to attend to more serious cases. Pharmacy workers are well equipped to dispense advice as well as medication, for minor ailments such as allergies, head lice, minor aches and pains and skin infections.
(Tip - Please use your discretion, when it comes to seeking medical assistance. For example, you can easily visit a pharmacy for hay fever medication, but if you are suffering from dizziness, please consider visiting the GP.)
The idea is to advocate the idea of using your community or local pharmacy, in the event of minor ailments which do not warrant a visit to the clinic. Moreover, the pharmacy sector in the UK can play a pivotal role in increasing accessibility to health services, especially in remote or rural areas. People who live in such areas do not often have access to other forms of healthcare services. Improvement in pharmaceutical care has tremendous potential to help people gain access to healthcare.
1.10 Key Delivery Channel
Furthermore, pharmacy has been identified as a key delivery channel for NHS health check services, which are implemented regularly as a preventative step. Health checks usually comprise of lifestyle questions, collection of blood samples and routine physical measurements. Based on the test results, pharmacy workers are in a position to offer general advice to patients on aspects such as smoking cessation, weight loss and risks of alcoholism.
Similarly, they can advise those at higher risk to consult a GP at the earliest, without delay. At present, only about half of the NHS public health schemes are being delivered by using pharmacy services. The RPS (Royal Pharmaceutical Society) is urging the NHS to utilise a higher number of pharmacies, in order to implement health checks.
National policy makers are recognising the enormous potential of community pharmacies to offer cost effective and real services to patients. The RPS plans to work closely with the NHS, in order to reinforce pharmaceutical services across the UK. Pharmacy workers usually work in PCT's (Primary Care Trusts), where they work on a day to day basis.
The Royal Pharmaceutical Society of UK believes that pharmacy can play a larger role in healthcare delivery. This will involve the reduction of “waste medicine” or unused medicine, which costs the NHS several millions of pounds every year. The second point involves the establishment of the National Minority Ailments Service, which is expected to save the NHS nearly £1 billion per annum. The local pharmacy could help resolve thousands of minor ailments, for which people usually end up visiting the clinic.
Pharmacies can play an instrumental part in treating minor colds, coughs, minor eczema and athlete's foot, etc. People can save themselves time and trouble, by visiting the nearest pharmacy for guidance. Pharmacy workers are trained to recognise general health symptoms and in the case of minor ailments, can also dispense medication. If the problem is more serious and requires the attention of a doctor, the pharmacist will advise the patient to visit the clinic accordingly.
The National Commission for Minor Ailments suggests that conditions such as constipation, acne, earache, mouth ulcers, nappy rash, hay fever and haemorrhoids can be successfully treated by the local pharmacy. Under the Minor Ailment Scheme, pharmacies are authorised to dispense certain medicines in accordance with NHS guidelines. Those who have a PPC (Pre-paid Prescription Certificate) need not pay for the medication.
Activity
Estimated time 10-15 minutes
When should an individual consider going to the pharmacy for assistance, rather than a clinic?
1.11 Management of Patients
The third benefit of increasing the role of pharmacies is the management of patients with chronic conditions. Patients with chronic health care requirements will usually need regular medication to manage their condition. The Chronic Medication Service offered by the local pharmacy allows patients to access regular care and pharmaceutical health services. The patient may also be able to procure serial prescriptions from the doctor, in order to ensure a steady supply of drugs.
The pharmacy worker will also be happy to offer advice and recommendations on drug use and review the drug regimen, from time to time. If there are any adverse side-effects of the medication, the pharmacist may be able to work with the doctor to resolve the issue. Chronic health conditions involve treatment for over one year's time. This could include health conditions such as diabetes, asthma, osteoporosis and arthritis.
Lastly, pharmacy workers can also help chronic healthcare patients navigate the confusing and conflicting medication information that lurks between hospital and community care services. The Royal College of General Practitioners is making strong recommendations to the NHS to be able to incorporate pharmacy workers in their clinical teams, in order to reduce the workload on GPs.
At present, it is estimated that GPs in the UK handle about 70 million patient consultations per year. Inclusion of practising pharmacists, technicians and assistants as part of clinical teams will help provide resources and support to the patient, as well as to the GPs. As part of the clinical team, pharmacists can help reduce prescription and medication errors and communicate with the patient, as well as the medical practitioner.
MODULE SUMMARY
The pharmaceutical sector plays a pivotal role in healthcare and helps to maximise patient outcomes. Pharmaceutical care caters to a diverse and complex range of healthcare requirements and requires a dynamic and skilled workforce, in order to keep pace with the changing developments in the healthcare sector. Although the number of physicians have increased in the UK, the distribution of healthcare services is still skewed and allied health services have not been able to keep pace with the increasing number of healthcare providers.
Pharmacy practice settings can be varied and cater to communities, hospitals and clinics, ambulatory services, long term care and home care facilities. The pharmacy sector is undergoing a metamorphosis, as the government is attempting to harness the medication expertise of the pharmacy workforce. There is increasing emphasis on recognising and maximising the potential of pharmacies, as well as on consolidating the role of pharmacies within the community. Whilst pharmacies will be expected to continue their basic functions of dispensing medicines and overseeing medication therapy, they will play a more active role in increasing health literacy and preventing disease.
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