Will Hughes, independent prescriber pharmacist at R. J. Jones Pharmacy in Nefyn, speaks to reporter Costanza Pearce about how he sees the state of community pharmacy in Wales
How would you describe the current state of community pharmacy in Wales?
I think Wales and Scotland are in a far better place than England. My colleagues in England are having a very difficult time. Wales is still losing out because our drug tariff is based on the English drug tariff, so that is having a huge impact on us from a cashflow perspective.
Hopefully the new category M funding starting next month will ease things.
What have been the biggest changes over the past 10 years?
The development of our role clinically, moving from a dispensing role to a clinical services role. We’ve seen the nicotine replacement service (NRT) service, the emergency hormonal contraception (EHC) service and we were one of the pilot sites for the minor ailments service that’s subsequently been rolled out across Wales. We’ve been doing that for about five years now.
What are the particular threats you perceive to independent community pharmacy in Wales?
It will be interesting to see how the hub and spoke scenario pans out. I know that large multiples like Boots, Rowlands and Well are doing offsite dispensing and it’s having an impact on the workload they do in branch.
My concern is that the Government will look at the efficiencies they can produce there and apply some cost savings to what they will pay for dispensing volume. It’s something that independent community pharmacy can’t do by themselves. Independents don’t have access to that hub and spoke model and that is a threat to independent community pharmacy.
Any particular pharmacy opportunities in Wales?
We’ve been heavily involved in developing independent prescribing services in community. We’re also very lucky in Wales that the chief pharmaceutical officer Andrew Evans is very pro community pharmacy and is very pro developing innovative clinical services into the sector.
For example, we’re now looking at launching an acute minor illness service here soon hopefully. When someone has got an infection like a urinary tract infection, rather than that patient having to see a GP they could come into a pharmacy that has an independent prescriber (IP) and they could prescribe antibiotics for that patient or make an assessment and decide on the best treatment.
What would you like to see in the future?
Historically, community pharmacy hasn’t been deemed an integral part of the healthcare team. If you want to refer yourself for X-rays or to physiotherapy or mental health teams, while there is some movement towards pharmacists doing that, it’s a very long way off. At the moment, a lot of the referrals are going through GPs.
However, things are moving and the Welsh eye care service is a fantastic example. Patients have come in to see us with eye problems and we’ve been able to get them immediately seen by an optician. The optician has said ‘yes, this is a really serious condition’ and within two hours of walking into the pharmacy, the patient is then seen by an ophthalmologist in our local district general hospital.
They would have had to wait maybe a few days to see a GP to get that appointment and then be referred, or even longer. For something that’s quite serious, the service is really utilising the strength of our role in the primary care team.
If you could ask for one thing from your politicians, what would it be?
A fair playing field. At the moment, community pharmacy is being appreciated in that it can deliver a lot of the services, but there is still that mindset that it’s all about GPs.
The politicians need to be mindful that there is a whole team out there in primary care now, be it paramedics, advanced nurse practitioners, nurses or independent prescribers like pharmacists. These are positions that are highly qualified and utilising that team will address some of the concerns that people have got about GP pressures.
There are moves towards it, but they are only the first steps.
Welsh community pharmacy funding
- In April, health minister Vaughan Gething announced a £1.4m cash injection to Welsh community pharmacy funding for 2018/19, saying this would ‘secure further changes’ to the 2019/20 contract
- In the same month, a £3.6m investment in a multi-sector pre-registration training programme for 2020/21 was announced, rising to an additional £4.9m by 2023/24
- In May, £100,000 was set aside for training Welsh pharmacists to manage minor ailments, after the Common Ailment Scheme (CAS) was rolled out across North Wales in 2016-17