'Pharmacy, quit talking about it, start doing it!’
by Pharmacy Life - Published on 12 May 2014
Speaking at a conference organised by the Pharmacists’ Defence Association (PDA) entitled ‘Reclaiming your professional territory’, Professor Strand provided a crystallised exposé of the state of community pharmacy in the UK and compared this to her experiences in the USA.
Professor Linda Strand has directly challenged community pharmacy to take responsibility for its own future and warned that, if it doesn’t, ‘it WILL miss out on this current and fleeting opportunity’.
The PDA created a Strategic policy called the PDA Road Map which it launched in 2011. It is strongly built upon the platform of pharmaceutical care and it argues that services should be provided on a named patient registered pharmacist basis to patient on long term conditions. It has been lobbying this policy throughout the whole of the UK extolling the benefits to patients, public health, and the development of the pharmacy profession. The PDA’s conference sought to develop the core themes drawing on the practical experience and guidance of the leading authority in this area.
Professor Strand is much in demand, not least from her own business and her appearance at the conference is a reflection of the relationship developed with the PDA and her belief in patient good.
Why is this person credible? Why should you read on? Well, Professor Strand, has, after thirty years, ignored the machinations and procrastinations of the various pharmacy societies and associations in the USA, and, in two and a half years, developed agreements with physician organisations to deliver pharmaceutical care in four states including California to eight million patients. On average, her organisation receives $180 per intervention through Medication Therapy Management Services. Recently, an ‘opt in’ system has changed to ‘opt out’, broadening her potential patient base by 20 million people. An academic, practising pharmacist, co-founder of a company, few can speak with such authority.
Pulling no punches Professor Strand outlined the historical and - in many States - the current position, that many here would easily identify as the UK today. Pharmacy revenues driven down by the overarching priority of reducing healthcare spend; pharmacy backed into a narrow dispensing role; representative organisations failing to deliver, adapt, or, engage meaningfully with physician groups (GPs as we know them); delivering continuous projects, pilots, discussion papers while other healthcare groups consume the available budgets; no fundamental and authoritative demonstration of $ (£) value for services, a lack of willingness to do the service first to prove value and then hunt for the money.
However, underlying this extensive list is the real message; ‘take personal responsibility’, ie, come out from the comfort zone of complaining about the many representative groups’ failure to deliver, and ‘do it for yourself’.
Fundamental to Professor Strand’s approach was to align professionally to the doctor’s values, language, attitude and ethics relating to patient care, and, recognise that the patient’s ‘home’ is the doctor centre (GP clinic). Next was to develop standards of care that start from a simple concept: ‘the patient must receive 100 per cent best care available’ The standards developed provide a homogenous service; this is how doctors work and are judged, this is their expectation of pharmacy. The patient should receive this service delivered in the same way to the same standard every time. This permits evaluation, change or development of care programmes and cost and value accuracy.
Professor Strand has built rigorous and demonstrable cost and value proofs: ‘With the right value proposition you can convince anyone. The system needs to reduce cost, but if you can’t prove value by actions, not words, it won’t happen. The value cannot be found until you do it. Prove by your actions’.
Part of the services Professor Strand developed have a message that at first seems counter intuitive bearing in mind the ‘noise’ in the system. ‘Stop trying to increase compliance. If you’re doing this you are part of the problem not the solution’. Her philosophy is simple: until you conduct a thorough examination of the patient’s needs and medications, then how do you know that compliance is not for the wrong thing.
On average, findings show that patients are experiencing:
Indication
Unnecessary drug therapy - 5%
Need additional drug therapy - 34%
Effectiveness
More effective drug therapy - 8%
Dosage too low - 23%
Safety
Adverse drug reactions - 11%
Dosage too low - 5%
Compliance
Noncompliance - 14%
The essence of ProfessorStrand’s approach is integration and a proven value proposition. In her case value varies from a 4:1 to a 12:1 benefit/cost ratio.
Create a service that unites the needs of the patient
Professor Strand also had some advice for the UK: ‘Tie fragmented programmes into a comprehensive management plan. Create a service that unites the needs of the patient’. As someone who worked with Simon Stevens - the new head of the NHS - she offered: ‘Simon Stevens is a brilliant man. After seven years at United Health I can assure you he will be looking at population stratification, care management services, contracting initiatives and risk-bearing reimbursement.’ Professor Strand has several rules:
- What you do must be described simply in terms of what it means to the patient. Unless it’s patient first then you don’t get a seat at the table. In short, get over yourself.
- Base it on standards of care, ie, same service from every pharmacist to every patient. Homogenous, this produces the same level of quantifiable benefit/value.
- Base it on standards of care, ie, same service from every pharmacist to every patient. Homogenous, this produces the same level of quantifiable benefit/value.
- Doctors don’t trust you. Accept this. Work from this point. Integrate with their values, terminology and philosophy. Be consistent with their standards and approach.
- Produce measurable results that can be reproduced. Stop using terms that are not used and valued by other professions. If other professions decide the terminology, use it.
- Stop using the term ‘we counsel patients’. Doctors don’t recognise this unless you are a legitimate, fully-qualified psychiatrist.
Comment from Adrian Maginnis,
Managing Director, PharmacyLife
According to the latest Kings Fund report the NHS is bust and better value solutions desperately need to be found. GPs are, in many shapes and forms, bidding for contracts for scarce resources. Professor Strand’s message – ‘get on with it or lose it’ - is timely. Scotland has addressed the issue with Prescribing for Excellence, while other sporadic efforts are being made in Northern Ireland and England through a mixture of models such as Community Interest Companies vying for social funding. But the volume of approaches is not there in England, Scotland and Wales at this time. Are you waiting on representative groups delivering for you? Will you ‘get over yourself and get on with it?’ as Strand advocates. ‘Will you take personal responsibility?’………Time will tell.
