The Pharmaceutical Journal
Vol 268 No 7187 p281
2 March 2002

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Speaking for pharmacy: giving advice on medicines to NHS Direct and NHS 24

Pharmacy advisers have now been appointed for NHS Direct in England and Wales and NHS 24 in Scotland. Jonathan Buisson finds out what they are doing. Further information on the work in England is contained in this article (PDF* 75K)

Related websites
NHS Direct Online (www.nhsdirect.nhs.uk)
NHS 24 (www.nhs24.com)

The planners of NHS Direct seriously underestimated just how many callers to the service would want information about their medicines or about other medicines they wanted to use. With up to 40 per cent of calls involving medicines-related information, this is now being addressed through the appointment of pharmacy advisers and the option for callers to be advised to consult a community pharmacist.

Callers to NHS Direct in England and Wales will be referred, when necessary, to community pharmacies later this year, following a successful pilot scheme in Essex. When the equivalent NHS 24 service is rolled out in Scotland, pharmacy referral will be an option from the start.

Advising NHS 24

Pharmacist Debbie Jamieson was appointed pharmacy adviser to NHS 24, based at its Glasgow offices, at the beginning of the year. NHS 24 is to be implemented in three phases. The first phase will cover northern Scotland and will start in the Grampian Health Board area in the spring. Training for community pharmacists in the area is already under way.

"Community pharmacy is a key partner for NHS 24," Debbie Jamieson said. "Callers will be advised to consult a pharmacist if they have enquiries about medicines, minor ailments or if they need to obtain medicines. We have learned from NHS Direct in this respect."

To support this a series of evening briefings for pharmacists in the area has begun. NHS 24 has worked with the Scottish Centre for Postgraduate Pharmaceutical Education on a briefing pack for pharmacists. The first copies of this were sent to pharmacists in Grampian this week. Further copies will be sent out as the service spreads. The aim of the pack and the training is to familiarise pharmacists with the role of NHS 24 within the National Health Service and the kind of enquiries they can expect as a result.

"As pharmacy adviser to NHS 24, my role is to advise on policy and strategy in relation to pharmacy issues, to establish and develop the pharmacy referral option and to assess and provide training for the nurse advisers," Ms Jamieson explained.

Newly appointed nurse advisers receive four days of pharmacy related training during their induction period. This covers the role and activities of community pharmacies, minor ailments, handling questions related to medicines, and poisons information. When asked about medicines, they are trained to assess whether the question is a simple one, which they can answer using their own knowledge or the resources available onsite, or whether it is a complex one requiring referral to a pharmacist or general practitioner. "The role of the nurse advisers is to put people in contact with the right people at the right time," Ms Jamieson said.

Another of Ms Jamieson's roles is to chair the NHS 24 pharmacy forum. This consists of representatives of the main pharmacy bodies in Scotland and meets quarterly to review the pharmacy interface with NHS 24. Ms Jamieson represents pharmacy, together with a representative of the Royal Pharmaceutical Society in Scotland, on the NHS 24 clinical forum. She is also in regular contact with her counterparts in England and Wales.

Advising NHS Direct in Wales

Ms Jamieson's equivalent in Wales is Alana Adams who has recently taken up the post of senior information pharmacist to NHS Direct in Wales, based at the Welsh Medicines Information Centre at University College Hospital, Cardiff.

"As medicines information lead to NHS Direct Wales, my role is to provide information for nurse advisers about frequently asked questions — using information from both the medicines information service and NHS Direct in England and Wales — and to co-ordinate the training of nurse advisers on medicines," Mrs Adams explained. She is also part of the team which provides an all-Wales enquiry service on complex medicines related questions for NHS Direct. The service went live nationally in Wales in November last year.

Mrs Adams will be auditing the service by assessing a sample of the taped calls relating to medicines. This will help to determine whether appropriate information was obtained from callers and whether appropriate advice was given. It will also help assess the need for an out-of-hours medicines information support service. She has been appointed to the guardian group for NHS Direct (PJ, 19 January, p76) which will be reviewing the clinical content of the algorithms in the clinical assessment system (CAS) used by nurse advisers.

In England, like Wales but unlike Scotland, advice on complex medicine-related queries is provided by regional medicines information units. Joanne Dey, NHS Direct lead at the Trent information centre, said that around 50 enquiries a month were received at her centre, which covers the East Midlands, and these were handled in the same way as other requests. Monthly summaries of workload and common questions are provided to NHS Direct.

Pharmacy referrals

Although community pharmacy referrals in Scotland should start within the next couple of months, referrals in England and Wales may be a little later.

Hazel Jamieson, pharmacy adviser to NHS Direct in England, explained that the pilot in Essex had now been completed. A final report from the evaluation team at Sheffield University is expected shortly. Implementation of pharmacy referrals is planned to start this year, as set out in the pharmacy plan for England. Referrals in Wales should start shortly afterwards.

Mrs Jamieson clarified the position as it stands: "Pharmacy referrals in Essex have now officially ceased as the option is not included in the current version of the CAS software which has been standardised nationally. It will form an additional pathway in a new version of the software."

Georgina Craig, the National Pharmaceutical Association's head of NHS service development, was closely involved in the Essex pilot. She said that getting community pharmacy involved in NHS Direct, a key part of the primary care infrastructure, was a great thing for pharmacy. "It is an extension of the 'Ask your pharmacist' campaign."

As currently planned, referrals to pharmacies in all three countries will be a one-way process, with no direct follow up of patients, although some work is planned to assess the appropriateness of referrals.

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