Hiding in plain sight – a view from Scotland

May 2020 and Scotland embarked on its first tentative steps out of lockdown. In March, as Covid-19 paralysed the globe, the First Minister announced that we were in the midst of a global pandemic unlike anything we had ever seen before. In line with the rest of the United Kingdom, Government advice is clear; ‘stay home, save lives’. On reading this back it still feels strange somehow, despite living and breathing Covid19 for the past 12 weeks.

The NHS moved rapidly to implement Command and Control Structure, activating major incident plans and business continuity plans. NHS Boards continued to deliver pharmacy services to meet population need across community pharmacy, pharmacotherapy services and acute pharmacy against a challenging background of service retraction and redesign across other independent contractors and managed services.

Locally, acute hospitals mobilised staff and resources to discharge patients in order to free up beds for the expected surge in Covid19 cases. In the community, dental practices closed and GPs turned increasingly to telephone triage, video consultation with limited face to face appointments. NHS Pharmacy teams were deployed to support colleagues and critical services in care homes, community hospitals and hospital at home.  Meanwhile, isolated and alone on high streets and in communities, pharmacies remained open for patients and the public. As the last remaining source of health advice and support available for face to face consultation, community pharmacy teams wrestled with social distancing, with 94% unable to maintain social distancing of two metres (PJ May 2020) and confusion over guidance on the wearing, and availability of PPE. Perspex screens were rapidly installed to protect staff and patients as systems of ‘one in, one out’ were implemented.

Queues formed outside pharmacies as demand for medicines and repeat prescriptions rose dramatically. As anxiety levels increased, tempers frayed with episodes of public disorder and in some cases violence and threats to pharmacists and staff. Police increased visibility and patrols close to pharmacy premises and contacted pharmacies offering guidance and local contact numbers; support welcomed and much needed.  Social distancing and limited space within community pharmacy and across the NHS will mean we will be learning and adapting practice for some considerable time.  

The introduction of ‘Test and Protect’ brings specific risks to service delivery, especially in community pharmacy as there is the potential to lead to all members of the team at risk from exposure being required to self-isolate for 14 days which could result in closures. Although the detail is still being discussed and worked through this has the potential to impact significantly, particularly on communities who rely on a single pharmacy.  

Community Pharmacy teams have shown exemplary resilience during Covid-19, while I and my colleagues in NHS Boards have worked in partnership to support pharmacy networks through prioritised retraction of non-core services, changes to working arrangements and opening hours and extensive guidance and support.

As we adjust to a new, uncertain normal, I am humbled by all the key workers in the NHS, in social care, those in carer roles in care homes and in care at home and the emergency services and in retail, transport etc. Volunteers and deployed staff have worked with us selflessly collecting prescriptions and delivering medication to those in the shielded categories, vulnerable and those self-isolating with no family and friends locally to assist – THANK YOU.

It is now crucial that we take much needed time to rest, (note to self, start using that annual leave), recuperate and use this once in a lifetime opportunity to re-imagine delivery of services. There is no going back to the old ways. Decision making has been flexible, agile and rapid and rightly so – why would we revert back?

As I reflect personally and professionally on the most challenging 3-month episode of my 32 year career in Pharmacy, I would like to commend my profession and colleagues for their resilience, flexibility and generosity of spirit. Huge thanks to teams working tirelessly in the NHS and in the 1,258 pharmacies across Scotland who made sure your Grandparents, your children, your parents and friends could continue to access essential, life saving medicines and clinical services. So to the pharmacists, pharmacy technicians and an array of pharmacy support workers – we owe a huge debt of gratitude. No longer, to coin a phrase, are we ‘hiding in plain sight’, we are forefront and centre, right in the midst of healthcare in Scotland and, I must say, rightly so.

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