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Primary care pharmacists seize opportunities

About 100 people attended the first Primary Care Pharmacy conference held on May 24 at the Royal Pharmaceutical Society. The aim of the conference was to highlight the opportunities for pharmacists to develop new roles in primary care and to become more involved in the prescribing process. A full report will appear in the June 2001 issue of PCP. Pam Mason reports

Medicines management in the next 12 months
Be clear about what PGDs are
Dispensing should be delegated
Pharmacists can help people with Alzheimer’s Disease
Become part of the primary care team

Medicines management in the next 12 months

There are currently two major medicines management initiatives running in parallel — the national medicines management services programme, hosted by the National Prescribing Centre (NPC) and the Pharmaceutical Services Negotiating Committee-based pilot scheme.

CLIVE JACKSON, director of the NPC, explained that the main difference between the two was that the NPC-based scheme provided medicines management services within the multidisciplinary context of primary care organisations (ie, local health care co-operatives and primary care groups [PCGs]), and the PSNC scheme was designed to deliver this service from community pharmacy.

Starting in September 2001, during its first year the NPC programme would have about 20 to 25 funded pilot sites. Each of these would be co-ordinated by a local project facilitator. The programme was funded by the department of health, supported by the national primary care development team in Manchester and would employ methodology currently being used by the primary care collaborative scheme. This methodology was designed to produce rapid change based on what people thought they needed to do at a local level.

As part of the preparatory work for the project, the NPC had conducted a national survey of medicines management services in primary care organisations and health authorities. Of the 372 that had responded to the questionnaire, 120 had reported no current activity. From the 252 reporting activity, there were 358 relevant initiatives. The most common were prescription review (64 per cent), followed by patient counselling (52.5 per cent), patient education (51 per cent), management of repeat prescribing (44 per cent), provision of services within community pharmacy (40.5 per cent) and medication monitoring (39.5 per cent).

More than 190 initial expressions of interest had been received from PCOs keen to participate in the NPC-based scheme, and applicants would be told whether they had been successful by the end of June. A training programme was planned for local project facilitators, together with a one-day induction event for the pilot sites and a learning workshop for 400 attendees. Thought was also being given to plans for a second wave of pilot sites, to developing a wider understanding of the “collaborative” approach across the profession, and to the spread of good practice beyond the pilot sites.

Be clear about what PGDs are

It is important to be clear about what patient group directions (PGDs) are BARBARA ADIE, principal pharmacist, Community Health South London NHS Trust, told the conference participants. Confusion had arisen because of the shift from group protocols to PGDs, the advent of nurse prescribing, and the supply of emergency hormonal contraception as a pharmacy medicine in addition to its supply on PGDs, she said.

PGDs should only be used in certain situations, and should be developed according to strict criteria. They were not a solution to being short of staff. Indeed, writing them required a great deal of work, which often had to be completed to a tight deadline, and the decision “to PGD or not to PGD” should, therefore, not be taken lightly. The main issues that needed to be considered when writing PGDs were format and what to include. In addition, they had to be written concisely, with no “grey” areas. The legislation might be open to interpretation, but a PGD should not, she emphasised.

A survey of prescribing nurses and pharmacists had found that the nurses had, initially, found PGDs restrictive to their practice. However, pharmacists had viewed them much more positively, saying that they extended their professional role. Pharmacists had particularly valued the training they received. More recently, nurses had also become more positive, and both professional groups had agreed that PGDs improved their relationships with each other and enhanced patient care.

Dispensing should be delegated

Medicines management and pharmaceutical care require pharmacists to leave the dispensary, said JOHN HALL, a community pharmacist at Dixon & Hall, Co Durham.

Mr Hall, whose company has run anticoagulant clinics in its pharmacies for several years, emphasised that the role of the community pharmacist was to promote the safe and effective use of medicines. He said “if we feel our role is in dispensing, we ignore a lot of unmet need”. Operating any new service required commitment, he warned. “It is not a nine-to-five job, and you may have to visit patients in the evenings and on bank holidays.”

Funding was a problem and Mr Hall said that having a positive attitude was vital to making any project a success. “No pharmacist should provide these services for nothing ... but you can always find time to do the things you want to do,” he said.

Pharmacists can help people with Alzheimer’s Disease

JULIA CREAM, research and policy officer for the Alzheimer’s Society, identified pharmacists as one of the main professional contacts for patients with dementia and their carers. A recent survey had shown that 54 per cent of carers had concerns about administration of medicines, often because the patient had swallowing difficulties. In addition, neuroleptics were often used excessively in people with Alzheimer’s Disease (AD), particularly in nursing homes. Pharmacists had an important role to play in rationalising the prescribing of drugs of patients with AD.

Become part of the primary care team

Dr ANDREW FOULKES, the chairman and prescribing lead of Regis PCG, emphasised the contribution that pharmacists could make to the health improvement programme (HiMP), to national service framework implementation and to intermediate care. PCTs had a role in helping to shape local pharmaceutical services to meet local needs and the HiMP. “Pharmacists now have a real opportunity to become part of the primary health care team and work more flexibly alongside other health professionals. This will enable better health care and a better experience for the patient.”