The Future Of Pharmacy: 'Next step: genetic testing'

The transformation of pharmacies from shops to mini health centres is well underway. Kate Hilpern reports
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The Independent Online

Pharmacies of the future will be more akin to health centres than shops, predicts David Pruce, director of practice and quality improvement at the Royal Pharmaceutical Society (RPS). In fact, the transformation is well underway, with pharmacists already prescribing more medicines, carrying out more diagnostic tests, selling a wider range of drugs, giving more advice to the public and working more closely with GPs and other NHS partners than ever before.

Whether a member of the public wants to go on a weight loss programme, have their blood pressure monitored, work out a better way of synchronising their medicines or be treated for certain ailments, it's the pharmacist they are increasingly calling on to help.

The revolutionary shift in the role of pharmacists began to take effect in England and Wales when the new pharmacy contract was made compulsory in October last year. The Scottish contract is currently being implemented, while Northern Ireland expects the final details of its contract to be agreed by the end of this year. What they all have in common is making better use of pharmacists' clinical expertise, enabling them to finally come out from behind the dispensary.

"The public's awareness of this is probably not as high as it should be," admits Pruce. But as more and more people visit a pharmacy, it won't be long before they notice. Indeed, all pharmacists are now available to advise, in private if necessary, on healthy lifestyles - whether it's about protection from the sun, questions about flu vaccinations or where to find an asthma clinic. In addition, more and more are dealing with repeat prescriptions and, as Pruce points out, it shouldn't be long before the new Electronic Prescription Service (EPS) will enable patients to nominate a preferred pharmacy where they'd like their GP to send their prescription.

"Both these changes in prescribing will enable pharmacists of the future to better plan their work, as well as saving patients having to visit their GP to pick up their prescription," he says.

May this year also saw the announcement of independent prescribing powers for pharmacists. Hundreds of the UK's pharmacists are already what's called "supplementary prescribers", which means that once a doctor has diagnosed a condition, they take over the patient's treatment plan. "But the problem with this is that they've had to draw up an agreement between the doctor, the patient and themselves about the areas they can prescribe for. With independent prescribing, pharmacists will be rid of this bureaucratic barrier."

Hemant Patel, president of the RPS, describes it as "the most significant professional development opportunity for pharmacists that we've seen in a generation. We are delighted that the Government has given the professional such a vote of confidence and we know that pharmacists will rise to the challenge," he says.

It's not just community pharmacists that will reap the benefits. Hospital pharmacists, who are trained in independent prescribing, will be able to authorise prescriptions to patients, leading to patients receiving their medication sooner, as well as less likelihood of doses of essential medicines being missed, and doctors' time being saved. Pharmacists who independently prescribe in clinics, prisons and GP practices will also have a greater role in patient care.

A further major change in the way the pharmacists work has been brought about by the introduction of Medicine Use Reviews (MURs), whereby pharmacists discuss their customers' medicines with them, in private, in some depth - reducing the need for unnecessary GP appointments. "The aim is to sit down with patients - usually those on four medicines or more - to find out how well they are coping with them, as well as giving them advice on how to use them better."

Latest figures from April this year found that 33,000 MURs were completed in the first nine months of their implementation. With 7,000 pharmacists accredited to perform them, that equates to just five MURs per pharmacist in real terms. With the Department of Health having expected nearer 200 reviews per pharmacy, Pruce admits the take-up has been slower than anticipated. But he puts it down to teething problems, and is confident that interest is growing.

For many pharmacists, the problem lay in the fact that the pharmacy had no private consultation area - which is key to providing this service. For others, a lack of resources has proved problematic, both in terms of time and staff cover. Dany Ros, a pharmacist in Paignton, Devon, adds that at first, pharmacists can find themselves taking 30 to 40 minutes per MUR. "But we've organised it now so that the actual time spent with the patient is just 10 minutes."

He adds that he couldn't seem to "sell" the idea of an MUR to patients in the beginning. "We were asking them if they have a few moments to spare with the pharmacist when they came to pick up their medicines, but they were saying they were in a hurry. We've found a better way is to say the pharmacist would like a word with them about their medication."

The sorts of patients that pharmacists have focused on include those with diabetes, cardiovascular disease and arthritis. With asthma, which is Ros's main focus, a common problem is inhaler misuse. "I was seeing people who said they knew how to use their inhaler because they'd been using them for 30 years, but when they demonstrated their technique, it was wrong. This can lead to overuse and over-prescribing of inhalers, which is a waste of money, as well as being a risk factor in side effects."

With 80 per cent of his recommendations having been followed up by the GP, he says it is rewarding to see the changing role of the pharmacist accepted by both GPs and patients.

Pruce believes that diagnostic tests will become increasingly common in pharmacies of the future. "Many pharmacists are already providing free testing - for example, for diabetes and pregnancy - and monitoring for things like cholesterol levels and blood pressure. As technology improves and there become more tests that can be done outside a laboratory, I think we'll see a lot more of them come into pharmacies," he says.

Viren Patel, a pharmacist in South London, has been working with Lambeth and Southwark Primary Care Trust (PCT) on a pilot project that allows pharmacists to test for Chlamydia. "Posters were put up in local GP surgeries, as well as in the pharmacies, and it really took off. We take urine samples, do the test, and give the results. If the result is positive, we also get involved in the treatment," he says.

The strengthening relationship between pharmacists and PCTs has led to other services being set up in conjunction between the two - ranging from stopping smoking clinics to Minor Ailments Schemes, whereby pharmacists treat minor illnesses such as stomach problems, children's ailments, coughs and colds and skin complaints. Meanwhile, an increasing number of medicines - for example, to treat acute migraines - are being reclassified from prescription only medicine to pharmacy medicine, making it available from pharmacies without the need for a GP's prescription.

Pruce believes that the next big area that pharmacists will get involved in is genetic testing. "This is about looking at someone's genetic make-up and tailoring the drugs to their genes. It's already happening in a small way with some anti-cancer drugs, but I'm told that it could really take off by 2020."

With an inquiry into the future of pharmacy having just been launched by the Government, the profession looks set to continue on the journey of becoming increasingly professional, responsible and exciting.

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