continuing professional development supplementary prescribing prescription-only medicines medicine
information counselling emergency contraception exotic diseases generics public awareness
affordability methadone convenience high street chronic diseases electronic tranismission of
prescriptions medicine reviews smoking cessation supplementary medicine counselling advice
registration quality standards nutrition public health advice self testing over the counter
substance misuse partnership sporting injury community flu vaccination mental health rural and
urban interventions continuing professional development supplementary prescribing prescription-
only medicines medicine information counselling emergency contraception exotic diseases generics
public awareness affordability methadone convenience high street chronic diseases electronic
tranismission of prescriptions medicine reviews smoking cessation supplementary medicine
counselling advice registration quality standards nutrition public health advice self testing over
the counter substance misuse sporting injury community flu vaccination mental health rural and
urban interventionscontinuing professional development supplementary prescribing prescription-
only medicines medicine information counselling emergency contraception exotic diseases generics
public awareness affordability common cold methadone convenience high street chronic
diseases electronic tranismission of prescriptions medicine reviews smoking cessation supplementary
medicine counselling advice registration quality standards nutrition public health advice self
testing over the counter substance misuse sporting injury community flu vaccination mental
health rural and urban interventionscontinuing professional development supplementary prescribing
prescription-only medicines medicine information counselling emergency contraception exotic
diseases generics public awareness affordability methadone convenience high street chronic
diseases electronic tranismission of prescriptions medicine reviews smoking cessation supplementary
medicine counselling advice registration quality standards nutrition public health advice self
testing over the counter substance misuse sporting injury community flu vaccination mental
health rural and urban interventionscontinuing professional development supplementary prescribing
prescription-only medicines medicine information counselling emergency contraception exotic
diseases generics public awareness affordability team working methadone convenience high
street chronic diseases electronic tranismission of prescriptions medicine reviews smoking cessation
supplementary medicine counselling advice registration quality standards nutrition public health
advice self testing over the counter substance misuse sporting injury community flu vaccination
mental health rural and urban interventionscontinuing professional development supplementary
prescribing prescription-only medicines medicine information counselling emergency contraception
exotic diseases generics coronary heart disease public awareness affordability methadone
Putting people at the heart of their health
convenience high street chronic diseases electronic tranismission of prescriptions medicine reviews
a pharmacy manifesto for Scotland
smoking cessation supplementary medicine counselling advice registration quality standards
nutrition public health advice self testing over the counter substance misuse sporting injury
community flu vaccination mental health rural and urban interventionscontinuing professional
development supplementary prescribing prescription-only medicines medicine information
counselling emergency contraception exotic diseases generics public awareness affordability
Putting people at the heart of their
own health
a pharmacy manifesto for Scotland
We all want Scotland to be a healthier place in Pharmacy is at the heart of every community,
which to live and work. It is our belief that leading the effort to ensure that healthcare services
NHSScotland should move beyond its traditional are targeted to meet the people’s needs. The public
barriers to improve healthcare delivery. has ready access to informed professional advice and
treatment through the national network of pharma-
This manifesto from the Royal Pharmaceutical cies across Scotland. This service helps keep the
Society in Scotland highlights four key actions that healthy healthy and treat those who are ill.
we believe will make a difference to the health and
well-being of the people of Scotland and is illustrated The pharmacy in the high street is a walk-in
with case studies. All examples are based on sound health centre where people receive advice and
evidence. Further details on any specific item are treatment day in, day out: a true resource in Scottish
available from Dr Sheila Stevens, Secretary of the public health.
Royal Pharmaceutical Society in Scotland.
1. Your pharmacist should be your
adviser on medicines
2. Community pharmacies should
be designated and promoted as
NHS walk-in centres
3. Pharmacists should prescribe
4. Substance misuse
5. Sexual Health
6. Health promotion
Your pharmacist should be your
adviser on medicines
Scotland’s pharmacists are already advisers on maximum benefit from the use of prescribed medi-
medicines to our population, but we believe that cines. Patients often lack an understanding of how
NHSScotland should formalise this and promote it as their medicines should be taken, the potential side
part of its provision of healthcare. effects and drug interactions that may occur. We
believe that patients should be full therapeutic
Pharmacy is a dynamic profession actively partners in their treatment.
