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Pharmaceutical Services Negotiating Committee

About Community Pharmacy

Community pharmacists were known in the past as chemists. Like GPs, community pharmacists are part of the NHS family. Every day about 1.8 million people visit a pharmacy in England.

Community pharmacies are situated in high street locations, in neighbourhood centres, in supermarkets and in the heart of the most deprived communities. Many are open long hours when other health care professionals are unavailable. There are several different types and sizes of community pharmacies, ranging from the large chains with shops on every High Street or in edge of town supermarkets, to small individually owned pharmacies in small communities, in the suburbs and often in deprived areas or rural settings.

The traditional role of the community pharmacist as the healthcare professional who dispenses prescriptions written by doctors has changed. In recent years community pharmacists have been developing clinical services in addition to the traditional dispensing role to allow better integration and team working with the rest of the NHS.


The accessibility of community pharmacies

Pharmacy ServicesCommunity pharmacists are easily accessible with around 10,500 community pharmacies in England located where people live, shop and work. The latest information shows that 99% of the population - even those living in the most deprived areas - can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport.  Community pharmacy is consequently a socially inclusive healthcare service providing a convenient and less formal environment for those who cannot easily access or do not choose to access other kinds of health service. Most pharmacies now have a private consultation area specifically for confidential or sensitive discussions.


NHS services

The NHS Community Pharmacy contract for England and Wales was introduced in 2005. Under the contract your community pharmacy will provide the following Essential Services:

The Dispensing Service - working to a prescription, pharmacists will provide you with your medicines labelled correctly following the directions of a GP or other healthcare provider who can write prescriptions (e.g. nurses, dentists or pharmacists). The number of prescription items dispensed by community pharmacies in England in 2008-09 was 771.5 million.

The Repeat Dispensing Service - this service allows you to collect your regular repeat prescription medicines direct from your local pharmacy for an agreed period of time, without having to go back to your GP. You will need to give your permission to your GP for him/her to share information with your chosen pharmacist. When you need your prescription, instead of requesting it from your GP, you will be able to get your medicines directly from your local pharmacy.

Disposal of Unwanted Medicines - if you have any medicines that you no longer use, you can take them to your local pharmacy for safe disposal.

Promotion of Healthy Lifestyles - this service will provide you with advice on keeping healthy; this could be advice on healthy eating, stopping smoking and exercise. You may be able to get leaflets and written information to help you make healthier choices. Your pharmacy will also take part in local health promotion campaigns such as taking care in the sun and understanding the risks of long term conditions such as diabetes.

Signposting to other Services - your pharmacy will provide you with contact details for additional help if needed from other healthcare professionals, social services or voluntary organisations.

Support for Self-Care - this service helps you to look after and care for yourself and your family. Your pharmacy will provide you with advice on treating minor illnesses, e.g. coughs and colds or long term conditions such as arthritis or diabetes. This support may include medicines which you can buy over the counter from the pharmacy without a prescription.


Use of IT in pharmacies

PrescriptionThe use of IT is starting to develop rapidly in community pharmacies. PSNC is currently working with the Department of Health to integrate community pharmacy into the many NHS IT programmes. This may eventually include pharmacists having access to patients' electronic care records where there is a need to access information in order to safely provide pharmacy services.  Additionally, electronic prescriptions are now being issued by some GP practices and by the end of 2010 it is likely that the majority of prescriptions will be issued as electronic messages, rather than the current pieces of paper. 


Helping people get the most from their medicine

Consultation AreaThe pharmacy contract has prompted the installation of private consultation areas in most pharmacies where patients can freely discuss sensitive issues, safe in the knowledge that they will not be overheard by other members of the public. These private areas are also used to conduct a new national pharmacy service called Medicines Use Reviews (MURs). An MUR is a consultation between the pharmacist and a patient that lasts approximately 10-20 minutes. It provides an opportunity for the patient to discuss how they use their medicines and to find out more about them; and the service is designed to supplement (and not replace) the more in depth clinical reviews that are conducted at GP practices.

Almost any patient can have an MUR consultation providing they have been using the pharmacy for more than 3 months and the pharmacist feels that the patient will benefit from the review.  Since the introduction of MURs there has been a steady increase in the number of pharmacies offering the service to their patients. In 2009/10 1.4 million MURs were provided in England.


Local services for local people

Sharpe's PharmacyAs well as national services provided by all pharmacies, the pharmacy contract also includes Enhanced services that are commissioned at a local level by the Primary Care Trust (PCT). There are many different services that are operating throughout the country, reflecting the varying needs in different areas.

Examples of such services include:

  • Emergency out of hours services to provide special medicines for the terminally ill;
  • Emergency hormonal contraception services to reduce the incidence of unwanted teenage pregnancy;
  • Screening services (e.g. for diabetes, Chlamydia, high blood pressure etc.);
  • Minor Ailments Services to reduce waiting times in GP practices;
  • Obesity management services;
  • Stop smoking services;
  • Anticoagulation monitoring and phlebotomy; and
  • Supervising consumption of Methadone and provision of Needle Exchange Schemes for drug users.

