| Open any NHS document, and it is likely that somewhere within it will
be a reference to improving access to services — “access” is
a buzz word right now. What is surprising, however, is that community
pharmacies, with their convenient location on most high streets, have
yet to star in this battle to improve access. Not, at least, until now.
Community pharmacy’s potential was highlighted last year in the
Scottish Government’s strategic health policy document “Better
health, better care”. And now the promised pharmacy pilots to assess
walk-in access to a wide range of services are under way.
“The
pilots will offer a different mix of services in suitable locations,
such as major shopping areas and main commuter points,” the document
states. “Services provided will include nurse-led minor injury
treatments, sexual health screening, simple diagnostic tests and some
adult immunisations.”
The pilots are being project managed by Allan Thomas, senior community
pharmacy adviser at NHS Ayshire & Arran. “The pilots will form
part of a wider package of planned improvements to expand the availability
of, and access to, primary care services,” he explains. The walk-in
pilots comprise two phases.
The first, which is already taking place,
is all about improving access to existing services. Phase two, which
gets going this month, concentrates on improving the range of services
offered. “Phase one involves extending the opening hours at evenings
and weekends, and builds on the services already available under the
pharmacy contract, like the minor ailment service and the urgent supply
of medicines through the national patient group direction,” explains
Mr Thomas.
The sites have also been getting the infrastructure in place
to support phase two, for example, new IT, staff recruitment and training,
and establishing processes to underpin multidisciplinary working. Focus
Some divergence exists between the different pilot sites within phase
two. Each of the health boards involved — NHS Grampian, NHS Greater
Glasgow & Clyde, NHS Lanarkshire, NHS Lothian and NHS Tayside — were
asked to put forward proposals on the types of service they wished
to test. The result is that each location’s pilot has a different
focus.
“The central themes being pursued by most sites are the
co-location of nurse-led minor illness and injury clinics (which complements
the minor ailment service provided by pharmacists), and the development
of links with the local NHS 24 hubs to ensure these work in a joined-up
way with the local out-of-hours service,” says Mr Thomas. “Chlamydia
testing and treatment, and other screening and diagnostic testing are
also core in phase two,” he adds.
But each pilot site has additional local developments. In Tayside,
for example, the key issue is pharmaceutical public health (see Panel).
This is mirrored in Glasgow and Lothian, with all three boards looking
to
develop the “Keep Well” initiative within the pilot site.
In Glasgow, co-location of other health care professionals in the pharmacy
is being explored. Meanwhile, NHS Lothian is exploring immunisation services
and NHS Tayside the possibility of lithium monitoring.
One of the organisations working with NHS boards to develop the pilot
sites, and to integrate them within existing out-of-hours services, is
NHS 24. “The pilots will allow NHS 24 to increase the number of
referrals to a pharmacy, improving patient access to pharmacy-based healthcare,” explains
John McAnaw, head of pharmacy, NHS 24.
“The pilots will further
integrate community pharmacy into the delivery of unscheduled care, and
potentially ease the demands on existing out of hours service providers.
With some of the pilot sites looking to provide multidisciplinary health
care, the increased variety of services delivered from the pharmacy could
play a key role in delivering care closer to home.”
With the second phase about to begin, it is clearly too early to say
whether the initiative will be extended across Scotland. However, the
aim is to produce a variety of models from which NHS boards can pick
services that meet local needs. To help this, an extensive evaluation
is planned.
“Evaluation will take place over the period of the pilot from October
2008 until November 2009, with a view to reporting in April 2010,” says
Mr Thomas. “The main focus will be to determine the success of
the pilot, the long-term sustainability of services, and their possible
future development and spread.
It will also consider the professional,
legal and contractual implications of the model, as well as any educational
needs and workforce issues.”
How pharmacy walk-in services
pilot works in Tayside
In NHS Tayside, the walk-in service pilot is taking
place at Boots The Chemists in Albert Street, Dundee. Alistair
Jack, director of pharmacy, NHS Tayside, explains that the pharmacy
is situated at the centre of a highly deprived area: “When
boards were invited to put forward proposals for pilot sites, one
of our criteria was that the pharmacy served a deprived area. The
other part was having existing premises.”
So far, the pilot has concentrated on extending
access to existing services. In April, the pharmacy began opening
for extended hours:
9am–9pm, Monday to Friday, 9am–5pm on Saturday and
noon to 4pm on Sunday. Until then, no other pharmacy in Dundee
had been open after 7pm on weekdays and none was open on Sundays
(other than a one-hour rota).
Improved patient access to services, at
the right time, at the right place
|
“Friday evenings and Sundays
are our busiest times, but we have a steady stream of people all
the time,” explains Kirsty Geddes, pharmacist manager (pictured).
Services on offer include the minor ailment service, urgent supply
of repeat medicines, smoking cessation, palliative care, supervised
methadone, needle exchange and emergency hormonal contraception,
plus the core pharmacy service of dispensing prescriptions and
medicine sales.
Top of the list for phase two of the pilot are chlamydia testing
and treatment, an alcohol brief intervention service, cardiovascular
assessments and a computer program which provides cognitive behavioural
therapy.
“We also have a GP who is interested in offering
two clinic sessions a week from the pharmacy,” says Carol
Watt, regional pharmacy manager, Boots. The GP is attracted by
being co-located within an extended pharmacy service, plus the
fact that it is easier to operate from one room in a pharmacy compared
with opening an entire surgery, receptionists and all.
The Government is funding the operating costs of keeping the pharmacy
premises open, allowing the pilot to concentrate on service development,
explains Mr Jack. Already, the pharmacy has improved its links
with NHS 24 and the local NHS out-of-hours service hub.
“We
told them when we started offering extended hours and now we get
referrals from both the hub and NHS24,” says Ms Geddes. “The
bulk of the referrals are for emergency prescriptions and urgent
supplies of prescriptions, with some minor ailments too.”
The pilot has received positive feedback from patients. But perhaps
a stronger demonstration of its value is the story of a methadone
patient who was recently referred to the pharmacy for an evening
supply of supervised methadone. His job had meant that getting
to a pharmacy during the day was difficult.
Now he can collect
his methadone in the evening, he is much more likely to be able
to hold down his job, something that will provide him with the
stability he needs to establish a life post-heroin. As Ms Watt
says: “It is all about improved patient access to services,
at the right time, at the right place.” |
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The
Pharmaceutical Journal