seeking opportunities to redesign and improve
services. In some hospitals, pharmacy staff are based This on-going, individualised review of therapy
in pre-admission clinics and admission wards to should involve pharmacist management of repeat
ensure that the correct medicines are prescribed and prescriptions (as already discussed). To allow phar-
available soon after a patient is admitted to hospital. macists to do this properly and for proper integration
Wastage is reduced by the appropriate use of pa- with the rest of the healthcare team, pharmacists will
tients’ own medicines that they have brought into need read and write access to the relevant parts of
with them. Multidisciplinary discharge planning patients’ medical record and NHSNet.
helps to facilitate better communication between
hospital and primary care, thereby reducing the Such individualised treatment will give patients
likelihood of medicines-related problems. greater control over their treatment. When everyone,
not least the patient, is agreed on and understands
Pharmacist-led reviews in primary care of the nature of treatment and the desired outcome,
patient medication would assist GPs to optimise then that outcome is more likely to be realised.
patients’ treatment. Many patients do not get the
Community pharmacies should be
designated and promoted as NHS
walk-in centres
Pharmacists are the most accessible healthcare patients.
professionals and see the greatest number of pa-
tients. Every day, approximately 600,000 people visit The public want and deserve more immediate
one of Scotland’s 1,140 community pharmacies – and easier access to the healthcare. Scotland’s com-
with no appointment necessary. 94% of the popula- munity pharmacies are where people need them – in
tion are seen in a community pharmacy every year. the heart of their communities.
Pharmacies are already delivering new services We do not think that NHSScotland should
in the treatment of minor ailments, and the manage- repeat the expensive trial being carried out in Eng-
ment of chronic diseases and are pioneering innova- land, where 40 NHS Walk-in Centres have been
tive services, such as immunisation programmes. “established” at an initial cost of £31million in their
Some of these new services are currently limited to first year. Scotland’s community pharmacies are
discrete geographical areas, or only delivered over a walk-in health centres and should be designated and
finite period of time. With appropriate investment, promoted as such by NHSScotland.
these services could be made available to many more
CASE STUDY ONE
Mrs Smith is an elderly patient on long-term medication for coronary heart disease and osteoarthritis. She
lives on her own with limited social support. She is on seven different medicines for her conditions, including
sleeping tablets. She has to walk to the surgery to order and collect her prescriptions because she does not
have a telephone.
Mrs Smith fell, as a result of a drug interaction, and was admitted to hospital. The reason for admission
was recorded as injuries due to a fall as a result of her osteoarthritis. Consideration was not given to this
being a result of drug-related morbidity. On admission to hospital any medicines brought in with Mrs Smith
were taken away and kept for her whilst a new prescription was issued from the hospital pharmacy. Whilst in
hospital two of her original medicines were discontinued and a new medicine commenced. On discharge, Mrs
Smith received her old medicines back together with a seven-day supply of all her current and new medicines
from the hospital pharmacy.
She presented her hospital discharge summary to her general practitioner, who issued prescriptions for all
her medicines listed on the discharge summary, which she took to the pharmacy to be dispensed.
Pharmacists should prescribe
Pharmacists have completed a four-year under- tions, which require them to regularly attend their
graduate course followed by a year’s in-practice GPs, often only to collect their prescription, followed
training, culminating in the Royal Pharmaceutical by a visit to their pharmacist to collect their medi-
Society’s professional examination. Many pharma- cine. This process is especially challenging for the
cists have post-graduate qualifications and second elderly and disabled. Trials have demonstrated that
degrees and the profession is committed to a future the community pharmacist can monitor treatment,
of continuing professional development. No other reduce drug wastage and identify new problems at
health professional knows more about medicines the point of authorising and dispensing a further
than the pharmacist, the health service is failing to supply of medicine,. This is liked by, and convenient
take full advantage of this expertise. to patients and has proved popular with GPs.
We believe that, in the long-term, doctors The public should be given easier access to
should diagnose and, where medicines are the appropriate medicines. Many people with minor
identified therapeutic option, pharmacists should ailments go to their GPs for NHS prescriptions rather
prescribe. Multidisciplinary partnership working than pay for the same medicines that available
practices are already moving this way in some without a prescription from a pharmacy. We should
hospitals, and there are limited developments in not be placing hurdles in patients’ paths that prevent
primary care which confirm the feasibility of this them getting the medicines they require, when they
approach. There is much, however, to be done to are needed. This is an unnecessary imposition on
speed up the process of change. both patients and their GPs. NHS pharmacy supply
of these medicines, currently being piloted in two
Patients suffering from chronic illness, such as Health Board areas, and positively evaluated should
asthma and diabetes, receive regular repeat prescrip- be made available across the country.
