Published in Scottish Pharmacist Magazine Vol 10 Issue 3 2018 

Alison Strath is Principal Pharmaceutical Officer in the Scottish Government. With roots in community pharmacy and academia, she advises teams delivering both the big ambitions for the pharmacy profession and the day to day provision of pharmaceutical care across NHSScotland. Alison outlined the Scottish Government’s current priorities for pharmacy to John Macgill.

AS: I work across the two branches that constitute the Pharmacy and Medicines Division of the Scottish Government, which is led by Chief Pharmaceutical Officer, Dr Rose Marie Parr. The Pharmacy Branch is responsible for delivering the Government’s Achieving Excellence in Pharmaceutical Care strategy. It also oversees policy and funding arrangements for community pharmacy remuneration and reimbursement, the Scottish Drug Tariff and reimbursement of appliance contractors and dispensing doctors. The Medicines Branch develops and implements policy on access to new medicines and influences policies on the safe use of medicines, which often involves working with UK Government departments on reserved policy areas such as the Pharmaceutical Price Regulatory Scheme and controlled drugs regulations.

I have a particular interest in the Scottish Government’s ePharmacy Programme which underpins the community pharmacy contract services and allows electronic prescription data to be shared between GPs, community pharmacists and National Services Scotland. We were the first part of the UK to have end-to-end electronic sharing of prescription information, which links prescribed and dispensed data on an individual patient level and provides the NHS with robust data capture which, in turn, can underpin improvements in the planning and delivery of NHS services. Meanwhile, the new Universal Claim Framework is removing the need for community pharmacy teams to hand-write forms for services like smoking cessation, the gluten free food service and access to emergency contraception.

A developing area of work is to meet the challenge of the new European Directive on Falsified Medicines which aims to make the supply chain as safe as possible by eliminating any risk of counterfeit medicines entering it. While one element of this is to have tamperproof packaging, the other is about the ability to track every medicine. Each pharmacy, whether in the community or a hospital, will need to be able to decommission a medicine at the point of supply to the patient and this will verify that it has left the supply chain.

The Directive comes in next year and I am currently working with digital colleagues in Scottish Government, CPS and the NHS to ensure it is implemented in a way that causes as little disruption as possible. Equally, it provides a platform to realise new benefits by introducing tracking and scanning systems that can support safe dispensing and, if there is a recall, allow the immediate identification of where that medicine is. If we are clever about how we design these systems, we will be able to collect all sorts of real world data, giving us new tools to examine the impact of medicines on improving public health. These are potential long-term advantages, but we are not there yet. In the short term, it is going to be about an iterative work programme across all pharmacy environments.

JM: One access to information issue is around access by pharmacists in the community to patients’ Emergency Care Summary records. How close are we to having Scotland-wide access?

AS: We have made some progress on this. Several important information governance pieces of work needed to be put in place. Work has now been completed to create a Scottish Code of Practice between NHS Boards and GP practices to promote the safe sharing of information in accordance with the Data Protection Act. This provides a framework which can now be taken forward and used with other professional groupings. And while this governance work was being done, a couple of NHS boards have been testing access not just to the Emergency Care Summary but also to the Key Information Summary and discharge information through the use of clinical portals. NHS Tayside, in particular, has run a pilot for a couple of years and shown the benefit for community pharmacists, particularly over weekends and public holidays when NHS24 is also likely to be under the most pressure, and also, importantly, the benefits for patients and the public. Whilst the pharmacy profession is clear on the benefits, it is equally important to make sure that the profession takes the public with them and that people know that pharmacists will be using that information safely and responsibly. There is also progress being made, through the ePharmacy Programme to support the sharing of information on admission and discharge from hospital, as is being demonstrated in Forth Valley, Grampian and Glasgow, where the pharmacy care record is part of the core IT infrastructure, giving the hospital pharmacist a look-up facility and, equally, their community pharmacy colleagues getting information from hospital colleagues when the patient is discharged. 

