Prescription for Excellence - the future of pharmaceutical care: vision and plan

Executive Summary

Our Vision: Prescription for Excellence

All patients, regardless of their age and setting of care, receive high quality pharmaceutical care from clinical pharmacist independent prescribers. This will be delivered through collaborative partnerships with the patient, carer, GP and the other relevant health, social care, third and independent sector professionals so that every patient gets the best possible outcomes from their medicines, and avoiding waste and harm.

The Scottish Government Vision for healthcare is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.

This Vision will significantly contribute to the following 10 of the 12 priority areas of the 2020 Route map below:

• person centred care
• safe care
• primary care
• unscheduled &emergency care
• integrated care
• care for multiple and chronic illnesses
• health inequalities
• prevention
• innovation
• efficiency and productivity

Integrated delivery of care as set out in the 2020 route map will require new and innovative approaches to pharmaceutical care^[1] in Scotland. Our Vision described in the driver diagram (Figure 1) begins to set out how the future of NHS Pharmaceutical Care in Scotland will contribute to the 2020 Vision and Route Map. The Vision will significantly contribute to 10 of the 12 priority areas identified in the route map.

The aim is to create models of care that are safe, effective and person centred, provide long term sustainability and facilitate and design an environment for pharmacists to engage with other health and social care professionals.

In order to release capacity to deliver the clinical role, the dispensing process may benefit from better use of pharmacy technicians and be largely automated and managed by them. In addition, using technology to deliver clinical care more effectively will need to be embedded into practice.

NHS Pharmaceutical Care in the community would not be reliant solely on delivery from a high street pharmacy. Delivery through a distributed model from GP practices, the domiciliary setting or via remote consultations using telehealth are among the models that should be explored. Pharmaceutical care provision by pharmacists should also complement and support patients served by dispensing doctors. This distributed model should ensure that all patients have equitable access to NHS pharmaceutical care.

By 2023 all pharmacists will require to be NHS accredited clinical pharmacist^[2] independent prescribers in order to provide clinical care to patients in the community. They will be referred to as general practice clinical pharmacists regardless of the setting in which they work. In the management of long term conditions they will work in partnership with the medical profession so that post diagnosis caseloads can be allocated to these pharmacists to optimise their complementary skills.

Clinical use of medicines continues to become increasingly complex. One reason for this results from new developments in translational genomics, for example, stratified medicine. Stratified medicine is a developing concept where using genetic analysis of patients' likelihood of benefiting from particular drugs will allow for more specific targeting of drug treatment.

Changes to the delivery of healthcare described in the Quality Strategy, and the advancement of therapeutics (use of medicines), places greater emphasis on the need for healthcare teams in hospital and community to work closely together. In addition, some medicines, which previously were only able to be administered in the hospital setting, are now provided to patients in their own home due to advances in technology and medicine design. It follows, therefore, that NHS pharmaceutical services should undergo significant redesign in order to enable pharmacists to play their part in delivering safe and effective care.

Advances in technology, robotic dispensing and telehealth would need to be harnessed to contribute to a health service fit for the 21^st century. This will be part of the work programme to deliver the Scottish Government's Vision for innovative NHS pharmaceutical care.

The Route Map to the 2020 Vision for Health and Social Care^[3] describes the way in which the NHS and Local Authorities will work together and in partnership with the third and independent sectors, to ensure a more seamless experience for the service user and carer. This adds a further dimension to the importance of pharmaceutical care in the community and the therapeutic partnerships needed to underpin that^[4]. It acknowledges the issues facing Scotland such as inequalities, an ageing population, increasing multimorbidities (e.g. two or more long term conditions), and increasing expectation from new drugs, treatments and technologies.

The focus is on improving outcomes for people by providing consistency in the quality of services, ensuring people are not unnecessarily delayed in hospital, and maintaining independence by creating services that allow people to stay safely at home for longer. It encapsulates a transformation in public service working and establishes a milestone in the wider agenda of the Scottish Government's programme of reform.

Pharmaceutical care is the responsible provision of drug therapy to achieve agreed outcomes that improve an individual's quality of life. It involves cooperation with the patient, and if appropriate their carer, and other professionals in designing, implementing and monitoring a pharmaceutical care plan that will produce a specific therapeutic outcome for the patient.

At the end of each chapter we have set out the main areas considered to deliver the vision. This work will be taken forward under a governance structure in the Scottish Government Health Directorates to consider each of the areas identified for development and to provide a detailed work programme and delivery plans.