Chapter 6 - part 3
Getting organised for promoting and
supporting self care as a pharmacy team

Patient and public awareness of new pharmacy services

While patients and the public are supportive of the new community pharmacy contract, general awareness of the changes it is bringing is low. PCTs and pharmacies should work together to raise public awareness. Pharmacists’ initial experience of inviting patients to attend a medicines use review, for example, shows that proactive information giving is needed, including use of the booklet highlighted in Box 6.15.

Box 6.15:

Resources to inform patients and the public about new services

Medicines use review

The Medicines Partnership, supported by the Department of Health, have produced a booklet for patients which explains what a MUR is and enables patients to prepare for their reviews.18

Patients also need information about prescription-linked interventions (PLI). These interventions will be opportunistic and triggered by a prescription for treatments for diabetes or CHD. An information leaflet summarising the changes that patients can expect to experience when visiting the pharmacy, and the reasons why, could help to prepare patients. Pharmacists could produce such a leaflet with their PCT.

Quality and audit

The community pharmacy contract has a strong focus on quality.1 Clinical governance requirements in the essential services component of the pharmacy contract are wide ranging. They pose a challenge in developing a culture where clinical governance becomes second nature. Box 6.16 indicates resources that support clinical governance.

Box 6.16:

Resources to support clinical governance

Clinical governance and the new pharmacy contract – just what is required?19

The Royal Pharmaceutical Society of Great Britain (RPSGB) has a series of resources to support community pharmacy audit. Audit templates are available from RPSGB and a selection relevant to self care are included below.

RPSGB Audit templates relating to self care

Non-prescription medicines – referrals between pharmacist and GP: an audit of cross-referrals between pharmacists and GPs
Requests for non-prescription medicines: measures the safety of pharmacy only sales for a certain drug or group of drugs
Responding to symptoms: suitability of questioning of a customer asking for advice for treating a symptom.
Availability of leaflets: ensuring that appropriate health information leaflets are available in the pharmacy
Health promotion – smoking cessation campaign: evaluation of a smoking cessation campaign (part of the ‘Ready to go’ series)
Health promotion – travel health: sun awareness campaigns and other travel health issues
Patients’ knowledge of the correct use of the oral contraceptive pill: concerns patients being informed about the correct use of the oral contraceptive pill.

The RPSGB has produced the following resources for interprofessional clinical audits:

Improving patient care – a team approach: guidance about involving community pharmacists in multiprofessional clinical audit. It looks at what can be gained from involving community pharmacists and the main barriers to their involvement
Improving patient care – a team approach: contains 10 examples of multiprofessional clinical audits involving community pharmacists. These include use of aspirin in secondary prevention of cardiovascular disease, patient’s knowledge of emergency contraception, patient compliance in mental health.

The RPSGB also produces guidelines on specific aspects of practice such as that on medicines switched from POM to P (e.g. chloramphenicol eye drops, simvastatin) and on health improvement (e.g. obesity, stopping smoking). All of these resources are freely available on the RSPGB website.20

Clinical audits play an important role in the quality of self care-related advice and services provided by a community pharmacy, as in Box 6.17. The contract requires that ‘pharmacists and their staff should participate in clinical audit – at least one practice based audit and one PCT determined multidisciplinary audit (to aid the development of team working) each year. The PCT must give reasonable notice to allow the pharmacist to leave the premises to participate in any local meetings relating to the multidisciplinary audit. Both audits must have a clear outcome, which will assist with developing patient care. The two audits should be capable of being completed within five days of pharmacist time’.1

Box 6.17:

Multidisciplinary clinical audit

Many PCTs, in thinking about multidisciplinary audit, plan to start with a simple audit in the first year to introduce the principle and build local relationships. In many cases the audit is likely to be linked to general medical practice, and while participation in one multidisciplinary audit per year is a compulsory part of the community pharmacy contract there is no requirement for general medical practice to do so. Engaging GPs by finding a common agenda will be an important part of the topic selection process.

Strengthening links in primary care

Pharmacies need to have working links with their PCT, service commissioners, local GP practices, other primary care health professionals, social care and with effective patient and public involvement – as in the examples given in Box 6.18.

Having a good understanding of the local PCT’s priorities and ofhowtheGPcontract steers the priorities of localGPpractices,5 is important as a basis for targeting particular groups of the public for advice and information, as well as giving opportunities to be commissioned to provide enhanced services. Understanding how future commissioning will work under practice based commissioning is essential for community pharmacy.

