Marion Harvey: patients are used to talking to me about their medicines |
Marion Harvey, owner of Keats Pharmacy, has a close working relationship
with the 12-doctor Keats Group Practice surgery, located just round the
corner from her premises in Hampstead, north London. As a result, she
is now carrying out medicines reviews at the surgery with full access
to clinical records, access that she says is vital to undertaking successful
reviews.
Dr Harvey explains that the opportunity to carry out the reviews came
as a result of her involvement with the Camden medicines management collaborative,
part of the National Prescribing Centre scheme. The Camden collaborative
holds meetings at GP surgeries every six weeks involving doctors, pharmacists,
nurses, practice managers and primary care trust staff.
“We are looking to improve the quality of service for patients,” Dr
Harvey says. “We have set out markers of improvement for prescribing.
These include synchronising the dates for repeat prescriptions, making
sure that all prescriptions include doses, checking that all the anti-inflammatories
are actually needed by patients, and checking if patients have any problems
with ordering or collecting repeat prescriptions.”
As a result of this work, Dr Harvey was invited to undertake reviews
for patients aged over 65 years who are on four or more medicines. She
acknowledges the help the GP surgery, and in particular Barbara Rasburn,
one of the partners, has given her.
Access to records
“They preferred me to go round to them to do the reviews. They
have given me a room and trained me on their computer system, EMIS, and
I have full
access to medical records.” For the first set of reviews, Dr Rasburn
spoke to the patient while Dr Harvey observed. For a second set they
shared the task and now Dr Harvey conducts the reviews on her own. “It
was interesting to watch the doctor consulting with patients,” Dr
Harvey says. “I noted the way in which she talked to patients and
drew information out of them.”
Patients are invited by letter to book a time for a medicines review
and are encouraged to bring all their prescribed and over-the-counter
medicines in with them. Each review lasts for about 30 minutes. Dr Harvey
has about 20 to 30 minutes preparation time before the first appointment
to look through the records and check on prescribed medicines and the
results of blood tests.
Access to medical records and time to prepare are essential to successful
reviews, Dr Harvey believes. “I have to see the notes in order
to see why a patient is on a medicine.” She adds that she is able
to talk to a doctor at any time during or after a review. The GPs have
been happy to discuss all the prescribing issues she has raised with
them and to make necessary changes.
Dr Harvey says that, at first, she did not think there would be much
she could do, but there is. “I didn’t realise how much I
know. I am coming at it from a different angle to the GPs.” In
addition, the patients she is reviewing are all regular customers at
her pharmacy. “They are used to talking to me informally about
their medicines. They weren’t disturbed or put out to have me doing
the reviews.”
For patients, separate reviews allow them to discuss any problems they
have with their medicines aside from other issues. “It is important
to remember that it is a medicines
review, it is not to sort out all their other aches and pains; having
the pharmacist in front of them helps to focus on that.”
Tests and values
During the reviews, Dr Harvey looks at generic prescribing and checks
that all necessary blood test results are up to date and the values
are satisfactory. If any tests are necessary a GP will be informed.
In time, these might be something for the pharmacist to order. Dr Harvey
looks to see if the patient understands why he or she is taking the
medicines and how they are used and she discusses compliance. “It
is important not to make too many changes at one go,” she declares.
The pharmacist’s views on the patient and the medicines can be
recorded in the EMIS system medical notes. However, she says that this
is not easy because the system has templates that deal with each medicine
separately, rather than as a group.
Dr Harvey believes that community pharmacists have a huge amount to gain
from conducting medicines reviews. “The respect you stand to gain
from customers is an invisible goodwill benefit — this is important
when patients think they know better.” She says that pharmacies
which are able to offer continuity of service to their customers will
manage best. “This will take off where there is a good relationship
with GPs. The rest will follow on later.”
The surgery is currently paying the pharmacy about £100 for a three-hour
session from its own budget. Dr Harvey’s training sessions were
funded by the primary care trust. The payments may be revised in future.
Medicines management and the new GP contract
Under the new general medical services contract
for GPs, which comes into force in April, medical practices can
achieve income
by meeting set standards. Each standard has a number of points
attached to it. For 2004–05, each point will be worth £75.
This rises to around £120 in 2005–06.
Under the heading of medicines management, there are two similar
standards relating to medication reviews.
• Medicines indicator 5 A medication review is recorded in the
notes in the preceeding 15 months for all patients being prescribed
four or more repeat medicines (7 points).
• Medicines indicator 9 A medication review is recorded in the
notes in the preceeding 15 months for all patients being prescribed
repeat medicines (8 points).
For both indicators, the practice will have to achieve a target
of 80 per cent in order to receive payment. Guidance notes say
that the reviews can be carried out by a doctor, nurse prescriber
or pharmacist. The aim of the reviews is to assess the continuing
need for medication and the progress of the contition. Reviews
do not necessarily have to be conducted face to face, but could
be done by telephone or by a review of records. |
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