THE PHARMACY SOLUTION
A pharmacist managed repeat dispensing system for chronic conditions, such as those piloted in Tayside and
Grampian, would have meant that Mrs Smith would have got direct access for her repeat prescriptions from her
community pharmacist, as well as a six monthly review meeting with her general practitioner. The pilot studies
demonstrated further benefits such as improved accessibility, improved quality of care, improved compliance, de-
creased costs, decreased wastage and decreased surgery time on behalf of general practitioners and their staff.
Mrs Smith would have also benefited from a formalised patient medication review to identify any current or
potential drug-related problems. This would have led to a rationalising of her therapy and may have prevented a
hospital admission with its associated costs.
On admission to hospital, Mrs Smith would have benefited from a proper admission procedure, with a pharma-
cist on the admission clinic identifying and remedying any medication problems at an early stage. Mrs Smith could
have been encouraged to self-medicate on the ward so that any problems with compliance could be addressed. On
discharge, Mrs Smith again would have benefited from a pharmacist-led discharge plan, removing her old medicines
and linking with her community pharmacist to discuss any follow-up required post-discharge.
Substance misuse
Substance misuse is a problem in Scotland. smoking and pharmacy-based schemes using nico-
There are well-established and successful pharmacy- tine-replacement therapy (NRT) are successfully
based strategies to minimise both individual and running in many parts of Scotland. Long-term
societal harm resulting from substance misuse; these cessation is greatly improved when people wishing
include the daily supervised self administration of to quit smoking are counselled by their community
methadone, and the provision of needle exchange pharmacist, rather than just being sold aids or given
schemes. Programmes such as this are vital to the information; however, the close relationship between
alleviation of the public health consequences of the community pharmacy and the public is not being
drugs misuse. The wider benefits that communities exploited to the full in every area of Scotland Such
receive by the provision of services to this needful counselling is not part of the pharmacist’s current
and demanding patient group must be protected NHS contract, and the wider implementation of this
professional service is often limited by failure to
However, substance misuse is not confined to identify appropriate funding.
street drugs and we must not overlook the burden on
the health of the nation consequent to the misuse of There is a lack of a coherent policy for reducing
tobacco and alcohol. the harm caused by misuse of alcohol. Lessons
learned from pharmacy involvement in treating other
There is now good evidence to show the value forms of substance misuse could be extended to this
of pharmacists’ support for people who want to quit area.
CASE STUDY THREE
Mr Green is a 50-year-old who suffers from hypertension and despite complying relatively well with his
medication he has not had his blood pressure checked in four years because he feels it is inconvenient for him to
take a day off his work. He is also a smoker and a carer for his wife who has multiple sclerosis.
THE PHARMACY SOLUTION
Mr Green’s circumstances highlight the problems of accessibility and the impact that chronic disease has on
people’s lives. Patients should not have to fit their treatment around health care professionals. A pharmacy managed
repeat dispensing service would have meant that Mr Green would have got better access to his repeat prescriptions
and he would have benefited from a medication review including blood pressure and cholesterol monitoring. The
pharmacist, within the boundaries of dependent prescribing, would have adjusted his blood pressure therapy, where
appropriate and in accordance with locally agreed protocols and SIGN Guidelines.
The pharmacist could also have offered Mr Green health promotion advice, especially on smoking cessation
including access to NRT.
As principal carer for his wife, regular contact with the healthcare (and other) professions via a pharmacy
would be beneficial.
Sexual Health Health promotion
Pharmacy has a long tradition of supporting There are, however, many positive messages for
advances in public health. Pharmacy can have an general population that can be re-affirmed to the
effective input to strategies on sexual health at both a general population on their many visits to pharma-
national and local level. The provision of emergency cies.
hormonal contraception through community phar-
macies is the pre-eminent recent example of this, but Pharmacists are willing to participate in large-
other projects are being carried out in various parts scale health promotion programmes and training
of Scotland. tangibly increases their level of involvement. Public
feedback from programmes of this kind are positive.
Pharmacists, of course, provide high quality
advice about contraception and sexual healthcare to NHSScotland should develop the role of phar-
all sections of the sexually active population, includ- macists in supporting national public health strate-
ing young men. gies.
