NHS Direct and pharmacy
Principles for pharmacy support for NHS Direct
Walk-in centres
An Italian system for booking diagnostic tests
In this session, which was held on September 11 and was chaired by Mr Marshall
Davies (Vice-President of the Royal Pharmaceutical Society), ways in which community
pharmacists could make it easier for patients to gain access to treatment, advice
and information about medicines were discussed
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| NHS Direct had drawn attention to gaps in current pharmacy services |
The services offered by NHS Direct and by pharmacy must be mutually supportive,
said Mrs Beth Taylor (pharmacy manager, Community Health South London NHS trust).
The first NHS Direct pilots began in March, 1998, and, like general practitioners,
many pharmacists were initially sceptical, if not openly hostile, to this development.
They had asked, quite naturally, why pharmacists could not have worked alongside
nurse advisers and how the service proposed to respond to medicines-related
queries. Despite these early fears, in reality, many pharmacists had been working
well with both the NHS Direct central team and with local pilots. Now, less
than three years later, the Government had signalled a central role for NHS
Direct in the NHS national plan, including the nationwide introduction of referral
of patients to community pharmacists, where appropriate.
The ultimate aim of NHS Direct was to ensure that members of the public were
able to get hold of appropriate and safe advice about their medicines. This
was to increase public access to high quality information, in order for them
either to care for themselves and their families or to access the NHS more appropriately.
Personal experience
Mrs Taylor described how NHS Direct worked in practice, using a pilot in South
East London as an example.
During a bid from the local community trust to be a second-wave pilot, it was
decided that 24-hour pharmacy back-up, although not a requirement, would be
desirable. A contract was made with Guy’s and St Thomas’s hospitals
NHS trust, as they had both a regional medicines information service and a 24-hour
residency. The bid had been successful, so to finalise the details of a pharmacy
service, a meeting was held with pharmacist representatives from each of the
pilots (where known) and representatives from the Royal Pharmaceutical Society,
Department of Health and the National Pharmaceutical Association. This was how
the NHS Direct pharmacy support network had first begun.
The NHS Direct pharmacy support network aimed to ensure that all NHS Direct
call centres had access to comprehensive, high quality pharmacy support and
it had put together a series of principles for providing this, some of which
are listed in the panel.
Issues about medicines arose in a far higher number of NHS Direct calls than
had originally been expected. Most commonly, medicines-related calls were for
advice on treatment of a symptom or condition, lack of efficacy of a treatment,
side effects experienced, childhood vaccination or use of medicines during pregnancy.
The critical importance of training nurses and call handlers about medicines
had been recognised by most, but not all, sites. Training programmes had been
provided to three pilots in South East England by the regional medicines information
service. In each case, a local pharmacist delivered a half-day session on community
pharmacy issues, using a training pack prepared by the NPA for this purpose.
As the NHS Direct service matured, quality assurance issues were receiving more
attention. NHS Direct was considering this nationally and locally and pharmacists
had to engage in the debate. NHS Direct nurses were recruited with a variety
of backgrounds, so the frequency with which pharmacy back-up was used would
vary accordingly. Generally, pharmacy back-up increased with new recruits and
gradually reduced as these nurses gained confidence.
Issues for pharmacy
NHS Direct represented a radically different way of delivering advice on health
care within the NHS. It was undoubtedly popular with the public but how did
pharmacists view it? What were the issues for the profession?
First, there was concern about the overlapping roles of nurses and pharmacists
as regards medication advice. NHS Direct nurses had found it useful when they
were given information about community pharmacy and community pharmacists. Pharmacists
might also need to be better informed about the different nursing qualifications
and training and the extent to which advice on common drug treatment was part
of their everyday activity.
Secondly, pharmacists in community pharmacy, in trusts and in health authorities
had all had to respond quickly to the NHS Direct initiative as it had been rolled
out across the country.
The third lesson had been that NHS Direct had drawn attention to gaps in current
pharmacy services, eg, the need for 24-hour dispensing services.
Some interesting continuing professional development questions for pharmacists
had emerged from involvement with NHS Direct, such as:
The profession should take heart from the fact that both community and secondary care pharmacists were among the first to recognise the strategic significance of NHS Direct and to work with it closely. The NHS plan signalled a number of interesting future developments — if all this had been achieved in two years, where might pharmacy be in five years?
