The organisation and development of primary care pharmacy in the United Kingdom

doi:10.1016/S0168-8510(03)00121-0

Health Policy

Volume 67, Issue 2, February 2004, Pages 207-214

https://doi.org/10.1016/S0168-8510(03)00121-0 Get rights and content

Abstract

Primary care pharmacists carry out clinical and administrative work directly for family doctors and primary care organisations. They are a relatively recent innovation and their role in the United Kingdom (UK)’s National Health Service (NHS) is still developing. The economic liberalisation of the NHS in the 1990s seems to have provided a major stimulus for the growth of primary care pharmacy. The establishment of the new professional group was not linked to a deliberate plan or change in health policy with respect to pharmacist development. Primary care pharmacy practice is much more varied and flexible than traditional pharmacy practice in the community and hospitals. Standards and professional organisation for primary care pharmacy are slowly emerging. Modernisation of the NHS is providing many new opportunities, which primary care pharmacists are well placed to take advantage of. Traditional community pharmacy faces many problems unless it can learn to develop alongside primacy care pharmacy. Pharmaceutical care is set to improve in the United Kingdom, but the precise nature of future services and providers remains uncertain.

Section snippets

Health service organisation and access

The United Kingdom (UK)’s National Health Service (NHS) is a comprehensive service funded from general taxation and subject to frequent organisational change. Access is open to all and services are generally free at the point of use. The main key to access is patient registration with a family doctor, that is, a medical general practitioner (GP). GPs work in single-handed and group practices, which also employ other clinical and administrative staff, for example, nurses and managers. Practices

The pharmacy profession

Historically, the pharmacy profession in the United Kingdom, like most other countries, comprised two main branches: community and hospital. Smaller numbers of pharmacists are employed in industry and academia. The function and organisation of the profession are like those in North America, and unlike most of Europe, in two main respects. Firstly, multiple retail pharmacy ownership is allowed and has become the norm. Secondly, hospitals tend to employ relatively large numbers of pharmacists

The development of primary care pharmacy

The modern history of pharmacy development begins in 1986 with the ‘Nuffield Report’ [1]. In this report, pharmacists were recognised as a highly trained and under-utilised healthcare resource. It was clear then, as it is now, that community pharmacists’ roles were failing to develop as they should. Before the National Health Service was created in 1948, community pharmacists were often the first port of call for healthcare advice. Community pharmacists then became independent contractors to

The roles of primary care pharmacists

While the viability of many small community pharmacies has been in decline, the roles of primary care pharmacists have proliferated. Every pre-2002 health authority employed a pharmaceutical adviser, usually with a small staff, many primary care organisations had their own pharmaceutical adviser and increasing number of practices were employing pharmacists. Many current PCT pharmaceutical advisors have a hospital background and post-graduate clinical pharmacy training. This is also holds true

The roles of community pharmacists

Community pharmacists greatest input to medicines management involves advice and supply for residential and nursing homes, this complements the work done by practice based pharmacists. Most care homes are now supplied with sealed monitored dosage systems from a designated community pharmacy. Medication for individual patients is re-packaged in these systems to facilitate administration. Pharmacists are paid by the NHS to provide advice on medicines ordering, administration and storage. They may

Pharmacist education and training

It is difficult for providers of pharmacy education and training to keep pace with NHS reforms, but the range and quality of provision has improved greatly. Pharmacy remains a life science, but the undergraduate pharmacy course is now 4 years long, which allows more applied healthcare and social science content. Post-graduate pharmacy courses have expanded and diversified greatly. In addition to basic qualifications in clinical pharmacy, it is now possible to complete courses specially designed

Future prospects

The NHS Plan for pharmacy development is classified under four broad headings:

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better access to services;
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helping patients get the best from their medicines;
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re-designing services around patients;
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staff development and clinical governance.

The background of pharmacists in commercial and managed services has not produced a deeply imbedded culture of formal healthcare evaluation. In the commercial sector, products and services are given a chance to make a profit and if they fail the axe falls. In the

References (34)

Clucas K (Chair of Committee of Inquiry). Pharmacy: a report to the Nuffield Foundation. London: The Nuffield...
Royal Pharmaceutical Society of Great Britain. Medicines, ethics and practice: a guide for pharmacists. 26th ed....
National Prescribing Centre and NHS Executive. Competencies for pharmacists working in primary care. London: Department...
Department of Health and Social Security. Promoting better health: the Government’s programme for improving primary...
Department of Health. Working for patients. London: HMSO; 1989 [Cm....
Joint Working Party. Pharmaceutical care: the future for community pharmacy. London: RPSGB on behalf of the Department...
Royal Pharmaceutical Society of Great Britain. Pharmacy in a new age: developing a strategy for the future of pharmacy....
Royal Pharmaceutical Society of Great Britain. The new horizon: a consultation on the future of the profession. London:...
Royal Pharmaceutical Society of Great Britain. Building the future: a strategy for a 21st century pharmaceutical...
Royal Pharmaceutical Society of Great Britain. Over to you: helping pharmacists shape their professional future....

H.K. Sinclair et al.

Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomised controlled trial in Scotland

Tobacco Control

(1998)

N. Freemantle et al.

A randomised controlled trial of the effect of educational outreach by community pharmacists on prescribing in UK general practice

The British Journal of General Practice: the Journal of the Royal College of General Practitioners

(2002)

A.G. Zermansky et al.

Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice

British Medical Journal

(2001)

L. Furniss et al.

Effects of a pharmacist’s medication review in nursing homes. Randomised controlled trial

British Journal of Psychiatry

(2000)

National Health Service. Pharmacy in the future: implementing the NHS plan. London: Department of Health;...

National Institute for Clinical Excellence. Guidance on the use of cyclo-oxygenase (Cox) II selective inhibitors,...

Department of Health. National service framework for older people. London: Department of Health;...

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