Ultimately, I would like to see a universal record allowing all members of the health and social care multidisciplinary team to have access to the information they need; and for that record to belong to the patient. 

JM: The Government’s Achieving Excellence strategy for pharmacy was published last year and then the GP contract came along, which overlaps but was written primarily from the perspective of doctors. How do they fit together?

AS: What is important for all professions involved in multidisciplinary teams is to think about what is good for patients, and what is good for patients will ultimately be good for the professions. The GP contract recognises the increasing role of pharmacists and pharmacy technicians in general practice settings. I think there are lots of opportunities around playing to the profession’s strengths and from new approaches, such as community pharmacists providing sessional work in GP practices with all the benefits that brings of cross-fertilisation of ideas and best practice.

‘Primary Care Transformation’ is now moving into an implementation phase. In Scotland we've always been lucky to have a Director of Pharmacy in each NHS board with an oversight role. As we introduce the pharmacotherapy service, the Directors of Pharmacy are there to help ensure an integrated approach to delivering the service. Good policy-making never takes place in isolation from stakeholders and so we have established a Pharmacotherapy Service Implementation Group with representation from all the Boards and other stakeholders to provide oversight and support local implementation in a sustainable way. 

JM: Responsibility for vaccination was removed from GPs in the new GP contract. How straight forward would it be to transfer that work to pharmacists?

AS: The legislation has now been updated to allow others to provide vaccination services; previously it was considered as being under General Medical Services and could only be provided by GP practices. Now, under the new contract, NHS boards will be looking at different ways of providing vaccination programmes and identifying the best people to deliver them. At the same time, if aspects of the vaccination programme were to shift to community pharmacy, under the current Patient Group Direction regulations, it is community pharmacists themselves who are identified as the people who would administer vaccines. Personally, I question whether that is the best use of community pharmacists’ time, skills and expertise. I'm really keen to work with the UK Government to re-examine PGDs to allow community pharmacy support staff, working within the right framework with the right training and oversight, to administer vaccinations. Pharmacists’ skills would, I believe, be much better employed in dealing with more complex and relevant tasks such as addressing why 50 per cent of patients don't take their medicines as intended, the adverse events some patients experience with some medicines, and providing polypharmacy and medication reviews. So, while I am ambitious about what the pharmacy profession does, we also need to make sure we are playing to our strengths and those of the entire pharmacy team. 

JM: You've been a professor in the Pharmacy School at Robert Gordon University. What are your thoughts about what’s in store for future pharmacists, and how we train them to meet the challenges? 

AS: I am really passionate about the education and training of pharmacists from undergraduate level all the way through their careers. One of the crucial things is to understand the ambitions of young pharmacists and ensure that their voices are heard in the design of the strategies for the profession of the future. 

One of the important developments for pharmacy education in the next few years will be the move to an integrated five-year Masters programme instead of the current four years undergraduate degree followed by one-year of preregistration training. The aim is to integrate these because we know that educationally this is a better way of consolidating students’ learning and to realise the benefits of much more practice-based collaborative learning in the workplace. If you look at nursing and medicine, students undertake significant periods of experiential learning, applying their learning in practice. Implementation groups have been established with representation from the NHS, CPS, students, the universities and the General Pharmaceutical Council, and we have started to look at the admission process, programme development, governance arrangements and a funding structure to support this. Many of the building blocks, such as existing governance structures and developments on a modular pre-registration year, are in place already so we’re not starting from scratch on this and we can also learn from the other professions. 

JM: At the end of the five years, will these graduates also be fully-fledged independent prescribers?

AS: The regulator has given a strong indication that they would consider a model where the underpinning educational content for independent prescribing could take place as part of a five-year integrated programme. The newly qualified pharmacist could then work for a period of time building their experience, in a similar way to the foundation programme that supports newly qualified doctors, possibly starting as supplementary prescribers and moving to independent prescribing once they can demonstrate that they have sufficient experience and competence.

There is an increasing expectation of what our profession can deliver and it’s both very exciting and a privilege to play a part in realising the ambitions of both current and future generations of pharmacists.