The Pharmaceutical Journal
Vol 269 No 7228 p840
14 December 2002

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National policy for NHS Direct to advise callers always to talk to a pharmacist

NHS Direct, the 24-hour confidential telephone health advice and information service, has formally set out its policy on all aspects of pharmacy and medicines. Binda Rai, senior communications manager for NHS Direct, London, elaborates

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

Since the inception of NHS Direct four years ago, as a pilot project with just three call centres, it has developed into a national service that spans across 22 call centres and handles around 120,000 calls a week.

The Pharmacy and Medicines Policy, launched at a recent meeting of the NHS Direct pharmacy co-ordinators and health information advisers, sets out national standards to be followed by all 22 NHS Direct call centres in England and Wales (PJ, 7 December, p798). Hazel Jamieson, National Pharmacy Adviser to NHS Direct, explains that the policy has come about as a result of good collaborative work between NHS Direct and local pharmacy organisations over the past four years, particularly with local pharmaceutical committees and regional medicines information centres.

The comprehensive policy covers a number of areas including:

• The definition of medicines and poisons-related calls as well as standards for handling them

• The content of pharmacy and medicines training for NHS Direct nurses and health information advisers

• Recommended information resources on medicines

• Details of service level agreements to be held between NHS Direct call centres and LPCs and medicines information centres (MICs).

LPCs are able to provide training on community pharmacy services and can facilitate clinical placements for nurses in pharmacies. MICs can provide training on how to handle medicines-related calls and how to use the common medicines information resources. They can also provide a back-up enquiry answering service to help NHS Direct staff answer calls about medicines.

Hazel Jamieson, says: "The national policy will help to ensure that formal systems are in place, which will provide guidelines in terms of the level of advice being offered to NHS Direct callers and the ongoing training of NHS Direct staff in this area. It will also ensure that NHS Direct call centres across the country receive the same level of support from their local pharmacists and that their staff have equitable access to resources containing information on medicines."

All NHS Direct call centres will now review their local pharmacy and medicines policy to ensure that they are in line with the national policy. Hazel Jamieson explains that many call centre pharmacy co-ordinators have already embarked on this process.

Some are already looking at their service level agreements with local pharmacists to ensure that NHS Direct staff, both nurses and health information specialists, receive training from pharmacists that covers all the components listed in the national policy. For example, these include learning how to use common medicines information resources or the type of background information that needs to be gleaned from the caller in order to answer a medicines-related question appropriately.

The policy also advocates that, where possible, nurse advisers should have a clinical placement in a community pharmacy. Hazel Jamieson, explains the reasoning behind this: "When NHS Direct nurses use clinical algorithms within the NHS clinical assessment system to triage the calls, they identify circumstances where the caller may benefit from a visit to their community pharmacist. It is therefore invaluable for nurses to spend some time in a community pharmacy to learn first hand about the services and medicines provided by the pharmacist."

She adds: "In the policy we make it quite clear that when referrals are made to the pharmacist, callers should always be advised to talk to the pharmacist rather than the medicine counter assistant. They should also be told to tell the pharmacist that they have spoken to NHS Direct and be encouraged to use their usual pharmacy, especially when taking other medication, because the pharmacy will hold their patient record."

And indeed the pharmacy placements have proved invaluable for NHS Direct nurses. Sarah Perry, NHS Direct's network D clinical co-ordinator (London and Anglia), says: "We have enjoyed excellent support from our local pharmacists over the past year and have a robust training programme in place, which is always well evaluated by our staff."

She adds: "In light of the new national policy we are keen to develop comprehensive medicines training for health information advisers. We look forward to seeing the outcome of the work being undertaken by our national pharmacy advisers on the role that health information advisers can play in handling medicines-related calls."

The new national Pharmacy and Medicines Policy is the culmination of work started by the Pharmacy Support Network set up in 1998. The network was then set up with the aim of sharing information on the development of pharmacy support to NHS Direct and facilitating networking among pharmacists providing that support. This group went on to establish and develop principles for pharmacy support and drew up guidance notes for both NHS Direct call centres and pharmacists to work from.

The national policy will continue to be reviewed on an annual basis to reflect current changes in the field as well as to ensure that any variations in pharmacy service delivery from one NHS Direct call centre to another are being addressed accordingly.

The need for a national policy on pharmacy and medicines has became increasingly apparent. Research carried out by Sheffield University shows that just under 5 per cent of all NHS Direct callers ask for advice about medicines and more than 2 per cent about poisoning. It further concludes that 40 per cent of all callers also receive advice about medicines from NHS Direct nurses.

In terms of moving forward, NHS Direct now hopes to develop links between its call centres and primary care trusts. Hazel Jamieson, explains with great enthusiasm: "I think there is huge potential for us to work in partnership with the PCTs to deliver a service that addresses local health needs around medicines".