Pharmacists in St Helens take on new services in advance of contract
deal
| Pilot projects in St Helens Primary
Care Trust anticipate the new pharmacy contract. Debbie
Andalo investigates |
Community pharmacists in the North West are already putting
the new contract to the test, despite the delays in the Government’s,
the NHS and the profession’s negotiations in reaching a national
agreement. Services which will be given enhanced status under the new
contract,
such as minor ailments management and providing emergency hormonal contraception,
are being offered by pharmacists in St Helens Primary Care Trust in a
series of pilot projects which will be rolled out across the district
in the next 18 months.
The PCT has invested nearly £200,000 in the initiative — to
cover the cost of pharmacy time and increased drugs costs — with
22 of the district’s 38 pharmacies taking part. Senior primary
care pharmacist and community pharmacy lead pharmacist Davina Halsall
said: “This is all about increasing our capacity to achieve our
targets in order for the people of St Helens to get the best out of their
medicines — the pharmacists have the skills to help us increase
our capacity.”
The PCT has deliberately developed the role of the community pharmacist
as part of its overall strategy. Historically the responsibilities of
the profession have been allowed to develop in an ad hoc way, Mrs Halsall
admitted. She said: “Before now there wasn’t any thought
about how it all fitted into the bigger, wider picture. But now, for
example, pharmacists offering the emergency hormonal contraception service
fits in with our priority to reduce teenage pregnancies, while the support
they offer to asthma inhaler users came about because locally we have
high levels of chronic obstructive pulmonary disease and respiratory
disease.”
Other services that some pharmacists are taking on for the first time
are a needle exchange scheme and supervision of methadone consumption
for drug misusers, a minor ailments service and smoking cessation counselling.
All services have been given enhanced service status under the new contract.
Seven of the pharmacies are also involved in a national pilot — one
of only three in the country — to offer direct support to patients
with Parkinson’s disease.
Pharmacists rely on an agreed pro forma to keep GPs informed about their
patients and a team of primary care support pharmacists are on hand to
offer any extra advice or help to the pharmacists who have taken on these
new responsibilities.
The new roles for pharmacy reflect the PCT’s strategies for medicines
management and community pharmacy — the priority was not the new
contract, Mrs Halsall said. But she added: “All these services
which we have thought for pharmacy do fit into the framework of the new
contract — if it ever gets approved and funded.”
The PCT acknowledged right from the start that if pharmacists were to
offer these extra services it would cost them time. Mrs Halsall explained: “If
you consider that pharmacists can get £1 for dispensing — without
talking to a patient — and they can dispense one item a minute,
then I think if you expect them to have a five-minute consultation with
the patient you have to reimburse them.”
Phil O’Neil is one of the community pharmacists who, since last
year, has taken on a range of additional services. He admitted that the
extra money they generate is noticeable. Giving minor ailments advice,
he estimates, has brought in on average an additional £600 a month
while offering smoking cessation counselling has boosted income by around £3,000
a month of which 25 per cent, he believes, is probably profit. He said: “This
is money which wasn’t there before. It’s noticeable. There
is also the added benefit that by offering these services it is bringing
people into the pharmacy who weren’t coming in before. We are getting
more and more prescriptions — patients are seeing the services
which we provide and feel that we are offering a really professional
service so they decide to bring their prescriptions to us as well.”
Mr O’Neil has been offering patients and customers minor ailments
advice by working to an agreed formulary of over-the-counter medicines
and to a list of conditions agreed with the PCT. The conditions include
hay fever, constipation, head lice, headaches and temperatures. He explained: “If,
however, somebody comes in with a minor ailment which we cannot support
and we feel they need to see a doctor there is the ability for us to
fast track the patient to the practice for a GP appointment.”
The pharmacist who manages Knights Pharmacy is also involved in offering
patients smoking cessation counselling. Patients can either be referred
to him by the GP for a session which takes place in the pharmacy’s
consulting room, or patients can self-refer. The initial consultation
takes half an hour but with two pharmacists working in the pharmacy he
has the flexibility he needs to offer the service. He said: “Sometimes
if a patient just comes in off the street and wants advice about smoking
cessation I can see them straight away. If not I can arrange a consultation
for them at a later date.”
Working to patient group directions the pharmacist also offers female
patients trimethoprim for uncomplicated urinary tract infection and he
can also give chloramphenicol for conjunctivitis. The pharmacy also supervises
methadone consumption for 12 patients.
Expanding pharmacy services in the community has been popular with patients
and brings professional satisfaction. Mr O’Neil’s advice
to other pharmacists who may be reluctant to adopt these new professional
roles was simple. He said: “I think people have to be positive
and look at these new services not as new work, but as another income
stream and a way to improve patient care. Anybody interested in doing
what we are doing should go and speak to their PCT. Fourteen years ago
when I qualified I don’t think I ever thought that this was the
future for pharmacy but over the past couple of years I have begun to
believe that this is the direction in which the profession should be
going.”
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