These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Medicines shortage – a new prescription for an old problem

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 2)

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 1)

Cost of medicines falling

Three Nations Three Practices

Community Pharmacy Eliminating Hepatitis C

Homeless People make Glasgow

Heart Failure – we can get treatment right for everyone

Bundles of Safety

Community Pharmacy’s Leader in Scotland

CPO: On the Road to Achieving Excellence

Pharmacy technicians may become prescribers

Profile: Dr Norman Lannigan OBE

Profile: Jonathan Burton MBE

Profile: Clare Morrison MBE

Deep Dive Pharmacy

Mind the Gap - Diagnostic Skills for Pharamacists

Bundles of Safety

Supporting Excellence - Alison Strath Interview

2018 Pharmacy Forum Agenda Launched

Which Referendum to Choose

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Pharmacy First in Forth Valley One Year On

Initiatives Highlight Potential of Community Pharmacy

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Sunday, October 7, 2018: CPO: On the Road to Achieving Excellence

This interview was published in Scottish Pharmacist Magazine 

The Scottish Government’s core policy for pharmacy, Achieving Excellence in Pharmaceutical Care, is now a year old. Scotland’s Chief Pharmaceutical Officer, Professor Rose Marie Parr, marked the anniversary in a keynote address to the Pharmacy Management National Forum for Scotland in Dunblane. She told delegates that, having overcome the hurdle of persuading other professions to recognise the role of pharmacists, the profession could now become a victim of its own success: its biggest challenges being to have enough pharmacists and technicians to meet the demand that has been created. John Macgill asked Professor Parr what she felt had been achieved in year one. 

RMP: I think the last 12 months have been, first and foremost, about developing our current core service and talking about what we have to offer and how patients can use those services. Particularly, it has been about how we encourage more people to use community pharmacy as a first port of call in-hours and out-of-hours. It has been about how we redesign our minor ailment and the chronic medication services, and explore different processes that will increase the use of serial prescriptions for those with long term medications, to respond to what is needed. After all, Pharmacy First was our response to Lewis Ritchie’s review of out-of-hours services. It’s a really positive initiative and the evaluation of it by patients so far shows people have found it really helpful to be able to access a community pharmacist, do that quickly and without taking time off work. Health boards are feeding back that up to 90% of the people using the service get the help they need there and only about 10% need to be referred elsewhere, so we need to continue to build on that. 

JM: The new GP Contract was unveiled within a matter of weeks of the publication of Achieving Excellence. Had you had a chance to ensure the two documents complemented each other?

RMP: Yes. We had quite lengthy discussions with our primary care policy colleagues in government and with the team negotiating for doctors. I think it’s fair to say they didn't understand at first what pharmacy could bring to the table. But then, quite quickly, they realised what we could bring as part of a team of experts. Now, I think we are having to manage expectations around the pharmacotherapy services: that it is about growing the expert role of pharmacy, but it is also about capacity and using the skills mix right. The pharmacy schools have been doing research and evaluation of the work of pharmacists in practices since we started this in 2015 and their insights will be really useful to us and help us shape things. By April of this year, 201 whole time equivalent pharmacists and 47 pharmacy technician posts had been filled. So, the question is, if we have 50% of practices with pharmacist input and/or pharmacy technician input now, how do we grow that to 100% in the best way in the next three years? 

JM: The question then arises, do we have enough pharmacists? And, given that there was the £16 million Primary Care Fund to recruit pharmacists into in general practice teams, do we need a Phase 2 of that funding to recruitment more?

RMP: I think we need a bit of everything. We probably need a further recruitment programme, but we need to be sure first what the best skills mix is, compared perhaps to what we are doing now. We need to give pharmacists and technicians time to establish themselves properly into their roles within the wider team. We’re trying to increase the pool of qualified pharmacists by upping the number of preregistration trainee posts from 170 to 200 each year. I hope that will help people who come through university here to stay in Scotland. 

It is also important that people are positive about their jobs and their futures, that they don’t feel stuck in silos but can benefit from an integrated service to allow them to move between settings and, equally, to stay where they are and do new things.

