Health and Social Care Committee

Inquiry into the contribution of community pharmacy to health services in Wales

CP 10 – Royal College of General Practitioners

September 2011

To: Health and Social Care Committee, National Assembly for Wales

Inquiry into the contribution of community pharmacy to health services in Wales

Pharmacists have an important role to play in expanding the information given to patients by their GP. This helps in understanding what the treatment is for, how it works and results in increased compliance, reducing waste. There are also benefits in that patients can easily ask pharmacists for advice when they have problems and also pharmacists can monitor drug usage. Many GPs already have close working relationships with their local pharmacists and this should be encouraged. One example where this is especially relevant is the provision of "Just in case" boxes for patients at the end of life.

The use of computerised reminders for prescription review by the GP mean that there is often little added value in Pharmacist led medication review for the many patients having regular treatment for a straightforward long term condition (such as hypothyroidism). Patients with complicated drug regimes often have multiple co-morbidities and these patients will be seeing their GP regularly in any case. There may be a place for medication reviews of patients in nursing homes, in reducing over-prescribing, but again, these patients are also regularly seen by their GP and this may result in duplication of effort and cost. Governance of medication reviews is particularly important and information must be fed back to the GP in a confidential and timely manner.

We question the value of pharmacist initiated investigations, especially those which are clinically unnecessary and only serve to raise alarm in the "worried well", increasing the burden on GPs (to explain the significance of any results) and resulting in cost to the NHS.

GPs have a unique role in managing their patients in a holistic way. Seemingly trivial appointments for medication reviews with the GP are an important part of the way in which this care is provided. Symptoms which would not be mentioned at a pharmacist led review may be raised with the GP and can be identified and pro-active action taken. This is often of benefit to both the patient and the NHS in the long term. There is a danger that increasing use of pharmacists and other non-medical professionals leads to a fragmentation of care, to the ultimate detriment of the patient and resulting in increased eventual cost to the NHS.

Yours faithfully

Dr Bridget Osborne

Chair

RCGP Wales