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Last Updated: Sunday, 21 August 2005, 23:17 GMT 00:17 UK
The rise and rise of the pharmacist
By Nick Triggle
BBC News health reporter

Riaz Esmail
Riaz Esmail has been a pharmacist for 25 years
The glass-walled consultation room would be more at home in a GP practice.

But the small office in the corner of Fairview Pharmacy in Edgware, Middlesex, offers a clue to how pharmacies will look in the next decade.

Riaz Esmail has been running smoking cessation clinics from the room for the last two years.

Mr Esmail, who has worked as a pharmacist for 25 years, also sees elderly patients in the room to advise them about medication for chronic conditions.

It is all part of a contract he has with local health bosses to try to lighten the load on nearby GPs.

Quiet revolution

While such set-ups are far from common among the 10,500 pharmacies in England and Wales, such services could become commonplace over the forthcoming years as the industry undergoes a quiet revolution.

In April a new contract kicked in for NHS pharmacists, allowing them to take charge of repeat prescribing, conduct reviews of patient treatment and provide a range of "enhanced" services such as blood pressure testing.

While the services at Fairview Pharmacy pre-dated the new contract, they are very similar to what are likely to be rolled out up-and-down the country over coming years.

From a patients point of view, pharmacies are easy to access and it can be reassuring
Simon Williams, of the Patients Association

The smoking cessation clinic was part of a contract drawn up by Harrow Primary Care Trust ,with more than 50 local pharmacies, to help people kick the habit.

Of the 2,500 people seen in two years, nearly two thirds have given up.

The medicines review service Mr Esmail offers is something he agreed individually with local health bosses.

"Patients do not always feel it necessary to go to see a GP, but sometimes want to talk to someone about their condition," Mr Esmail said.

"We are there for that. It has the added benefit of easing the load on GPs. Pharmacists are highly-trained professionals so why not let them get involved in more?"

Under the terms of the contract, pharmacist NHS services in England and Wales are categorised under three categories - essential, advanced and enhanced services.

Repeat prescribing

All pharmacists must provide essential services such as dispensing and repeat prescribing.

But those wanting to expand into other services - and experts predict a majority will - can provide things such as medicines reviews under the advanced category or enhanced services such as smoking cessation, blood pressure taking and diabetes screening.

About a fifth of the pharmacies in England and Wales have applied to provide extra services to date.

John D'Arcy, chief executive of the National Pharmacy Association, said he expected to see the industry change completely over the next few years.

Dispensing pills
There are more than 10,000 pharmacies in England and Wales

"Many pharmacists have been innovative over the last few years, but this sets it out in a formal manner.

"We want patients to see us as a realistic and reliable option for health services."

However, Mr D'Arcy admitted some areas will be facing a challenge convincing people to use pharmacists in such a way.

He pointed out that a pharmacist has to complete a four-year degree followed by a year of training before they are ready to practice.

"Pharmacists are highly-skilled professionals, but there is a challenge there to convince people we are the right ones to do this. Some people do have a narrow perspective, and we will have to campaign to change this."

But Melanie Woodnick, of the Pharmaceutical Services Negotiating Committee, which represents outlets providing NHS services, said she was confident the public would embrace the expanding role of pharmacists.


"Of course, it will vary from area to area. But I think most people have a good relationship with their pharmacists and the new contract will build on this."

The new role has also been welcomed by patients - one in 10 of whom visit a chemist each day.

Simon Williams, director of policy at the Patients Association, said it was beneficial to patients that pharmacists were getting involved with services from blood pressure testing to medicines reviews.

"It is a sensible step," Mr Williams said. "From a patients point of view, pharmacies are easy to access and it can be reassuring to get advice from trained professionals.

"We have to get away from the culture where we think we have to see a GP for everything. It is not always necessary and in turn that will allow doctors to get on with things they should be doing."

But despite overwhelming support for the new direction, doctors do have concerns about what pharmacists are being asked to do.

Dr Mayur Lakhani, chairman of the Royal College of GPs, said he welcomed what he called the "team work" between GPs and pharmacists.

But he added: "We must guard against fragmentation of care. The GP has unique supervision of the patient's care.

"It is essential to have good communication in order to update clinical records whenever significant care is provided by a pharmacist."

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