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A joint workshop for pharmacists and general practitioners, focusing on making better use of pharmacists' skills and expertise in delivering primary care to patients, was held at the Royal Pharmaceutical Society's headquarters on September 22 |
Collaboration between health care professionals essential for developing primary care links |
The workshop was organised by the National Pharmaceutical Association and the National Association of Primary Care and jointly chaired by Mr JOHN D'ARCY (director, NPA) and Mr ROD SMITH (president, NAPC).
In his welcoming speech, Mr D'Arcy said that the workshop was focussed on partnership, among other topics, which was essential in the new NHS. "The new NHS is all about working together and making the best use of each other's skills and expertise," said Mr D'Arcy. It was very important to recognise the skills and expertise of the community pharmacist and the contribution they could make to primary care, he said.
The workshop was also about achieving a link between pharmacists and GPs. Dr Smith went on to say that, although it was becoming increasingly clear that pharmacists were going to become key members of PCG boards, the really "important link" was not between PCG boards and pharmacists, it was between pharmacists and prescribers. Pharmacists were an important link in achieving cost effective prescribing, he said.
Mr PHILIP LEECH (principal medical officer, Department of Health) said that there would be pilots of prescribing in pharmacies and that a working group was currently discussing the details of these.
Dr Leech said that over the next few years spending on pharmaceuticals would continue to rise faster than general NHS inflation. He suggested that prescribing issues should not be separated from other issues of clinical care and management. Prescribing was "data rich" but was still considered too much in isolation, he said. "Everything you do in the NHS always affects someone else or something else. Prescribing is no different. The pound spent on pharmaceuticals cannot be spent on other forms of health care."
In terms of rational prescribing, Dr Leech said: "The planning process is made much easier if we can predict what people will need, and measure how it is spent."
Information technology had also helped to improve prescribing. The Prodigy project, a computerised "decision support project for GPs" dealt with new, acute presentations in the surgery. The Prodigy screens were designed to be shared with the patient, thus enabling shared decisions between the doctor and the patient. "Forty per cent of practices will have Prodigy by Christmas," said Dr Leech. He also mentioned the use of ePACT for PCGs.
"Re-engineering prescribing" in the NHS was discussed by Mr DAVID KNASS (clinical director/chief pharmacist, Stockport acute NHS Trust). This included prescribing the most cost effective drugs, looking at how medicines were prescribed and supplied within secondary care and ensuring that patients stayed on their medication for only as long as they needed to. "What we have got to do is increase the quality of the services we provide," he said.
Mr ASHOK SONI (lead PCG pharmacist, South Lambeth PCG) talked about maximising the role of the pharmacist in delivering local and national health agendas. He said that, in this context, pharmacists provided a number of services, ranging from getting involved with NHS Direct to providing prescribing support to GP practices and advising patients on the key issues of smoking cessation and emergency contraception.
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Ashok Soni: pharmacists to integrate into the primary health care team |
Some pharmacists in Lambeth, Southwark and Lewisham health authority had been involved in the preliminary training of nurses for NHS Direct. This involved telling nurses about, among other issues, what pharmacy did and the services it provided. "This should help pharmacists to further integrate into the overall primary health care team," he said. He pointed out that the nurse prescribing budget was to be top-sliced from the total PCG prescribing budget and any overspend would have to be met from the PCG's cash limited funds.
Speaking about PACT data, Mr Soni said that, although it provided a large amount of information, it could not recognise local population differences and how this impacted on prescribing. "Local community pharmacists better understand prescribing of local GPs and also know the profile of the local population," he said.
Mr HUW THOMAS (pharmacist and chairman of Bridgend local health care group), spoke about the health improvement programmes which, he said, aimed to encourage joint working between health care professionals to improve the health of the population. Health improvement programmes would focus on outputs in terms of proposals to protect and promote health and tackle inequality, he said. Mr Thomas discussed the pharmacist's involvement in health improvement programmes in terms of the Government's main health promotion target areas.
Pharmacists also played a key role in health promotion as community pharmacies were located at the heart of the community. Pharmacies in deprived areas often offered the only permanent local access to a health professional, said Mr Thomas.
On the subject of communication, Mr Thomas said that PCG pharmacists could act as a central point for communication on all PCG prescribing issues.
In the afternoon session, four speakers outlined current studies involving collaborative work between pharmacists and GPs.
Dr Karen Hassell (research fellow, University of Manchester) described a "care of the chemist" trial. The trial, which was still undergoing evaluation, had been set up to explore whether, and to what extent, minor ailments could be shifted from general practice to community pharmacy. Patients contacting the GP surgery for an appointment, or a prescription, for any one of 12 specified self-limiting minor ailments, ranging from a sore throat and influenza to indigestion, were told about the trial by the receptionist and asked if they would see a pharmacist instead of a doctor. Patients who accepted the offer to see a pharmacist were given a list of eight pharmacies to choose from. A referral form was then faxed to the pharmacy and patients attended the pharmacy for a consultation.
A formulary for the 12 conditions, based on current prescribing practice and over-the-counter sales in the eight pharmacies, had been set up and included medicines with pharmacy only status. A completed advice form was used instead of an FP10 form and pharmacists were re-imbursed by the local health authority, providing they adhered to the formulary.
Also, a professional fee was received for each consulation, irrespective of whether or not a medicine was supplied to the customer.
In the first month of the trial, 78 patients had used the scheme, representing a shift of 43 per cent of the practice's consultations for minor ailments. GPs were pleased with the results and patients responded positively to the service.
The "Neyland lifestyle prescription clinic" was set up by Mr Jonathan David (community pharmacist, Neyland, Wales). The main aim was to identify and reduce coronary risk among asymptomatic patients. Patients referred by their GP to the clinic, in Mr David's pharmacy, underwent diagnostic testing (eg blood pressure, blood lipid and glucose profile) and were given lifestyle advice to help to maximise their health and well-being "whatever their capacity for fitness." It was hoped that health gain targets in heart disease, stroke, smoking cessation, consumption of fruit and vegetables and consumption of alcohol would be achieved, said Mr David.
Ms Bernadette Ryan-Wooley (project manager, University of Manchester) had recently completed a feasibility study, undertaken in St Helen's and Knowsley health authority. The study demonstrated an extended role for community pharmacists which involved working in partnership with GPs, making therapeutic interventions and delivering lifestyle advice to patients with ischaemic heart disease. The study was funded by the Department of Health and follow up reviews were currently under way.
Mr Sultan Dajani (community pharmacist and a member of the Royal Pharmaceutical Society's Council) reported on how he had set up a community pharmacist-led asthma clinic in a private consultation room in a pharmacy in Wiltshire. A pilot study investigated the role of the pharmacist in the management of asthma and assessed patient non-compliance, including the "disuse and abuse of preventer inhalers" and "regular use of reliever inhalers." These were found to be among the problem issues identified in 58 out of the 103 patients involved. During the study a total of 122 interventions had been made and where necessary the patient's doctor had been contacted. Further research showed that, out of 150 patients, 68 per cent did not adhere to their asthma medication regimens and nearly half of the patients underused their preventers.