Nodos Disponibles

In 1948 the NHS was welcomed by a population that up until then had limited access to medical care. However, soon after its introduction its spiralling costs began to catch politicians’ attention. Ever since, numerous reports have been written and new systems implemented to try and utilise health service resources better. Despite many attempts to rationalise the system, it seems that the money and resources provided are increasingly inadequate to deal with the public demand for health services.

The baby-boom after the second world, with the later reduction in the birth rates three decades later, has produced a skewed distribution between young and elderly in the population. Also, people are living longer due to a range of factors such as diet, vaccination and hygiene. Projections indicate that the world population of persons

60 years and over will increase from 376 billions in 1980 to 590 billion in the year 2000 (Belligan and Wiseman, 1996).

One way to contain costs is to make doctors more responsible for spending. The public’s satisfaction with the standards of the services in the NHS had dropped, and privatisation was encouraged to try and fill the growing vacuum of confidence. In the 1980s the Conservative government tried to do this by applying market economics to a sector that so far had been totally driven by public money. During their administration a local versus central control model was adapted from free marked economics. The result was that Health Authorities were divided into smaller and smaller working units. Today, under a Labour government, the strategy of decentralisation persists. Primary Care Groups (PCGs) (Bradley, 1998) have been introduced giving more autonomy to local areas. Health care to a local area is provided from a PCG which work from smaller, but more controllable, budgets. Hand in hand with this decentralisation process, recommendations to increase the efficiency and dynamism of the management system of the NHS has forced GPs to become more accountable for their budgets.

Within today’s NHS, patients are increasingly paying more for their prescription medication. The fee for each dispensed item has risen from £0.20 in 1979 to £6.00 in 2000. At the same time a new emphasis on self-care has been encouraged. A growing number of previous prescription medications are available as Over The Counter (OTC) medicines from community pharmacies, and a number of Prescription Only Medicines (POMs) have been deregulated to OTC medicines. Pharmacists have been promoted to the public as a person one should contact to advice and self-medicate on minor health problems. Politically, it is hoped that this should reduce the number of visits to the doctors and therefore the prescribing budget.

Recently, the White Paper, “Working for Patients” (Department of Health, 1989) recommended that patients should be given the autonomy to live in their homes, even if they needed health care. Long-stays in hospital were reduced. However, this required a change in the support system in primary care. As a result of the new legislation, patients were sent home to inadequate medical care, as the primary health care system was not

prepared to respond to the increased demand for care services. Following this, communication links between primary and secondary care have had to be improved. In this context, pharmacists have been shown to be placed in an ideal position to improve information transfer to this group of patients (Duggan et al, 1998).

To understand recent developments in the working role of pharmacists, the history of pharmacy has to be seen in a wider perspective. The work of pharmacists follows and reflects developments in society. New developments in the pharmaceutical industry, the increase in the number of medicines available to the public, progress in research, and the increased expectations of the public to what medicine and technology can and do, all affect the way pharmacy is perceived and understood. The public demand access to medical information, and demand to be treated fairly.

The pharmacist’s role is also affected by public health reforms and the need to control public spending on health care. In recent years, a total new market of effective but very expensive drugs been introduced and great hopes to what medicines can cure have been created in the public. Expenses are high and with new technologies and medicines available the distribution of the limited resources for health care is widely discussed by politicians, patient organisations, hospital management, and local health authorities. Medicines and treatments available to extend peoples life expectations raise pivotal ethical issues as to whether treatment should, or ought, to be given.

1.1.3 Aim of the introduction

Pharmacy is affected by discussions and decisions made in the above institutions, and the remainder of this introduction will reflect on how these changes in society and health politics challenges pharmacy in primary health care. The introduction will focus on six key areas:

• Patients managing medicine and disease.

• Prescribing policy and challenges with prescribing. • Evolution and debate on repeat prescribing.

• Development of new pharmaceutical roles.

• Attitudes to extended roles in primary health care. • Doctor-pharmacist inter-professional collaboration.