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Information prescriptions have been piloted in 20 sites throughout England
over the past year with varying degrees of success. The Government committed
in its White Paper “Our
health, our care, our say” to have
everyone with a long-term condition or social care need being prescribed
information in 2008. At this stage, however, details on how information
prescriptions will be fully implemented appear patchy.
The stopwatch is set. Pilot sites are idling. So what has been said about
the direction of travel? And who will be navigating?
Direction
John Cain, from the patient and public empowerment division at the
Department of Health, spoke at a conference on information prescriptions,
organised
by NHS Direct and held in London last week.
“Our aim is that
everyone with a long-term condition or social care need will be guided
to reliable sources of information to allow them to feel more in control
and better able to manage their condition and stay independent,” he
told participants.
He said that patients, carers and social care users have a desire for
information but that there is often too much information out there for
them to deal with. “If information comes from a trusted source,” he
pointed out, “people are more likely to make use of that information
in managing their condition.”
A report on the information prescription pilot programme was published
last month (see Panel below). It looks at how the pilots were developed
and delivered and makes recommendations on how the work could be supported
both nationally and locally.
Information prescription principles
The final
report on the information prescription pilots defines
a number of principles that information prescriptions need to reflect: • Holistic — available to support users in improving or
managing their own condition, wider health, well-being and quality
of life
• Personalised — designed around the needs of individuals,
regardless of their backgrounds
• Trustworthy — reliable, credible and quality-assured
• Supported — provided with additional support to help people
benefit from the information
• Integrated — made available as part of the standard delivery
of care, whether in healthcare, social care or the voluntary sector |
Mr Cain emphasised that there will not be
any single national implementation model. The roll-out is expected to
be delivered locally, he explained,
with the Government looking at what national infrastructure could support
this delivery.
Mr Cain said that the DoH was considering how the programme might be
delivered through primary care trusts’ existing commissioning processes.
He also said that the DoH’s information accreditation scheme would
play a part: “Ultimately we’re moving towards having every
source of information on information prescriptions … accredited through
the information accreditation scheme. That scheme is going to start getting
off the ground in early 2009.”
Significantly, Mr Cain told participants about plans to have an information
prescription generator integrated within the NHS Choices website. Expected
some time in the summer and subject to ongoing development, this initiative
would support self-prescribing by patients and carers and prescribing
by healthcare professionals.
“We anticipate that the information prescription will be given to people
by health and social care professionals — and clearly there is
a role for pharmacy in this context,” he confirmed.
The DoH has produced a resource pack containing templates and advice
from the pilot sites for other organisations wanting to implement information
prescriptions. “The message is,” he said, “that local
implementation can start now. We don’t need to wait until [all
the] national resources are in place.”
Navigation
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NHS Direct and Evelina Children’s Hospital
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NHS Direct was a integral part of a number of the pilots, including
(as pictured right) a pharmacist-led
scheme from Evelina Children’s Hospital,
Guy’s and St Thomas’ NHS Foundation Trust (PJ,
19 April 2008, p475).
This scheme involved parents and carers whose
children had a
long-term condition being offered a consultation with their hospital
or participating community pharmacist when they collected their child’s
medicines.
During the consultation the pharmacist and parent or carer
agreed what kind of information was required and this “prescription” was
relayed to NHS Direct, which gathered and distributed the relevant
information by e-mail or post.
Anne Joshua, associate director of pharmacy at NHS Direct, believes
that pharmacists should be among the providers of information prescriptions
as part of their clinical role: “As pharmacists you really need
to be out there providing information anyway.”
Sharing her thoughts with The Journal, Mrs Joshua said that community
pharmacists could be offering information prescriptions as part of a
medicines use review. “I’ve done an MUR, and now I can offer
an information prescription. But I don’t have to worry about getting
the information together and making sure it’s the right type of
information, I can just send off my request to NHS Direct,” she
proposed.
NHS Direct could act as a “dispensing house” for information,
Mrs Joshua suggested, with NHS Choices as the portal for people to access
information “templates”. She added that NHS Direct has not
only the information resources but also the telephone lines, staff and
established networks to support people accessing the information.
“There are things around healthcare and social care where [as a patient
or carer] you need to know that you are getting the information from
accredited resources, linking it perhaps to a face-to-face consultation
that makes it very personal to you — to know that this is the information
that you really need. That, certainly, came out of all of the pilots.”
Mr Cain made a similar point last week: “We want to move away from
the complex maze of information to a situation where users will be guided
to information [that is] tailored to individual needs.” He added
that people’s individual needs vary in terms of what their personal
circumstances are, how well they might be able to take on information
and how much assistance they need in interpreting it.
Mrs Joshua believes that the DoH is still deciding what it wants to do
with information prescriptions and that last week’s conference,
while “early in the understanding of information prescriptions”,
was a good platform to influence the decision-making.
“This is not a done deal,” she said. “There are opportunities
here for pharmacy to get involved.” |
The
Pharmaceutical Journal