The Pharmaceutical Journal
Vol 269 No 7219 p550
12 October 2002

Society summary

PCTs hear about clinical governance in pharmacy in Central Lancashire

Aspects of clinical governance in community pharmacy were described to representatives of local primary care trusts (PCTs) at a recent evening meeting organised by the Royal Pharmaceutical Society's Central Lancashire branch and the Central Lancashire Pharmacy Development Group — a subgroup of the branch.

The aim of the meeting, held in Preston early in September, was to raise awareness of the role of pharmacy in supporting the local clinical governance agenda with PCT colleagues and with pharmacists themselves. As well as board and executive members of the six PCTs in the area, the 70 participants included clinical governance co-ordinators, members of the boards of the Lancashire Teaching Hospitals Trust, general practitioners and a Member of Parliament, as well as pharmacists.

During the meeting, PDG members described three community pharmacy clinical governance projects completed during the past year.

Baseline audit The first project was a baseline clinical governance audit for community pharmacy. PDG committee member Magnus Hird (pharmaceutical adviser, Blackpool PCT) said that the baseline audit had been developed by the Society. The questionnaire survey had had a good response rate of 72 per cent (116 of 161 pharmacies). Some of the main results were that:

• 25 per cent of pharmacies had some additional pharmacist cover during the week

• 24 per cent of all pharmacists have a personal development plan

• 23 per cent of dispensers/technicians have no qualifications

• 23 per cent of premises recorded doing an audit

• 4 per cent of pharmacies did not appear to be registered under the Data Protection Act. although it is a legal requirement wherever personal data is processed

• 70 per cent of pharmacies had a written complaints procedure

• 52 per cent of pharmacies kept records of errors, which had been mandatory from April 2002

The audit also identified that only full-time employee pharmacists and part-time primary care pharmacists were undertaking the recommended 30 hours of continuing prefoessional development per annum. Most CPD was provided by the Centre for Pharmacy Postgraduate Education.

Dispensing incidents PDG chairman Malcolm Phillips (pharmaceutical adviser, Preston PCT) described the PDG's dispensing incident project, in which 96 pharmacies had participated. Pharmacies were invited to record incidents in the dispensing process that, had they not been identified, would have resulted in a dispensing error. These "near misses" were identified during and after the completion of the dispensing process, using a quick and easy recordingmethod.

During the eight-week project the participating pharmacies dispensed more than a million prescription items and recorded almost 4,000 near misses — an average of one for every 250 items dispensed. About 10 per cent of the incidents were identified by patients or carers, either at the time the medicine was issued. Errors identified after the medicines was handed out accounted for less than 0.1 per cent of the incidents.

In the project report, the data received from the pharmacies was anonymised. However, each pharmacy had access to its own data via a code for comparison with their anonymised colleagues.

Interventions PDG secretary Barbara Healey (prescribing adviser, Preston PCT) reported on an interventions project that had involved community pharmacists recording the reasons why they had to contact GPs before prescriptions could be dispensed. The reasons varied from simple process issues such as missing signatures to serious clinical issues such as drug interactions.

The intervention rate recorded was eight interventions for every 1,000 items dispensed. However, 75 per cent of the incidents were relatively minor. These mainly involved patient inconvenience.

Challenge

Earlier, Peter Curphey, a community pharmacist member of the Royal Pharmaceutical Society's Council, presented a vision for pharmacy in the new NHS. He told the meeting that the case for pharmacy had been won. The Government had accepted the value of pharmacy and the role it would play in the future. The challenge for pharmacists was to be equipped to deliver the changes ahead. This would mean new ways of working that would not always be comfortable.

Mr Curphey said that some of the main concerns for PCTs are that expenditure on primary care prescribing is growing at over 11 per cent a year, that only 50 per cent of patients take their medicine as the prescriber intended, and that up to 15 per cent of the drugs bill is wasted.

He then went on to specify the many ways in which pharmacists could be involved and what PCTs might expect from pharmacy. These included medication review, which was important because it had been shown that every £1 spent on reviewing medication saves £2 in prescribing costs. Pharmacists could also help with minor ailments schemes, out-of-hours services, electronic transfer of prescriptions and prescription delivery services. They could be involved in training and educating NHS staff about medication issues, in providing training for carers on medication and in helping to improve communication between primary and secondary care.

In addition, pharmacists' support for patients generally could be extended in ethnic minority communities. They could help overcome language barriers by labelling in minority languages such as Gujerati. And they could help with specific needs such as advising Islamic patients on how to take their medicines during Ramadan.

Anne Adams, the Society's professional development manager, said that the Government's expectations of pharmacy were well documented in Department of Health publications such as "Pharmacy in the future: implementing the NHS plan" and "Clinical governance in community pharmacy". As health professionals, pharmacists should be aware of these. Pharmacists should also make use of continuing professional development to develop the relevant skills needed to fulfil the new roles.

During the evening there was also a poster display, which included a report on intervention monitoring in hospitals.
— Contributed by Louise Winstanley, secretary of the Central Lancashire Branch, and a committee member of the Central Lancashire PDG (e-mail Louise.Winstanley@chorley-pct.nhs.uk).