Private company supports prescribers
| GP practices in Sunderland are being
helped to meet Government targets by a private company of pharmacists.
Debbie Andalo reports |
Debbie Andalo is
a freelance journalist
|
Pharmacists working for a private company in the north east have taken
the pressure off GP practices trying to implement a range of national
clinical guidelines.
The innovative working partnership in Sunderland recently achieved
national recognition when it was chosen as the best example of a medicines
management project linked to meeting national standards — as well
as the best example of team performance. The national director for primary
care services Dr David Colin-Thomé described the scheme
as “fantastically ambitious” which
set itself demanding targets and achieved results.
IntraHealth Ltd has been contracted by Sunderland Teaching Primary Care
Trust since 1999, and previously the area’s primary care groups,
to help
deliver all national prescribing targets.
The company employs 16 pharmacists from a variety of community and hospital
backgrounds, a practice nurse, a project manager and an
administrator. It is contracted by the TPCT which has 54 practices and
130 GPs responsible for a patient population of 300,000.
Key priorities
The key priority of the contract is to ensure that targets from NICE
are met across the trust and that GP practices work towards the standards
and targets of the national service frameworks. Every time a new NSF
or NICE guideline is published the company, set up five years ago by
primary care pharmacist Greg Moorhouse, assesses its implications for
the TPCT and individual practices. A multidisciplinary working group
is then established to develop an appropriate prescribing strategy,
including joint formularies, based on consultation with secondary care.
Detailed guidelines are then sent to every practice.
Company operational manager Phil Young who was previously a hospital
pharmacist explained: “We ensure that the medicines are being used
appropriately as far as the NSFs and NICE guidance is concerned and that
the organisation stays in budget.”
He added: “We have a team of 19 which means we can provide practices
with continuing prescribing advice. With a team of that size we have
the benefits of economy of scale and it means that we have a number of
people we can call on to write a guideline or develop a protocol for
any practice. There is always somebody available to deal with a call.”
Each of the practices has its own nominated pharmacist so if it has a
specific problem which needs to be tackled practice staff know who to
contact. Mr Young, who is also a prescribing adviser for Sunderland TPCT,
added: “We also have quarterly meetings with the practices to discuss
various prescribing issues or protocols we want to develop across the
TPCT.”
A city-wide cardiovascular formulary is being developed – including
up-dated guidelines for the use of statins – as part of the company’s
work on helping practices meet the
demands of the NSF for Coronary Heart Disease. A practice incentive scheme
is also being designed linked to CHD patients’ cholesterol levels.
More than 50 per cent of patients have to reach their personal target
before practices qualify for a payment.
Extra nurses are being taken on to help improve CHD clinics and IT has
been improved to help keep records up to date of those patients who are
seen at walk-in centres and not their own surgery.
Initiatives being developed to meet the needs of the NSF for Older People
include an incentive scheme for carrying out patient medication reviews,
training packages for carers developed in consultation with social services
and secondary care, and the setting up of patient user groups to improve
communication with elderly patients and help meet their needs.
The NSF for Mental Health has also been tackled. Practice-based withdrawal
clinics for patients on benzodiazepines have been set up and a mental
health formulary has been established in conjunction with secondary care.
Seamless care for cancer patients
A hospice-based pharmacist has been appointed by the company who aims
to provide a seamless discharge process for medication and is a key
link with community pharmacists and the Macmillan nurses to help meet
the TPCT obligations under the NHS Cancer Plan.
Smoking cessation clinics have been established in all practices. They
are run by community pharmacists and practice nurses trained to provide
smoking cessation counselling. They can also supply smoking cessation
products through a voucher scheme that has been developed under a patient
group direction.
The pharmacy team has helped with implementing of NICE guidelines on
proton pump inhibitors. It has ensured that practices have reviewed their
patients’ prescribed PPIs to check they are on the appropriate
maintenance dose. Another incentive scheme has also been designed which
is linked to ulcer-healing drug prescribing.
Similar patient reviews have been established with NICE guidelines on
COX-II inhibitors to include the development of joint guidelines between
primary and secondary care.
Mr Young boasts that for every £1 spent on prescribing advice the
TPCT achieves a saving of up to £10. He said: “We look at
joined up thinking. We know that the NSFs and NICE guidelines which we
have to implement can have an impact on prescribing budgets and the organisation.
“We know that some of the things we will be doing will push costs up but
we are able to look for inefficiencies in the system as an organisation.” Last
year the company identified £1m of inefficiencies across the TPCT.
He added: “Our main concern is that the patients receive the treatment
they require and the practices have the support to implement that. Last
year we surveyed the practices to see what they thought about us – 80
per cent said they valued what we were doing and 94 per cent thought
the support they were getting was excellent.”
Sunderland GP Dr John Mackay, chairman of the TPCT’s professional
executive committee, said the company was “dynamic” and offered
practical advice to GPs.
He said: “The company does regular practice visits, maybe three
times a year, and they come and talk to us. They make sure that whatever
they are proposing to change that we are very much on board with them.
I think one of the reasons it is so successful is that they don’t
create any work for GPs or the practice.
“I think the most important thing for us is that they have made prescribing
issues around the NSFs and NICE guidance ‘pain free’. They
make a good case for the changes and then the company team will do the
work. It’s definitely cost effective. I am sure it provides a good
model for other PCTs to follow.” |