CASE STUDY TWO
John is a young schizophrenic patient. He has recently transferred from a long-stay ward to a community
care residential unit. He is a known to have difficulties taking his medicines. When John is feeling well as a result
of his medication he has a tendency to stop taking his tablets because he believes that he no longer needs them.
John cannot read and write well and finds it difficult to fill in paperwork necessary for some of his benefit
entitlements. He hates sitting around on his own all day and is keen to take up some voluntary employment. He
has support from the local community psychiatric nurse and social services, but he doesn’t like meeting them in
his flat or in their offices as he feels “threatened” and often misses opportunities for the support they are able to
offer him.
THE PHARMACY SOLUTION
Current model schemes for pharmaceutical services would allow the development of a package of pharma-
ceutical care for patients with severe and enduring mental illness. This could include medication review, explana-
tion of the medicines and their side effects, the supply of John’s medication in a compliance aid with monitoring
of his compliance, referral mechanisms to the community psychiatric nurse and social services, community
pharmacy-based drop-in centres and general health promotion advice. If necessary, John could visit his pharmacy
daily to receive his medication. These model schemes could be extended to include other clinical areas, reflecting
both local and national priorities.
John would not be able to afford to self-treat minor ailments and would therefore have to attend his
general practitioner for treatment. Two pilot schemes, in Arbroath and Patna, are exploring the benefits of commu-
nity pharmacists being able to prescribe certain medicines for the treatment of minor ailments directly to patients
on the NHS.
There are approximately 1,140 community pharmacies in Scotland, all of which have potential to be walk-in
centres or healthy living centres to a greater or lesser extent. They could offer a range of services to suit their
local needs. These services could include sessions provided by other health and local authority colleagues such
as nurses, social and key workers and benefit agency staff in a non-threatening, neutral territory that the client
base frequents on a regular basis. This concept is about to be piloted in Glasgow in a community pharmacy and
there are examples of healthy living centre initiatives.
continuing professional development supplementary prescribing prescription-only medicines medicine
information counselling emergency contraception exotic diseases generics public awareness
affordability methadone convenience high street chronic diseases electronic tranismission of
prescriptions medicine reviews smoking cessation supplementary medicine counselling advice
registration quality standards nutrition public health advice self testing over the counter
substance misuse partnership sporting injury community flu vaccination mental health rural and
urban interventions continuing professional development supplementary prescribing prescription-
only medicines medicine information counselling emergency contraception exotic diseases generics
public awareness affordability methadone convenience high street chronic diseases electronic
tranismission of prescriptions medicine reviews smoking cessation supplementary medicine
counselling advice registration quality standards nutrition PATIENT public health advice self
testing over the counter substance misuse sporting injury community flu vaccination mental
health rural and urban interventionscontinuing professional development supplementary prescribing
prescription-only medicines medicine information counselling emergency contraception exotic
diseases generics public awareness affordability common cold methadone convenience high
street chronic diseases electronic tranismission of prescriptions medicine reviews smoking cessation
supplementary medicine counselling advice registration quality standards nutrition public health
advice self testing over the counter substance misuse sporting injury community flu vaccination
mental health rural and urban interventionscontinuing professional development supplementary
prescribing prescription-only medicines medicine information counselling emergency contraception
exotic diseases generics public awareness affordability methadone convenience high street
chronic diseases electronic tranismission of prescriptions medicine reviews smoking cessation
supplementary medicine counselling advice registration quality standards nutrition public health
advice self testing over the counter substance misuse sporting injury community flu vaccination
mental health rural and urban interventionscontinuing professional development supplementary
prescribing prescription-only medicines medicine information counselling emergency contraception
exotic diseases generics public awareness affordability team working methadone convenience
high street chronic diseases electronic tranismission of prescriptions medicine reviews smoking
cessation supplementary medicine counselling advice registration quality standards nutrition
public health advice self testing over the counter substance misuse sporting injury community flu
vaccination mental health rural and urban interventionscontinuing professional development
supplementary prescribing prescription-only medicines medicine information counselling emergency
contraception exotic diseases generics coronary heart disease public awareness affordability
methadone convenience high street chronic diseases electronic tranismission of prescriptions
medicine reviews smoking cessation supplementary medicine counselling advice registration
quality standards nutrition public health advice self testing over the counter substance misuse
sporting injury community flu vaccination mental health rural and urban interventionscontinuing
professional development supplementary prescribing prescription-only medicines medicine