PSNC believes that a lot of these services should be offered through all pharmacies nationally and not just when they are commissioned by the local PCT. Services such as sexual health advice, obesity management, stop smoking and basic diagnostic testing should be available, like the MUR service, through all pharmacies to ensure that patients wherever they live, can receive the same level of service from all pharmacies.


How are Pharmacists trained?

The underlying principle for all pharmacy education and training is ensuring safe and effective care for patients.  This principle underpins pharmacists' work throughout their undergraduate, postgraduate and continued learning and subsequent career pathway. Students undertake a four year Masters in Pharmacy degree course that teaches them about the origin and chemistry of drugs, the preparation and formulation of medicines and the actions and uses of medicines including physiology, biochemistry, microbiology, pathology and pharmacology. After the degree course the student undertakes a one year placement working in a pharmacy under the supervision of an experienced pharmacist. At the end of this year they take a professional examination and those who successfully complete the examination are able to register as a pharmacist.

Pharmacists continue to keep their knowledge up to date during their career by undertaking continuing professional development.


The daily life of a Community Pharmacist

The daily life of a community pharmacist is hugely varied, drawing on a wide range of clinical and non-clinical competencies and skills. Every pharmacy is required to be operated under the control of a ‘Responsible Pharmacist'. Daily tasks undertaken by community pharmacists include:

  • clinical scrutiny of prescriptions;
  • oversight of safe dispensing processes;
  • providing patients with advice about medicines and treatments;
  • provision of public health information to patients and customers and promotion of wellness;
  • signposting people to other services, self-care organisations or information resources;
  • assessment and treatment for minor ailments;
  • professional oversight of the sales of over the counter (OTC) medicines;
  • liaison with other healthcare professionals;
  • clinical review services for specific patient groups in GP practices, e.g. asthma, diabetes, hypertension;
  • medicines management support for GP practices, e.g. supporting practice formulary and clinical guideline implementation, repeat prescription management; and
  • providing locally commissioned Enhanced services such as supply of Prescription Only Medicines (POMs) under Patient Group Directions (PGDs), screening services, public health interventions and treatments.

Pharmacy support staff

Pharmacists have supported their staff to train and develop to ensure that the extended role of the pharmacist can be achieved by having a team who are competent to support and deliver a safe and effective pharmaceutical service.

 

Position

 

Role

 

Medicines Counter Assistant (MCA)

 

MCAs are generally the first point of contact for patients providing a wide range of functions to support the delivery of services and the retail functions of the pharmacy. They undertake the prescription reception process, including supporting patients to complete the declarations on NHS prescriptions. Advice on the treatment of self-limiting illness and basic healthy lifestyle support will be provided by MCAs working to a protocol and under the supervision of the pharmacist. Some MCAs will provide aspects of NHS commissioned services, such as NHS Health Checks, following appropriate training and accreditation. It is a professional requirement that any assistant who is given delegated authority to sell medicines under a protocol should have undertaken, or be undertaking, an accredited course relevant to their duties.

 

Dispenser/Dispensing Assistant

 

Dispensers support the pharmacist in the dispensing of prescriptions and the management of dispensary stock. They will also generally fulfil the roles of an MCA when required. It is a professional requirement that dispensing assistants are competent in the areas in which they are working to a minimum standard equivalent to the Pharmacy Services Scottish/National Vocational Qualification (S/NVQ) level 2 qualification or undertaking training towards this.

 

Pharmacy Technician

 

Pharmacy Technicians support the pharmacist in the dispensing of prescriptions and the management of the dispensary. Like Dispensers and MCAs they also provide aspects of NHS commissioned services, following appropriate training and accreditation. The statutory registration of pharmacy technicians across Great Britain started on 1 July 2009 following the Privy Council's approval of the Health Care and Associated Professions (Miscellaneous Amendments and Practitioner Psychologists) Order 2009. Registration is voluntary for two years after this date, becoming mandatory from 1 July 2011.

 

Accredited Checking Technician (ACT)

 

ACTs are pharmacy support staff that have undertaken additional training to allow them to undertake an accuracy check of dispensed medicines. The pharmacist will undertake a clinical check of the prescription during the dispensing process, but working with an ACT means the pharmacist does not need to undertake the final accuracy check of the dispensed medicines in most circumstances.

An increasing number of pharmacy contractors are supporting  members of their dispensing team to qualify as ACTs in order to improve the efficiency of the dispensing process and to free up pharmacist time to allow them to deliver other services.

All pharmacy staff are required to respect the confidentiality of patient information and to follow the NHS Code of Practice on Confidentiality, the Common Law on confidentiality and the Data Protection Act.


The future

PrescriptionThere have been some significant developments in the world of pharmacy over recent years; one of the most significant has been changes in the law to allow pharmacists to prescribe. This has helped pharmacists to provide more dedicated care to their patients and to work more closely with GPs and other health professionals.

Pharmacists are also starting to specialise in the treatment of certain medical conditions, such as diabetes; they are known as Pharmacists with a Special Interest (PhwSI). These pharmacists are trained to a much higher level of knowledge in a specific condition and can therefore provide a much more focused and specialist service.

The future will undoubtedly see more developments in community pharmacies across the country; the development of IT systems, additional services such as prescribing and the growth in the numbers of specialist community pharmacists will all help to ensure that patients continue to get excellent care from their local community pharmacy.