The Pharmacist spoke to Royal Pharmaceutical Society (RPS) director for England James Davies towards the end of 2023 to hear what he thinks the future of the profession will look like.

As the role of pharmacists and pharmacy technicians continues to evolve, how do you see both professions working well together, and what role does the RPS have in that?

Pharmacists and pharmacy technicians already do work well together. I think we see lots of pharmacists and lots of pharmacy technicians, particularly in secondary care, working very closely together, and recognising the benefit and the skills that both of those groups add.

The RPS is an organisation that is there for pharmacists and pharmaceutical scientists, and APTUK [the Association of Pharmacy Technicians UK] is there as the professional body for pharmacy technicians. And we do a lot of collaborative work together. There are a lot of areas that we have joint interest in. There's lots of things we want both groups to be able to develop, to do the best they can to deliver patient care. I think there's a lot of potential for far more pharmacists to be recruited, trained and developed, and to increase the pharmacy workforce. And again, as the long-term workforce plan also suggests, there's a need to increase the number of pharmacy technicians as well.

With all the changes happening in community pharmacy, what do you see as the future for pharmacists who work in general practice?

I recognise that people work in different roles, but sometimes the idea of talking about the different sectors – and I know I've been guilty of that – is not that helpful, because what we're starting to see is more portfolio working.

So, we see pharmacists who are working in primary care who are moving into doing some shifts in community or locuming between the two.

It's clear that the ARRS [Additional Roles Reimbursement Scheme] has changed the demographic of the workforce. More pharmacists have moved to working in GP practices, and working within PCNs [primary care networks], and it's moved them from both community and hospital and created a bit of a change within the overall mix.

I think part of the success of the number of pharmacists that have moved into primary care has been a testament to the work they've been able to do, the value that they've been able to add for patients, the difference they've been able to make in medicine supply, medicines optimisation, and sorting out the whole cadre of problems associated with medicines that, quite frankly, many community pharmacists have been dealing with for years, and actually, they’re now starting to get dealt with further upstream.

I think that there will be ongoing recruitment and ongoing growth in the number of pharmacists working within GP practices or within that primary care environment. But I just don't think the rate of that increase is going to be as big as it has been previously.

Many pharmacists who have moved into practice or PCN roles have done so because they want to take on more clinical work. If they’re thinking about training, if they’re thinking about where to focus their interests, what do you think is going to be the clinical development for that group of pharmacists?

The bedrock for that group of pharmacists has been very much around structured medication reviews, but what we're increasingly seeing is many of the pharmacists who have taken on these roles come from a slightly entrepreneurial background, and they've been working very closely with their practices to develop new clinics, new specialist areas and to move things forward.

I am aware of a huge cadre of different specialisms or specialist clinics that have been set up by pharmacists in that space.

There was a good example of a menopause clinic exclusively run by pharmacists that was talked about at CPC [Clinical Pharmacy Congress] North [in November], where, actually because it's all about the medication, it's all about the support that's given, it's all about understanding how you work with different medication, how you change the medication – it’s ideal for pharmacists to run and operate.

ADHD clinics are common at the moment because of the shortages, we've got hypertension clinics, cardiovascular disease clinics, there's even some that are doing sexual health clinics, so initiation of contraception and things like that – clearly, that's now going to move into community a little bit more, but there's lots of opportunity.

How is the RPS supporting pharmacists to develop those clinical skills?

We have a framework for pharmacists, from foundation to advanced and ultimately up to consultant practice. We create the framework and the curriculum that says where people's levels of practice exists and how they operate. You don’t have to do a course with us, we just set the standards of where you need to be. And then we'll assess you against those standards to see whether you're an advanced pharmacist or a consultant pharmacist.

And we can highlight, showcase and explain some of those things that are happening. We’ve gathered a series of best practice case studies on our website, and we keep updating those as we hear new stories about some of the incredible things that pharmacists are doing.

There’s a whole raft of pressures impacting pharmacists. Do you think the RPS should have a campaigning role on some of those issues?

The RPS exists to advocate on behalf of the profession. And we do a lot of that advocacy. I think sometimes that advocacy is best done with quieter conversations, rather than shouting about these things in the media, to get people on board and to help them move forward and to understand that the various arguments made.

I think a really good example of some of the advocacy that we're doing is the Health and Social Care Select Committee evidence session into pharmacy. And as part of that evidence, we talked about medicine shortages, the impact that it has on pharmacists on the ground and put some calls forward for significant changes to be made.

Shortages is such a complex issue. I think there are there are two areas to look at: one is that shortages will happen, but how do we stop that happening more often? Some of that's about international supply chains, onshoring of medicines, all that sort of stuff.

And the other question is, what do we do as a result of those shortages? Serious shortage protocols don't often work as well as they could do. In Scotland, for example, they have more powers to be able to change from a 20mg tablet to two 10mg tablets. It's that kind of area that we can advocate for.

So, we're looking at both the big global picture down to the very specific pharmacy, or pharmacist issues, and we're acting at every point in between. Now, that might not always be visible to our members, it might not always be visible to the profession. But some of those outputs do eventually land and make the difference.

Do you ever work with prescribers on shortages? Sometimes the issue is there's an uplift in demand that isn't anticipated in the supply chain. Are you involved in any of those conversations?

To some extent, yes. And often where we're aware of shortages coming in, or where there's issues, we will talk to our specialist interest groups to get their advice and their support on different clinical areas.

And does the RPS have conversations with its counterparts in other professions, like the Royal College of GPs (RCGPs)?

Yes, very much so. We meet with the RCGP, the RCN [Royal College of Nursing], the RCP [Royal College of Physicians] and the BMA [British Medical Association] on a monthly basis, and we have we have regular conversations with them about the work they're doing.

At the moment, we're working on a collaborative project with the RCGP, where we are developing a toolkit to look at repeat prescribing practices.

What we know is, when there are challenges associated with repeat prescribing, when it all goes wrong, it ends up in pharmacies. It’s Friday afternoon, it's always the worst time, someone's run out of their medication, they haven't got it. Community pharmacies also get all the pressure around 48-hour turnarounds of scripts and all that sort of stuff.

So, what can we do further upstream to make the prescribing better, so that the repeat prescribing problems don't end up reaching the pharmacy in the first place, because they've all been sorted further upstream?

Those toolkits will be picked up by the practice, but it may be pharmacists that work in those practices that use those to help improve the systems that they have locally.

When you’re speaking with other healthcare professionals, what’s the one message around pharmacy that you want them to understand?

It seems like in the last few years, particularly post-Covid, that other healthcare professionals out there certainly have a renewed understanding of what pharmacists do.

10 years ago, I was going in and arguing for what pharmacists can do. I now go and walk into a room with an open door where they actually know what pharmacists do. And it's now about saying: how do we integrate the excellent work of pharmacists into the system in a more collaborative way?

One message that I'm consistently pushing with all of the professions is to make sure that there is this recognition that medicines are not a cost, medicines are an investment in people's health.

In lots of different systems, the drugs is seen as a big cost pressure to be brought down. Historically, a lot of the work that pharmacists have done has been to manage that and to keep those budgets under control, and we're great at doing that.

But I think it's getting that message across to say, yes, we do want to control the budget, but medicines are helping people stay healthy. They're helping them stay out of hospital, they're helping them than to continue to live their lives. So, we need to continue to invest in medicines and we need to continue to make sure that we're doing that in a safe way.

Read more from our recent interviews with James Davies, RPS director for Scotland Laura Wilson and RPS director for Wales Elen Jones.