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EXECUTIVE SUMMARY
This report, which has been prepared for the Chief
Pharmaceutical Officer by a Joint Working Group of the
National Pharmaceutical Forum (
NPF) and the Scottish Medical and
Scientific Advisory Committee (
SMASAC), sets out the present and future
role of pharmacy in the provision of services to substance
misusers. It does so within the context of current policy
and covers health promotion, health education and harm
reduction in relation to the misuse of illegal drugs,
prescribed and over-the-counter medicines, volatile
substances, smoking and alcohol.
Pharmacists, as part of a team of healthcare
professionals, have a key role to play in providing
services to substance misusers. They also act as a signpost
to other relevant services. For some years now, pharmacists
in Scotland have been engaged in the provision of smoking
cessation services, the supervised self-administration and
ingestion of methadone, and pharmacy-based needle exchange
schemes. These areas of activity are the most well-known
and the most publicised areas of involvement. There are
many other areas in which pharmacists can, and do,
contribute to the wider field of preventing and treating
substance misuse. Some of these areas have been made
possible as a result of changes in legislation and the
changing context in which healthcare is being delivered to
the Scottish population.
Key drivers for change include:
- publication of
The Right Medicine - Scotland's strategy for
pharmaceutical care
- the extension of prescribing rights and the
introduction of supplementary prescribing
- the new community pharmacy contract
- publication of the consultation paper on
Modernising
NHS Community Pharmacy in
Scotland
- the establishment of ePharmacy to oversee the
development of information technology
- UK-wide developments such as the
recommendations flowing from the Shipman Inquiry.
This report encourages NHSScotland and other agencies to
take advantage of the opportunities to engage pharmacy more
fully in the planning, provision, delivery and extension of
services for substance misusers. These areas of activity
include:
- The adoption of a more proactive approach to health
promotion, health education and harm reduction.
- Engagement with local communities, especially
schools.
- Engagement with the general public to challenge
perceptions about substance misusers.
- The need to recognise leading partnership
practice.
- The need to explore new ways of delivering services
[
e.g. outreach via non-traditional pharmacy
premises such as hostels for the homeless].
- The need to identify patients who are ready to move
on from the daily supervision of self-administration of
methadone to some other type of arrangement.
- The need to encourage improved provision of
pharmacy-based needle exchange schemes.
- Increased participation in multi-agency,
multi-professional education and training.
Two of the main recommendations relate to the inclusion
of senior pharmacy representation on Drug and Alcohol
Action Teams and access to specialist pharmacist advice on
all areas of substance misuse. Pharmacy makes a
considerable contribution to the prevention of substance
misuse and the care and treatment of misusers, but there
are significant opportunities to improve and develop these
services. It is, however, essential that pharmacists are
involved in strategic and operational planning, and that
implementation is supported by pharmacists with specialist
knowledge of substance misuse and its treatment.
The emphasis is very much on partnership working, that
is, the pharmacist working in tandem with other relevant
agencies to deliver a consistent, high standard of service
which recognises state-of-the-art leading practice and
utilises to the full the particular knowledge and skills
that pharmacists and other members of the healthcare team
can bring to this vital area of work.
As a first step, it is recommended that the Scottish
Executive Health Department should establish a series of
integrated care pilots, based on the principles of the
pharmaceutical care model schemes, to encourage these
activities and to accommodate the different needs of
substance misusers within local populations.
The exact nature of these pilot schemes and the
mechanism by which they will be set up and funded will be
subject to further discussion within the Scottish Executive
Health Department.
Lyndon Braddick
Chairman of the Working Group
June 2005
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