Is clinical pharmacy bad thing?

[jzd4rma]

I just want to see what the general consensus is on community pharmacy providing 'clinical services', on my part I think it is a fools errand because all current clinical service provided by community pharmacy are fairly basic e.g. blood pressure and diabetes check which is overseen by a pharmacist but can be done by anyone and a pharmacist in reality looks at recommended guidelines to see whether the levels are appropriate or memorise the figures by repetition so anyone can be trained up to do this. And lets not forget all these services are free so how can community pharmacy survive with such arrangement. I have family members and friends who are doctors and they have all confessed that in reality GP's are unlikely to give any of their funding to provide such service by pharmacy because it affects their profits (all though the occasional health board might).

In my opinion I believe pharmacists should lobby for overseeing prescribing of medication because most GP doctors use the BNF for prescribing and do not have such a high level of understanding of how drugs work as a pharmacist. This I guess is like an MUR but an MUR involves patients encouraged to have a chat, where is the other arrangement makes it mandatory for patients to speak to their pharmacist, this would consequently remove the need for patients to have a chat with their doctor regarding their medication. However dispensing should still be done in pharmacy but could be done by ACTs. Who believes this is what community pharmacy should be about?

I just want opinions no fighting please!

[Asterix]

very good thread. I agree with every point. To add onto the basic point though, do you honestly think community pharmacists have a strong enough clinical core knowledge to offer such services, the hospital pharmacists are the clinical knowledge specialists.

[jzd4rma]

very good thread. I agree with every point. To add onto the basic point though, do you honestly think community pharmacists have a strong enough clinical core knowledge to offer such services, the hospital pharmacists are the clinical knowledge specialists.

No but I believe that, this is what should be addressed at undergraduate pharmacy course because currently their is an over emphasis on learning about clinical services such as blood pressure and diabetes check, cholesterol, smoking cessation which does not really engage expertise of a pharmacist, but can be done by anyone if they follow appropriate medical guidelines, where as appropriate prescribing involves an intimate understanding of how drugs work this is something a pharmacist can do with great competence if taught at university, which cannot be done by other medical professionals thus giving the pharmacist an exclusive role.

[Asterix]

If you asked any hospital pharmacist to perform the role you are suggesting they would do it with ease. Retail pharmacy would be a diff story.

[jzd4rma]

If you asked any hospital pharmacist to perform the role you are suggesting they would do it with ease. Retail pharmacy would be a diff story.

But what I am proposing is, that this is what a pharmacy student should be taught at uni level so that a pharmacist, once qualified can conduct such service at both community and hospital settings, kind of like a medical students who are taught clinical medicine right from the beginning. I believe this would have two benefits it would give pharmacist a better defined role and remove the cartel of multiples because this would be a nail in the coffin for multiples because pharmacists can be contracted to provide this service directly themselves and in return be responsible for overseeing the dispensing of the patients medication. Thereby bypassing the multiples, whose hold in community pharmacy is killing it off, I say this because such service would never be initiated by multiples because it is too complex for them to operate instead if we look at it carefully they focus on "clinical service" anyone can provide and this I believe is an attempt to marginalise the influence of a pharmacist.

[hibernia]

very good thread. I agree with every point. To add onto the basic point though, do you honestly think community pharmacists have a strong enough clinical core knowledge to offer such services, the hospital pharmacists are the clinical knowledge specialists.

Hospital pharmacists are specialists in the clinical knowledge of what goes on in hospital - treating acutely ill patients.
Patients in the community are chronically ill and it requires different clinical knowlege to deal with that, a knowledge that most community pharmacists have or could acquire very easily. Judging patient compliance isn't a skill hospital pharmacists need but it is vital in the community because it doesn't matter how wonderful the drugs are or how much you know about them if the patient isn't taking them, for whatever reason.

Most community pharmacists find our biggest problem isn't that we don't have the clinical knowledge but that we don't have the oppertunity to use it. We have very few oppertunities to influence prescribing and can only intervene in a small percentage of cases where there are real problems. If say a doctor is still prescribing pretty much the same as he did twenty years ago (and I have seen it) then there is very little we can do.

[Tony Schofield]

the hospital pharmacists are the clinical knowledge specialists.

Says who? Those working in aseptic or radiopharmacy? We all start with the same qualification so do your CPD. Pharmacists managing long term conditions in their pharmacies has to be a future role. If you don't have the skills acquire them. I really do get angry at this cerebral capitulation to those working in hospital JUST because they work in hospital.

[jzd4rma]

Says who? Those working in aseptic or radiopharmacy? We all start with the same qualification so do your CPD. Pharmacists managing long term conditions in their pharmacies has to be a future role. If you don't have the skills acquire them. I really do get angry at this cerebral capitulation to those working in hospital JUST because they work in hospital.

I don't think it really matters whether we have these skills or not, I am saying why don't the great powers to be push pharmacy in that direction, because modern pharmacy from an academic point of view is a specialised field of medicine, which involves understanding the use and application of medicine, which is more important now than it was 20 years ago because of the list of treatments available on the market is immense compared to what existed 35 years ago and doctors do not have the time really to learn this stuff in depth and rightly so because they are more focused on the diagnosis of the problem so the pharmacist can play a very important role. Instead the clinical roles championed by community pharmacy are so basic that I can say with great confidence that any a-level students with a background in biology can conduct and interpret the results.

[Tony Schofield]

So titrating and detoxing drug dependent patients in a pharmacy can be interpreted satisfactorily by an "A"level student? Doing a LARC implant likewise? Managing long term conditions?

You need to look at what actually is being done as opposed to that which Lloyds does.

[jzd4rma]

So titrating and detoxing drug dependent patients in a pharmacy can be interpreted satisfactorily by an "A"level student? Doing a LARC implant likewise? Managing long term conditions?

You need to look at what actually is being done as opposed to that which Lloyds does.

Well actually Tony, I was referring to what Lloyds and Co-op do, which are two of the largest chains in the UK, so what they do is rather substantial because they hold a large market sector. And unfortunately the 'clinical services' they provide are so basic, these can indeed be conducted and interpreted by a competent A-level students.