Communication between community pharmacy and general practice staff will become increasingly important. Multidisciplinary training will offer the chance to build and strengthen links, for example through the training course on self care underpinned by this book.21

Box 6.18:

Examples of collaborative working between pharmacies and others in primary care

Stockport’s prescribing incentive scheme includes payments for GPs and community pharmacists for holding quarterly joint meetings provided the meeting minutes are submitted to the PCT.
Elsewhere, a community pharmacist has been attending his local general practice meeting on a quarterly basis for over a year. He was initially apprehensive about making contact with the practice, but updated them when simvastatin moved from being a prescription only medicine to becoming available OTC. The pharmacist and practice agreed how requests for OTC simvastatin would be dealt with and who would be referred to the practice.

Since then, regular contact has continued.

Some PCTs have developed a local enhanced service (LES) on self care for their GP practices, for example in Erewash, Southwark and Lambeth PCTs. 98 Supporting self care in primary care

Building relationships is more straightforward for community pharmacies that dispense prescriptions for patients from one or two general practices, than for a city centre pharmacy where many general practices are involved. Local workshops to introduce repeat dispensing have helped because pharmacists have met GPs they did not previously know. As repeat dispensing requires clear communication protocols, it has ‘kick started’ greater collaboration between pharmacies and practices.

Primary care links have been strengthened through the development of local strategies where pharmacy contributes to delivery on key health service targets. Hillingdon LPC and the PCT worked together to develop a community pharmacy strategy (see Box 6.19).

Box 6.19:

The community pharmacy strategy in Hillingdon PCT

The strategy was created to help the PCT regain financial balance, to offer patients a more versatile choice of treatment options and healthcare service provision and to utilise the skills and accessibility of community pharmacists in Hillingdon. It took into account financial benefit (savings on drugs budget and other budgets):

1 PCT priority (using the LDP and national priorities as guidance)

2 urgent and unmet needs identified from Hillingdon PCT’s pharmaceutical needs assessment

3 access to services for patients

4 ease of delivery (taking into account current skills and capacity in community pharmacy and other health care outlets)

5 patient-led demand.

After several group meetings of the pharmacy strategy group (including members of the PCT’s medicines management department, the chair and secretary of the LPC and local pharmacists), several areas were identified where pharmacists could make significant advances. These were further developed into potential services that could have a significant impact on patient care, broadly based on five principal areas:

phlebotomy
anticoagulation
respiratory
weight management
elderly care.

Potential service specifications were then developed for the identified key areas.

Conclusion

Community pharmacies will extend their involvement and support self care as a result of their new community pharmacy contractual framework. PCTs, general practices and pharmacists should be proactive in ensuring that advice, information and support from the pharmacy are linked to local services and practice. These changes will help to improve the integration of community pharmacy into primary care and to increase recognition of pharmacy’s contribution to supporting patients and the public.

References

1 Pharmaceutical Services Negotiating Committee. New Contract: index and service details. Aylesbury: PSNC; 2005.

2 The European Society of General Practice/Family Medicine (WONCA). The European Definition of General Practice/Family Medicine. Barcelona: WONCA Europe; 2002.

3 Pharmaceutical Services Negotiating Committee. www.psnc.org.uk

4 Department of Health. Prescribing Guidance. London: Department of Health; 2003.

5 The General Practitioners Committee/The NHS Confederation. New GMS Contract. Investing in General Practice. London: British Medical Association; 2003.

6 Kerins M, Maguire E, Fahey DK et al. Emergency contraception. Has over the counter availability reduced attendance at emergency departments? Emergency Medicine Journal. 2004; 21: 67–8.

7 Anderson C and Blenkinsopp A. Community pharmacy supply of emergency hormonal contraception: a structured literature review of international evidence. Human Reproduction. 2006; 21: 272–84.

8 Modernisation Agency. Management of Long Term Conditions – what’s in it for pharmacists? London: Department of Health; 2004.

9 Department of Health. Choosing Health through Pharmacy. London: Department of Health; 2005.

10 Covey D. Joint Pharmacy Asthma Project to Launch. London: Asthma UK; 2005.

11 Modernisation Agency. Integrating Community Pharmacy into Chronic Disease Management. London: Department of Health; 2004.

12 Department of Health. Supporting People with Long Term Conditions – an NHS and social care model to support local innovation and integration. London: Department of Health; 2005.

13 National Institute for Health and Clinical Excellence. Helping Smokers to Stop: advice for pharmacists in England. London: NICE; 2005.

14 www.clinicalevidence.com

15 Pharmaceutical Services Negotiating Committee. New Contract Workbook. Aylesbury: PSNC; 2005. www.psnc.org.uk

16 www.cppe.man.ac.uk

17 www.npa.co.uk/departments/membership.html

18 Medicines Partnership. www.medicines-partnership.org/our-publications

19 www.cgsupport.nhs.uk/Primary_Care/Pharmacy/What_is_Required-ques-.asp

20 Royal Pharmaceutical Society of Great Britain. www.rpsgb.org

21 Working in Partnership Programme. www.wipp.nhs.uk

part 2

part 1

Chapter 6 - part 3 Getting organised for promoting and supporting self care as a pharmacy team