THE experience of community pharmacy in Scotland over the last 20 years shows that devolution of this major arm of the healthcare system has yielded far superior results compared to what has happened south of the Border. Here are some of the many developments that illustrate this:
1. Passed by the Holyrood Parliament in its first year was a bill to achieve proper distribution of community pharmacies. This avoided the dog-eat-dog competition that threatened Scottish pharmacies, with clusters around large health centres and no service in large housing estates, leading to a more equitable distribution of pharmacies to meet patient needs rather than business needs. In England, the application of market economy principles has led to a situation where the proliferation of community pharmacies over the last 20 years is now resulting in business failures.
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2. Prescription transmission going digital has been achieved smoothly in Scotland, with great cost-saving benefits. It has meant that forgery, which used to plague doctors and pharmacists, is almost impossible.
Mistakes due to handwriting are avoided and pricing of the dispensed items for payment to the pharmacy is being steadily automated, markedly reducing costs. While the system has been running for several years in Scotland with relatively little teething trouble, huge IT problems have occurred in England, with massive financial waste in their NHS.
Recently, the Universal Claim Framework has been introduced for community pharmacies, which will eventually make all pharmacy services paper free.
3. Through the smoking cessation service in Scotland, nicotine replacement therapy is provided by pharmacists along with provision of the drug Varenicline, with considerable success. Gradual reduction in the number of smokers comes partly as a result of pharmacists’ time-consuming support of potential quitters. There will be huge long-term savings to the NHS as this trend continues.
4. In a clear contrast to creeping privatisation of the NHS in England and Wales, the first SNP Government was quick to introduce its flagship policy – abolition of prescription charges in Scotland. This bold move was not as expensive as some perceive, since so many of those who used the service heavily (such as the elderly and children under 16) had previously been exempt from charges anyway. In fact, nearly half the extra cost of free prescriptions was paid for by savings in the administrative costs of policing the exemptions.
5. For all those who previously didn’t pay for their prescriptions, there is now the national Minor Ailments Service under which they can obtain from pharmacies free over-the-counter consultations and advice and then, where appropriate, be supplied with relevant medication to treat the described symptoms. There is a large added benefit in that GPs are no longer using valuable appointment time to provide advice or treatment to patients with minor ailments such as coughs, colds and minor aches and pains.
6In Scotland, pharmacists are part of the health and social care team providing services to patients in partnership with other members of the health team, instead of competing with them to win tenders to provide these services. The aim is, of course, to improve patient care and deliver efficiencies in both costs and workforce deployment.
An example of this can be seen where increasingly a GP practice will have a pharmacist working within the practice to improve prescribing. This not only delivers cost efficiencies but also ensures safe and appropriate prescribing and sometimes better patient understanding of how to use their medication.
7. The NHS is arguably Scotland’s biggest “industry”, with its budget of around £13 billion and 162,000 employees. If Scotland can run its NHS so well in comparison to England and Wales, why should she not run the other great departments of state with equal success?
Willie Wilson and Garry Scott are partners in a Glasgow community pharmacy. They are members of NHSforYES
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