Meetings and Conferences

Primary Care Pharmacists Association

The second annual conference of the Primary Care Pharmacists Association (PCPA) was held at the Botanical Gardens, Birmingham, on 15 June and was attended by over 140 participants. Duncan Petty reports

Implementing medicines management: from boardroom to consulting room

Dr Jim Smith, chief pharmaceutical officer, Department of Health, who chaired the conference, said that the content of the NHS pharmacy plan was not negotiable and there would not be another one. This was pharmacists’ last chance to extend their role and they had a short period (probably two years) to demonstrate that they could do it.

Pharmacists may be negligent if they do not inform patients of all the treatment options even if they are not available locally within the NHS. This was one of the messages from Chris Newdick, reader in law at the University of Reading. Pharmacists, when they are given prescribing rights, may be restricted in what they can prescribe if they are employed by a primary care organisation (PCO). In contrast the terms of service for general practitioners working under GMS (general medical services) or PMS (personal medical services) state that they “shall order any drugs or appliances which are needed for the treatment of any patient”. This means that GPs cannot be forced to comply with PCO formularies. Mr Newdick also outlined the legal position of National Institute for Clinical Excellence guidelines. A NICE publication is a guideline unless the Secretary of State issues directions that it shall be followed. No minister has yet done this, but that does not mean he or she might not in future.

Geraint Davies, locality director from Hillingdon Primary Care Trust, said that prescribing was high on his board’s agenda because it constituted a large proportion of expenditure and was one of the few parts that were measurable. At a strategy level, pharmacists should be responsible for implementing national service frameworks and NICE guidelines, managing prescribing budgets and managing relationships with the pharmaceutical industry. Pharmacists should also be implementing prescribing policy within general practices. He has, however, had less success involving community pharmacists in developing strategies for changing how they work to deliver new services.

Medicines management has not been clearly defined. Duncan Jenkins, a pharmacist from Morph Consultancy, viewed medicines management as every aspect of the therapeutic use of medicines at both organisational and individual patient level. He outlined how pharmacists could deliver the key milestones announced in the pharmacy plan for England. Community pharmacists would deliver instalment dispensing, assess the need for and provide compliance aids where required, be empowered to initiate and manage approved changes to medication and deliver pharmaceutical care, as well as prescribe when appropriate. However, medicines management is not only the domain of pharmacists, and other professionals are better placed to deliver many aspects of it. Pharmacists need to work as part of the primary health care team in delivering this agenda.

Dr Arnold Zermansky, a GP and academic from the University of Leeds, described the work he had done on repeat prescribing and pharmacist-conducted clinical medication review in general practices. Dr Zermansky described research conducted several years ago in 50 Leeds practices that showed that over half of repeat prescriptions had no evidence of authorisation by a GP and just over a quarter had evidence of review within the last 15 months. Things had not improved.

More recent work in elderly patients found that 40 per cent had no review within the last 12 months. One solution might be for a suitably trained pharmacist or nurse to conduct medication reviews instead of GPs. The results of a recently completed randomised controlled trial showed that a pharmacist conducted clinical medication review produced interventions in half the patients reviewed, more changes to medication, a lower increase in the number of repeat medicines prescribed and reduced costs than for patients who receive normal care.

It was clear from the conference that pharmacists were moving away from viewing themselves as the sole custodians of prescribing management to more a team approach. Medicines management was seen as the domain of all health care professionals but pharmacists could take a strategic role in ensuring the implementation by others. They also had a role to play in becoming much more involved in holistic patient care, ie ensuring the pharmaceutical care needs of individual patients are met.

The PCPA

The PCPA aims to promote the development and recognition of primary care pharmacy and provides a forum for the education and training, and peer support, for pharmacists providing prescribing advice and support. It has established a network of pharmacists working within community pharmacy, secondary care and general practices, primary care organisations and health authorities. For more information see www.pcpa.org.uk