Alison Strath had a background in community pharmacy before joining the Scottish Government 20 years ago. Effusive in her praise of the sector’s response to Covid, she speaks of an exciting change agenda taking root. “The efforts of pharmacy teams help us make the case for investing in the sector,” she says.
She faces a stacked in-tray as she sits down to her first pharmacy press interview since her permanent appointment in August after a year as interim CPhO. While Covid is still with us the pandemic is no longer raging, leading thoughts to turn to the recovery of the health service.
So what role will community pharmacy play? As an example, Strath points to the “exciting” plans to overhaul pharmacy undergraduate training. She is confident that the new GPhC training standards, which mean every newly qualified pharmacist from 2026 onwards will be on the prescribing register, “will help trainees contextualise pharmacy practice earlier on in their undergraduate career”.
Some in England may worry about whether community pharmacist prescribers will be able to use their skills in their everyday practice – but Strath is confident that the NHS Pharmacy First service (see below), which enables pharmacists to prescribe for a range of common illnesses, will give Scotland’s upcoming cohorts of prescribing graduates a chance to hit the ground running.
While Pharmacy First is the keystone service in Scotland, it is far from the only show in town. She mentions the recently announced bridging contraception service, which she views as a stepping stone towards the provision of long-acting contraception through pharmacies.
Other pipeline ideas include a beefed-up public health role looking at areas including mental health and the provision of systemic cancer therapies. It is all about matching pharmacy practice to the “pressure points” in the NHS, says Strath.
Another major priority is developing and implementing a new contracting framework for community pharmacy in Scotland. She says some of the regulations surrounding the sector need to be updated with a renewed emphasis on pharmaceutical care needs, and also that funding arrangements will need to be looked at.
“That will be a big piece of work over a number of years – we’ll need to consult quite heavily on it,” she says.
Strath is clear that the pharmacy workforce is her number one priority. “It is really important for me that we invest in ensuring that we have a motivated and enthusiastic workforce, regardless of what the role or sector is,” she says.
She notes that Scotland’s NHS recovery plan and programme for Government both “make a number of commitments for the pharmacy profession and in particular for community pharmacy”, offering a handy route map for professional development.
It is all about delivering “the right care in the right place at the right time,” she insists. “I think sometimes we get into numbers too quickly, when actually we need to think about what is it we need pharmacists and pharmacy teams to be doing, and how we can make that happen. Then the numbers fall into place.”
She plans to establish a workforce forum involving all the pharmacy sectors and consulting with employees and locums, as well as contractors and health board representatives.
“We want to produce a vision that sets out what good looks like at 12 months, three years, five years and 10 years from now,” she says.
Workforce matters in Scotland have recently been a source of controversy, with Community Pharmacy Scotland calling for a temporary halt in recruiting community pharmacists to general practice, warning that this could badly hobble the sector. Is this slipping under the Government’s radar?
“We are keeping a close eye on it,” Strath says. “Pharmacy is an ecosystem – if we pinch it in one place, we’ll feel it in another” – but “I don’t believe there are large numbers of pharmacists switching to general practice right now.”
She acknowledges there was a substantial migration when Scotland first started work on the primary care pharmacist programme – and says hospital pharmacy was affected just as badly – but now “our health board directors of pharmacy have a firm grasp of recruitment and they are managing that by growing a distinct workforce for primary care”.
It is partly a question of making sure community pharmacy careers are attractive, she argues, suggesting that the more enhanced clinical role that is evolving is “one of the reasons I think we’ve seen that early move into general practice stem off. I’m also really conscious of the growing interest from younger pharmacists in portfolio careers. As a profession we need to think about how we support that new way of working.”
Are ingrained attitudes among the public a barrier to community pharmacists playing a more clinical role? “It does take time to change public perception. I think some of that has changed over the years as we’ve delivered more face-to-face services, and will continue to change.”
While the Government and professional bodies have a role in promoting awareness, the key driver will be satisfied patients, she says. “Every pharmacy has an in-built PR unit that is more effective than any announcement I could make.”
Another controversial issue that appears to have been especially acute in Scotland involves pharmacies closing at short notice, sometimes without informing local NHS teams. Strath says she is working to ensure continued service provision and adds that the Scottish Government is “also exploring what further powers we can give to health boards to allow them to deal with persistent occurrences if necessary”.
The landmark development in community pharmacy practice in Scotland has undoubtedly been the Pharmacy First service, which launched at the height of the pandemic and is now reaching 50 per cent more patients than the minor ailments service it replaced, according to official figures.
“I’m delighted to see how well community pharmacy teams have responded – they have collectively undertaken over 1.5 million consultations and offered advice and treatment using their skills and knowledge to help people manage common clinical conditions. That is a lot of GP, emergency department or out-of-hours time that is potentially absorbed,” says Strath.
“It will continue to be an important pharmacy service as we look at NHS recovery” and will evolve to respond to pressure points in the health service, she says, citing the provision of COPD rescue packs as one example currently being looked at.