|
First Contact GPwSI scheme, South Tyneside
Tony Schofield, pharmacist Morris
Gallagher, GP
David Julien, GP
Deborah Forsythe,
counsellor |
Left to right: Sir Cyril Chantler with winners Morris Gallagher,
Tony Schofield and David Julien |
A pilot service in which a community pharmacist prescribes methadone
for drug misusers has won a Pharmaceutical Care Award.
Qualifying as
a supplementary prescriber allowed pharmacist Tony Schofield to join
a GP with special interests (GPwSI) team, giving drug misusers the option
of receiving their treatment through a community pharmacy.
Mr Schofield
assesses dependence and tolerance in opiate-dependent patients and
prescribes substitute medication, such as methadone or buprenorphine,
under a clinical
management plan. He also prescribes palliatives, such as senna, paracetamol,
amitryptiline, sedating antihistamines and lofexidine. In order to provide
the service, Mr Schofield completed a Royal College of General Practitioners
course in substance misuse management and gained new skills in consulting
and brief intervention. He also has to be prepared to help support patients’ physical,
housing, relationship, criminal justice and child protection needs.
There are many reasons for GPs to share the care of drug misusers with
pharmacies. Pharmacies are seen by patients as more relaxed and friendly
than GP surgeries or specialist clinics. They have convenient opening
hours and, unlike many clinics, appointment times are not rigid. Another
advantage is that pharmacies are often located closer to patients’ homes
than drug and alcohol clinics. The pharmacy service also recognises that
some patients do not want to attend drug and alcohol clinics where they
might interact with other users and there is less stigma involved with
entering a pharmacy.
The pharmacy-based service was part of a larger project to improve services
for drug misusers in South Tyneside. “The pharmacist has established
himself as an essential member of the GPwSI team to the extent that he
was the only prescriber in the team available during two weeks in August
2006 as the GPs were both on holiday,” said Morris Gallagher, one
of the two GPs involved in the project.
The contribution that the service has made to managing drug misuse has
been recognised by South Tyneside PCT, which agreed to pay the pharmacist
an identical fee (as an enhanced service) to that agreed with participating
GPs. According to Richard Barker, chief operating officer, Gateshead,
South Tyneside & Sunderland PCTs: “There is high potential
in this approach and we are considering how to roll this out across our
community”.
Mr Schofield said that GPs have been reluctant to get involved with drug
misusers because of the anti-social nature of some of the interactions. “The
introduction of prescribing by pharmacists has opened up undreamt of
opportunities for pharmacists to get involved in patient care,” he
said. “Treating opiate-dependent patients works. Patients in treatment
live longer, get employment opportunities and cause [fewer] problems
for society than those who aren’t,” he added.
An example
of the service’s achievements is that one patient was able to take
out a mortgage to buy a house. “It is fair to say that if he hadn’t
accessed out treatment service he would not be where he is today,” Mr
Schofield commented. |
The
Pharmaceutical Journal