Slugger’s energetic commissioner asked me to post about what I do all day. Who would be in the slightest interested in such quotidian ennui, I replied. We need to understand how each part of the Health Service works if we ever hope to fix it, he more or less suggested. Well-intentioned while somewhat naive, he was interested in which medicines GPs prescribe that could be pharmacy supplied so GPs can get on with what they should be doing all day.

It does surprise me, yet it should not, that few in the general public, MLAs and strangely even some of my own colleagues, know little of the facts and figures on community pharmacy services. Why should they?

Thankfully, each year BSO publishes a comprehensive report on what medicines it provides through the network of 511 contracted pharmacies that over 90% of the population visit every week.

The medicines pharmacies supply for the Health Service is, off course, not the only thing we do, there is much more to your local pharmacy. You might be asking for advice, accessing a service (with or without a medicine being supplied) or picking up some health aid. Community pharmacy implicitly is, but explicitly should be, the front door of the Health Service.

To achieve this, the profession and the Health Service need to agree on a clear strategy – something they have largely done- and to get the proper support from our MLAs to realise this strategy.

https://www.health-ni.gov.uk/publications/community-pharmacy-strategic-plan-2030

This would be one aspect of transforming the Health Service and achieving the necessary efficiencies and improvements proposed by Bengoa. We visit the GP three times more than people in ROI. We are not three times more healthy because of this so visiting our GPs less often, taking more care of ourselves, is one option but not one we seem too comfortable or reassured with. Is our network of pharmacies an option in providing that reassurance?

Top-line figures from last years BSO report is that But the fees pharmacies receive are for more than dispensing and include fees for an increasing range of services. Pharmacy First, for example, allows patients to access common ailment advice and management, emergency contraception, urinary tract infection and sore throat treatment services. Using desktop tests, the latter two services allow pharmacists to prescribe antibiotics when these are indicated, ensuring that antibiotics are not overused.

My typical day might give some idea of what we do, where the challenges are and what the future might look like. There is a rush after opening to get the “Daily” and “Weekly” medicines made up. An adherence service is in place to allow patients who have difficulty taking their medicines to have them supplied in adherence devices such as a medicine tray or if they are likely to overuse their medicines can be supplied daily. This allows community care support patients at home with their medicines and keeps them out of hospital.

Since Covid in 2020 all pharmacies collect prescriptions from local GPs. For us these arrive mid-morning. Medicine labels are produced, medicines assembled, labelled and checked before bagging and racking for patient collection. Prescriptions are coded for payment and submitted to BSO twice monthly.

Dispensing remains the central activity in all pharmacies yet it could be much more efficient. Electronic Transfer of Prescriptions (ETP) has been in place in England for 10 years. We won’t have ETP until 2032. If I had EPT, I would not need a driver to collect from the GP and I would have more time to provide other services allowing me to reduce pressure on GP and potentially Emergency Departments. EPT would allow me to draw down the prescription on request of the patient/GP, my computer would help with clinical checks and then my scanner would check the correct item is supplied. I would then electronically submit the dispensed prescription to BSO for payment. The paper prescription would disappear. I could then concentrate more on providing services, which might include taking more care of patients with long-term conditions, but I would really struggle to do this at present.

We are a small pharmacy and a typically day last week was Tuesday. In addition to the team dispensing over 350 prescription medicines and making up 25 “Dailys”, we had 6 needle and syringe exchanges, supervised 9 methadone patients, prescribed 2 emergency contraception pills (organised “the pill” for two teenagers with follow-up to their GP). We had one patient with severe sore throat referred by her GP and who was positive on testing for Strep A. I prescribed Penicillin for her without the need for her to return to the GP. We had two urine samples, also referred from GPs; one was positive on testing, the other negative. Antibiotics are only supplied by the pharmacy on positive tests. We had 3 follow-ups on our smoking cessations service and supplied Nicotine Replacement Therapy. I supervised 5 Pharmacy First common aliments supplies and we also sold over 100 medicines for minor and common conditions with about half of these supplies needing some advice or reassurance.

There was similar, if not more, activity in the other 510 pharmacies with some of my colleagues expanding into private service offerings; weight loss, holiday vaccination and ear wax removal all important to support self-care. A lot is being done in the pharmacy network to relieve pressure on GPs but so much more is possible and it could be happening faster.

There must be better referral options for pharmacists if this is to work for patients. When I triage a patient, I should, if I need to, refer them on and to be able to target my referral into the wider health service with appropriate urgency. At the moment I can only encourage self-referral to the GP and we all know how efficient that is.

Why this is, is perhaps more cultural than medical. More medicine efficiency, bringing us into line with England could mean an efficiency saving of £70 million. Yet, there is no political appetite for a remedy, for example, a universal prescription charge of say £1 per item that might help address this. It would be interesting, at least, to know what effect such a charge would have.

Complaining about the Health Service is easy but if we really want it to change, we have a duty to better understand how its component parts work and how they interact with each other and then seek to improve. Community pharmacy is only one smallish cog in our Health Service but by improving the efficiency of each cog in the system, and ensuring they are fully integrated and engaged, we could get the Health Service we all aspire to have.