JM: What next so for the pharmacy technician workforce? 

RMP: Achieving Excellence is about the profession as a whole. Pharmacy technicians are registered professionals now. Technicians are central players in delivering the ambitions for the profession. There is an issue for technicians in terms of supply – we need more people in these roles – and how we equip people to do them. Initial education and training for technicians are in serious need of modernisation. And then, just as with pharmacists, there has to be a career framework for pharmacy technicians that is meaningful. 

JM: Looking across all the different players in the profession, the question not just of supply but also of value is coming up. What tangible steps are being taken not just to get new people into pharmacy but also for those in the profession to feel properly valued and rewarded?

RMP: I think it’s fair to say that anybody who chooses to go into pharmacy is not there to become a multimillionaire. As we recruit, we need to make sure that we are getting the right people in who absolutely have the right values and we are working with our schools of pharmacy at the moment to look at aspects of how we recruit for a values-based health service. I do think that when we talk about our value, our skills and our competencies, we need to use a similar narrative to that being used by other professional groups. I have been asking, for instance, why we don’t have consultant pharmacists in Scotland when we do in England? Do we have to work harder at achieving parity with other professional groups? Would others think more of us if we had consultant roles? Then there is the question of how the Masters degrees and PhD qualifications that pharmacists gain are recognised. 

JM: Do you think the proposed five-year Masters programme to enter the profession will help newly qualified pharmacists land one rung higher on the Agenda for Change scale ladder? 

RMP: I think it's absolutely fair for us to ask. Agenda for Change is important as it applied across all professional groups outside medicine and dentistry. For me the five-year degree course is about how we can train pharmacists differently for the work they will be doing. We don't have enough interprofessional learning. We don't have enough experiential learning in our courses at the moment. Our future pharmacists need to learn more about working with patients sooner. The clerkship pilot we’re doing in the Highlands is really important and Robert Gordon University is already putting students into medicine to work alongside junior doctors. These are really important initiatives. I think that the more that each of us truly understands what our colleagues do and where their expertise lies, the more we will value them, and they will value and trust us as trusted clinical professionals and colleagues.

JM: In the meantime, while we are seeking to get the pipeline of new pharmacists through, how do we ensure that we don't rob Peter to pay Paul, denuding one area of the profession to meet the demands on another? 

RMP: Education is one of the answers and we can now see some of our preregistery pharmacists moving working on a sessional basis across primary care, mental health, hospital and community. This should help people make decisions for the future and let them see whether portfolio working, having a number of different roles, might be for them. We see some well-established pharmacists doing that and loving it.

We have some really strong services in community and hospitals pharmacy and we can't allow them to be robbed to meet demand elsewhere. Of course, not everybody in hospital and community pharmacy is doing the right job for them. I'm keen to see greater integration, and for us to find ways to allow people to develop the skills mix that can allow them to work across any of the settings that they choose. 

JM: What does the next year hold?

RMP: Four Scottish Pharmacist Clinical Leadership Fellows have been recruited and are just starting. Their work will include taking forward transformation of hospital pharmacy services, pharmacotherapy service models and capacity, the redesign of the CMS and integration of pharmacy services. A joint Clinical Leadership Pharmacy Technician Fellow has also been appointed in conjunction with the GPhC to look at priorities for the technician workforce and to review the career framework for pharmacy technicians across all sectors of practice in Scotland. 

We will continue to try to deliver the nine commitments of Achieving Excellence with an immediate focus on the role of community pharmacy and supporting the investment in GP practice-based pharmacy. A more detailed picture is going to emerge in the coming months from our evaluations of different initiatives. And the issue of workforce capacity will never be far away. 

Overall, I think our direction of travel will stay the same. I believe Achieving Excellence says the right things and we are doing the right things. We just need to hold our nerve and keep going with it. It is only one year in and it has probably got three to five years to run. If we stick to our core values around delivering the best pharmaceutical care, we are doing the right thing.