Primary and Community Care Pharmacy Network
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The Primary and Community Care Pharmacy Network held its annual conference in Brighton from 13 to 14 October. Jane Swan, chief pharmacist at Gedling Primary Care Trust, Nottingham, reports
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Safeguarding our service users
The role of pharmacy staff supporting community health
services is often poorly understood and the development of primary
care organisations (PCOs)
has highlighted the need for a better understanding of this role
and the skills and qualities needed to provide it. The national committee
of the Primary and Community Care Pharmacy Network therefore commissioned
the development of a competency framework, which was launched during
the meeting. The key objectives of the document are:
• To help lead pharmacists and service and clinical managers in PCOs
to understand the pharmacy services needed for community health services
• To support identification of resources needed to recruit and develop
staff with appropriate competencies
• To be a resource for newly appointed pharmacy staff delivering services
to community health services and those who may extend existing primary
care skills to meet the needs of such services
Developments in primary care
Has pharmacy got a future and if so what might it be, Clive Jackson,
chief executive, National Prescribing Centre, asked when he addressed
the meeting. He said that pharmacists must not only reasonably predict
the future, but they must also prepare for it and shape it. He proposed
seven pillars of change for pharmacists:
• Medicines management services
• Pharmacist prescribing
• Workforce and skill mixing
• Mandatory continuing professional development and revalidation
• Pharmaceutical public health and pharmacosocial care
• Patient and public involvement and ownership
• Pharmacogenetics
These will improve patient care, choice and convenience, while delivering
value for money for the National Health Service. Pharmacy will change
by increased integration into the multidisciplinary health care team
with better use of pharmacists’ expertise by introducing a wider
range of roles and responsibilities. Pharmacist prescribing will reduce
GP workload, improve repeat prescribing, use improved formulation regimens
and reduce waste. There will be new responsibilities for pharmacists
in committing NHS resources, new professional responsibilities, new relationships
with doctors, nurses and patients, and changed interactions within elements
of pharmacy. Mandatory CPD and revalidation will raise, and be seen to
raise, professional standards for the benefit of patients and the public.
There will be a new life long learning and reflective culture. Pharmacosocial
care will improve the health, well-being and safety of patients in relation
to pharmaceutical care, particularly where this interrelates with social
care issues and where medicines are involved, Mr Jackson explained.
He went on to say that people consistently overestimate the effect of
short-term change, and underestimate the effect of long-term change.
Pharmacy in primary and community care has a potentially exciting future
and current practice will change fundamentally over the next five to
10 years. Those pharmacists who embrace change will prosper in the new
health and social care environment. Standing still is not an option,
he warned.
NPSA update
The National Patient Safety Agency is to launch new tools to support
safer patient care, Wendy Harris, senior pharmacist, NPSA, told the
meeting. These tools are to include an induction video, patient safety
e-learning programmes, an incident decision tree, root cause analysis
and patient safety managers, of which there will be 28 in England and
four in Wales. These will provide local facilitation, local training
with NPSA toolkits and follow-up and sharing.
Ms Harris also said that, in establishing a national reporting and learning
system (NRLS), reliable patient safety incident data will be collected,
analysed and reported. The NRLS will be a comprehensive system covering
all NHS-funded care in England and Wales. Medication errors account for
a quarter of the incidents which threaten patient safety. At present
there are an estimated 850,000 adverse events each year costing £2bn
a year in additional hospital stays and the NHS pays out £400m
a year in settlement of clinical negligence claims. The NRLS will be
implemented in NHS organisations from November 2003 to December 2004.
Immunisation issues
The review of evidence by expert panels concludes that there is no evidence
of a link between MMR vaccination and autism, said Dr Richard Pebody,
immunisation department, HPA Communicable Disease Surveillance Centre.
Turning to the HiB catch-up campaign he said all children aged six months
to four years are to receive a single dose of HiB vaccine during 2003.
The use of whole cell pertussis DTP-HiB is to be resumed.
The place of conjugate pneumococcal vaccine in the UK is initially for
high risk children aged under two years. This year a new Pnc polysaccharide
programme has been introduced for the elderly over 80 years, from April
2004 for those over 75 years and from April 2005 for those over 65 years.
The implications of licensure of a varicella vaccine were considered.
Is exposure to varicella important for protecting against zoster and
if so what is the likely effect on zoster of a mass immunisation programme?
There is recommended selective use of varicella vaccine to susceptible
health workers, known susceptible women of child bearing age and healthy
siblings of immunocompromised children.
A second speaker on immunisation issues pointed out that there are only
seven manufacturers supplying vaccines in the UK. Alan Russell, technical
pharmacist, NHS Purchasing and Supply Agency, said that three supply
meningitis C conjugated vaccine, two supply MMR vaccine and all the other
vaccines are currently a single source supply. There are barriers to
entry into the vaccine market including it being a limited market and
the need for specialised manufacturing plant. It is a long production
cycle of nine to 22 months with the quality control time longer than
the production time.
The World Health Organization aims to eradicate polio infections. The
recorded incidents of wild polio infection in the UK is now zero. Oral
polio vaccine represents a source of vaccine-induced polio infection
and, to overcome this, there will be a switch to inactivated polio vaccine
in the near future. This will be a major change to the UK vaccination
programme.
Medicines handling in children’s services
The legislation covering children’s services is the Care Standards
Act 2000 and the Children’s Homes Regulations 2001, said Hazel
Sommerville, senior professional adviser, pharmacist, National Care Standards
Commission. She went on to quote Standard 13 of the National Minimum
Standards: “Children’s health needs are met and their welfare
is guarded by the home’s policies and procedures for administering
medicines and providing treatment.” Not mentioned are Controlled
Drugs, storage, handling or reference to Royal Pharmaceuticao Society
publications, particularly the “Administration and control of medicines
in care homes and children’s services”. For the future the
National Service Framework for Children is expected early in 2004, and
this should contain a separate chapter for medication
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