This week I went to my second conference with pharmacists, and was very impressed about the grasp of the issues that we face. Tremendous opportunities exist for shifting resources from lower value activity to higher value activity, using our basic unit of value namely £76,000 to employ a district nurse and a care assistant for a year, as the test.
Some of these moves appear to be relatively simple, the shift to generic prescribing for example, but others are more complex because they involve clinical judgement.

One issue that comes up consistently is the prescribing of medication for people with multi-morbidity, namely more than one condition, but what is emerging is probably not so much multi-morbidity as multi-specialty medicine. A person with three conditions will be referred to three different specialties, each of which will prescribe specifically for the condition which is the focus of their specialty, leaving the poor GP and the poor patient to try to sort out possible interactions that may emerge in the weeks or months that follow.

One group that has the brain power to help sort out this problem is the pharmacy profession but at present it, the call of the clinical professions is sharply divided into generalist and specialist branches. With every hospital pharmacy for example there is someone who really understands drugs for cardiovascular disease. Within every Mental Health Trust there is a pharmacist who really understands drugs for the profession, but the pharmacist working in a branch of a pharmacy chain or indeed in a health centre is a generalist, and we need to bring those two groups closer together just as we need to bring together generalist physicians, general practitioners, and specialist physicians.

We need population based pharmacy based practice as well as community based practice and hospital based practice. Fortunately with the move to bigger populations under the concept of the Primary Care Home, the appointment of pharmacists not just the CCGs but for all populations is increasing and this is a very welcome trend.

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