Medicines Management
Issue no 1, pp1-6
January/February 2002

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Welsh collaborative schemes take off

Collaborative medicines management schemes are starting up in areas of Wales where there are close relationships between community pharmacists and GPs.

Although the National Assembly for Wales is due to set up an all-Wales Strategy Group to consider formal medicines management schemes, no such agreement has yet been reached. But pharmacists expect the first schemes to be designed and approved soon.

Rachel Russell, head of pharmacy advice, Dyfed Powys Health Authority, said: "There are pockets of collaborative working on medicines management between GPs and community pharmacists, but as yet we have no formal wave of pilots similar to those being overseen by the National Prescribing Centre and PSNC in England."

She added that the Task and Finish Group on Prescribing had agreed on an implementation plan, and that had been approved by the Health and Social Services Committee of the National Assembly for Wales. "That is the plan that will send forward recommendations for medicines management in Wales, so it is high on the agenda," said Ms Russell.

She added that the strategy group would soon be sitting down to develop recommendations for medicines management. "They have been tasked with setting up medicines management in community pharmacies, in the hospital setting and also in primary care."

One scheme already demonstrating close working between community pharmacists and GPs is taking place in St David's, Pembrokeshire, looking at repeat dispensing for patients on five or more medicines. Chris Martin, pharmacist at St David's Pharmacy Ltd, and chairman of Pembrokeshire Local Health Group, said so far the scheme had registered more than 250 patients. "We're looking at repeat dispensing on behalf of patients, so at the point of introducing the scheme we conduct a medicines review with them, using a questionnaire to ask about side effects, iatrogenic illness, and report back to the GPs any problems that have been picked up."

The aim is to rationalise the repeat prescriptions so that all patients are on 28-day cycles. Mr Martin said that patients thought the scheme was "wonderful" because it was much more convenient for them.

"Most of the patients are on five or more medicines so it takes a bit of time to review them," said Mr Martin. "The patients think it is wonderful from a convenience point of view, because it means they can come directly to us for their medicines and have any problems sorted out in the same place. We monitor how they are using the drugs."

Although no formal payment has been negotiated for providing the service, Mr Martin said that having patients on 28-day prescriptions meant the pharmacy did more business on an item basis. And he predicts that there will be savings for the NHS.

"It is an investment on my part to show people what can be done in community pharmacy," said Mr Martin. The data are not being collected for formal evaluation yet.

Another project the pharmacy has embarked on is ensuring patients are on their correctly monitored doses, under agreement with the local GPs. "We have about 35 patients on monitored doses, which is great for them because otherwise they'd have to be in nursing home care. It's not unique, but it works extremely well."