The role out of Home Medication Review services and similar medication review services in Residential Care institutions have provided pharmacists with both challenges and new responsibilities that have enhanced the professional rewards of many pharmacists who have risen to providing the new services to their customers.
This has not been without some pain and cost both in time and dollars. The rewards have been, to most involved, more in professional satisfaction and challenging roles than to the hip pocket. The majority of pharmacists supplying these services in my Division of General Practice have on the whole been happy with the results for them personally and for the patients and General Practitioners involved the results have been worthwhile.

My role in 'academic detailing', visiting General Practitioners with evidence based information on prescribing in various therapeutic areas is also a cognitive service role pharmacists are well qualified and highly regarded and trusted to do.
At present this role is well supported by The National Prescribing Service both in monetary support and information supply and training.
The service is operated through the Divisions of General Practice with pharmacists in the main employed to offer it.
This could well be a role for a community pharmacist with a relationship with a community medical centre.
All such roles in supply of cognitive services involve a change in engineering of existing practices and thought processes.
To start with a pharmacist must be freed up from the regulatory requirement of having to be in the pharmacy at all times.
Pharmacies need to be bigger entities with a staff of pharmacists able to share the load of dispensing and cognitive services in the community.
We have to be able to go to the clients at their homes, residential support agencies or in the surgeries. Time has to be devoted to preparation.
Researching areas of need, analysis of prescribing patterns in a community, analysis of current evidence based information that is always developing in the literature and an acute awareness of the medication issues in the community.
The pharmacist, to do these functions well, needs to be in touch with all the health agencies in the community including hospitals, support groups, universities and centres of research.
So not only will a pharmacist need to be free of the dispensing function there will be a need to also be a part of it.
To achieve a balance and to be remunerated not only for supply but also adequately for the service of supplying cognitive services will need to be refined and committed to.
The services should be able to be directly related to cost savings in Quality Use of Medicines in a community. For example such cost savings as a lowering in hospital admissions for medication adverse events, more judicious risk/benefit prescribing from a GP practice that reduces waste and non compliance while optimising the health benefits from therapeutics applied where the evidence supports the benefit.
When the future of pharmacy is discussed now these should be the items on the agenda.
New technology has and will continue to streamline the supply function - what is supplied and how, should be our business and emphasis.
As this is beginning to be recognised so is the dawn rising on an exciting and evolving profession.
That is what will ensure a future - not who is supplying the goods.