(Top)
Principles for pharmacy support for NHS Direct (Top)
All call centres should have representation from both medicines information
pharmacists and community pharmacists to ensure that there is effective pharmacy
support
All NHS Direct sites should have access to comprehensive pharmacy support including:
When a nurse feels that a medicines-related query lies outside his/her competence,
he or she must be able to contact the contracted medicines information service.
All NHS Direct nurses will be trained to advise callers routinely that their
community pharmacist is a helpful source of advice on all medicine-related issues.
NHS Direct nurses’ core training should enable them to identify instances
when a visit to a community pharmacy is appropriate. Medicines information pharmacists
providing back-up services to NHS Direct will continue to advise inquirers to
consult other health professionals when appropriate
The UK Medicines Information service will collate information about frequently
asked questions and develop regularly reviewed standard responses for NHS Direct
nurses to use.
All pharmacists will benefit from comments from NHS Direct on the number and
types of medicines-related queries that the service is receiving. (Top)
Walk-in centres (Top)
Walk-in centres were challenging the concept of doctor-led care, said Dr Fay
Wilson from the Birmingham Walk-in Centre.
The centre in Birmingham had been opened in April, 2000, and members of the
public could walk in for services that included advice about medicines and health
issues, health promotion information and treatment of minor injuries. There
were no doctors, no appointments, no prescriptions, no sick notes and there
was no continuing care.
The centre had been developed with the help of local hospitals, general practitioners,
nurses and Boots the Chemists. The centre was based in a Boots store but was
independent of it. The reason for this was that pharmacies had a different culture
and outlook on health to other providers of health care, she said. This fitted
in with the philosophy behind the centre, which was to "de-medicalise"
the process of obtaining access to health care. The emphasis was on people looking
after their own health.
The centre was open from 7am to 10pm every day and was most busy when the Boots
store was open. This was probably because people tended to drop in while they
were shopping in the store, she said. For the same reason, every day (except
Sunday) was equally popular. A 24-hour service could probably be offered but
was not currently possible because the store was closed at night.
On average, the staff in the centre saw 12-15,000 people each month. Visitors
were most commonly female and aged 16 years or more. The elderly used the centre
but few inquiries were made about treating children. The centre was currently
trying to encourage more men to visit, as a recent survey of callers had shown
that only 36 per cent were men. Most patients had heard about the centre from
leaflets or by being referred to it, or they had simply seen it as they were
passing by, Dr Wilson said.
About 90 per cent of callers to the centre needed to see the centre’s nurse
and many said that they would either have visited an accident and emergency
department or asked their general practitioner for an emergency appointment
for treatment if the walk-in centre had not been there.
New services that were under development at the centre included men’s and
women’s health clinics, smoking cessation programmes and clinics for stress
management, cervical cytology, adolescent health (offering advice on alcohol,
drugs and sex), phlebotomy and vaccination.
The centre’s staff did not currently prescribe or dispense prescriptions
and patients were referred to the pharmacy in Boots for this. However, the nurses
occasionally applied dressings or administered medicines. Professional links
had been established with ophthalmic opticians and chiropodists. (Top)
An Italian system for booking diagnostic tests (Top)
Dr John Schaechter (director of social policy, PMA Partnerships Ltd) described
a system that was available in pharmacies in Bologna in Italy that allowed members
of the public to book themselves in for tests and x-rays quickly.
The system had originally been set up in community pharmacies only but was now
also available from special "booking stations" or by telephoning a
central base.
If a general practitioner decided that a patient should have a certain test
or x-ray, they wrote them a sort of prescription for it. The patient then took
this prescription to one of the above places for the test to be arranged. The
prescription took the form of a card that was issued to every citizen in Bologna.
It had their individual personal and medical details logged on to it.
When making a booking, the patient entered specifications into the system of
whether they preferred a male or female consultant and the location and time
for the test that was most convenient for them. The system would then match
this against the diaries of all local clinics and consultants and gave the patient
an appointment that was convenient for them.
The result was that the patient had more choice and control over their test
and waiting lists were virtually non-existent in Bologna. This was because the
majority of empty appointments were filled, so the average wait for a test had
decreased from 60 days to three.
This system pointed the way to new relationships between patients and health
care professionals and to better ways of working together in the patient’s
interest, Dr Schaechter said. (Top)