The next steps for primary care services

By Paul Gimson MRPharmS, Director for Wales, Royal Pharmaceutical Society

Can primary care be improved? What should be the role of local pharmacies in supporting patients with minor ailments? How could out of hours care be improved? How can Government balance meeting local needs and delivering access to healthcare of equal range and quality between the 7 Local Health Board areas?  These were the questions I was asked to address at a conference held in Cardiff today.

We know that as many as 50% of patients don’t take their medicines as prescribed, which means, that as a result they are receiving sub-optimal care and probably unintentionally wasting NHS resources.  Pharmacists are the experts in medicines, yet the medicines management services they provide, particularly in primary and community care settings are not integrated in NHS care pathways and are therefore not benefiting the patients. Redesigning services and the underpinning infrastructure to ensure healthcare professionals are working much closely together, needs to be a key priority for Wales now.

The debate about the future for primary care services needs to centre on patients and what they need, not just what the healthcare professions want or what is easiest to deliver. Yet despite all the policies, the government intentions and the hard work of the health boards, the integration of primary and community care services is yet to be achieved.

Healthcare integration doesn’t just ‘happen’ because you put organisations together, or when you operate from the same locality. It is the behaviours of healthcare providers, teams and individuals working together that make integration ‘happen’ and it is on this principle that new services should be designed and delivered.

This integration is vital when it comes to administering and taking medication. The development of a national community pharmacy minor ailments service is a good example of where integration can support patients while also creating capacity and ensuring the expertise of health professionals are used in the right place and at the right time. It has the potential to shift less urgent care away from the GP and free them up for dealing with issues that perhaps make better use of their time. But a pharmacist treating minor ailments is nothing new and is not particularly ground-breaking news. What could make a real difference is how this service links into delivery of healthcare overall. If pharmacists are empowered to take on responsibility for more aspects of patient care through, for example, patient registration and access to shared care records, then they will be in a position to deliver a much more holistic service as part of the whole patient pathway. A wheezy cough for a patient with asthma isn’t just a wheezy cough. It’s a manifestation, exacerbation or complication of their chronic condition, and if pharmacists were truly integrated into the care pathway then they would be in a position to do more for that patient.

Getting the infrastructure right for the minor ailment service is critical for the future integration of community pharmacy and the primary care team. It will provide new opportunities for utilising the clinical skills of pharmacists such as independent prescribing, and contribute to inter-professional working which firmly places the patient at the centre of care.

I believe passionately that pharmacists can do so much more to support the patient in using their medicines if given the tools to do so. But this will only happen if community pharmacists are allowed, through the joining up of information flow and services, to truly be part of the system. This will require support and understanding from health boards, the Welsh Government and the health professions. I believe that a mature debate is now needed to establish how an integrated community resource team can be brought to life in all communities across Wales.