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Primary Care Pharmacy September 2000 Vol 1 No 4 p116-118

News

Implementing the NHS plan

Providing high quality pharmaceutical care and services to patients is the key to implementing the NHS plan for pharmacy, Lord Hunt (parliamentary under-secretary of state for health) told participants at the British Pharmaceutical Conference in Birmingham on September 12.

Launching the document “Pharmacy in the future — implementing the NHS plan”, Lord Hunt announced that, by 2004, 500 new one-stop primary care centres, which would allow pharmacists to work alongside general practitioners, dentists, opticians and health or social workers, would be opened. New, locally tailored contracts would be negotiated, that would be free from the restriction of remuneration services and terms of service.

The document highlighted repeat dispensing, in which prescriptions could be dispensed in instalments, giving pharmacists the opportunity to answer patients’ questions and check on the continuing appropriateness of medicines.

Another major area discussed in the document was medicines management. The Government planned to invest a total of £30m over three years in this area. Leading edge health authorities and primary care trusts had already begun to invest in services like medication review, support for patients with particular medicine-related needs and other kinds of pharmaceutical care, and this needed to be expanded throughout the country.

An action team would be set up to promote medicines management services, which would offer extra support to a number of health authorities and primary care trusts identified as having the capacity to develop good ideas. In addition, the action team would support a national trial of a structured medicines management service exclusively from community pharmacies, which might be based on a model proposed by the Pharmaceutical Services Negotiating Committee.

Local pharmaceutical services would be a collaboration between health authorities, primary care trusts and existing pharmacy contractors. “Our vision for pharmacy in the future is one where pharmacists spend more time focusing on individual patients’ clinical needs and, in particular, helping [them] get the most from their medicines,” he said (PJ, September 16, p384).

Society launches guidance on respiratory disease and mental health

Two sets of guidance produced by Royal Pharmaceutical Society task forces — one on respiratory disease and one on mental health — were launched at the Conference on September 11.

Speaking at the launch of the guidance on asthma and chronic obstructive pulmonary disease (PJ, September 16, p390), Mr Hemant Patel (chairman of the Society’s respiratory task force) said that its aim was to help to integrate pharmacists further into the health care team, especially when responding to symptoms and providing advice and information. The guidance was aimed mainly at primary care but it could be applied elsewhere, too, he said.

Dr Michael Rudolf (chairman, British Thoracic Society) said that pharmacists had a role in diagnosis, responding to symptoms, alterations to medication and referral to general practitioners. The guidance contained a referral form for pharmacists to use when sending patients to their GP, which had been endorsed by the Royal College of General Practitioners, he said. The role of pharmacists in smoking cessation was the “single most cost-effective thing” that pharmacists could do in reducing the incidence of COPD.

Launching the guidance on mental health (ibid, p391), Mr Hassan Argomandkhah (chairman of the Society’s mental health task force) said: “Pharmacists across all sectors have the potential to get more involved in the care of patients with poor mental health.” He added that the guidance provided information that would help pharmacists extend their existing services and “make the move forward.”

Mr Stephen Bazire (pharmacy services director, Hellesdon hospital, Norwich) added that medicines in mental health were a big issue, as they were often “badly used.” Pharmacists were often not up to date in this area and were not assertive in asking for changes to medication to be made. “Supply is not the end of the pharmacy service, it is the beginning,” he said.

The respiratory guidance aims to help primary care pharmacists to promote good practice in relation to asthma and COPD and to help ensure that high quality, cost-effective pharmacy services are provided at local level with reliable outcomes. It discusses the approach that should be taken with patients who have been discharged from or admitted to hospital, audit and record keeping. In addition, an example of a patient self-management plan is given.

The mental health guidance says that pharmacists involved in commissioning, monitoring and advisory roles need to become aware of the importance of medicines in mental health and the need for pharmaceutical services that ensure their safe and effective use. It adds that pharmacists should ensure that there is adequate pharmaceutical input into local implementation strategies. It also recommends that primary care pharmacists use the expertise of specialist pharmacists in mental health.

Pharmacists wishing to obtain a copy of either set of guidance, should e-mail acanning@ rpsgb.org.uk, fax 0207 582 3401 or tel 0207 735 9141 ext. 278.

Royal Pharmaceutical Society steering group for primary care pharmacy

A new group has been established by the Council of the Royal Pharmaceutical Society to work with primary care pharmacy groups (see below) for a 12 month period, initially. The main aims of the group are as follows:

  • To foster the special interests of pharmacists in the primary care sector
  • To provide access to the specialist knowledge and expertise of pharmacists working in primary care
  • To present the views of pharmacists working in the primary care sector to the Society
  • To advise the Society, through its policy support unit, of any need for policy development or review of existing policy relevant to the practice of primary care pharmacy.

For the purposes of the group, primary care pharmacy is considered to comprise the activities undertaken by pharmacists and their support staff in the primary care sector outside community pharmacies. Each of the following organisations is represented, as they have pharmacist members already working in the primary care sector:

  • The Society’s Community Pharmacists Group
  • The Society’s Hospital Pharmacists Group
  • The Primary Care Pharmacy Association (PCPA)
  • The United Kingdom Clinical Pharmacists’ Association (UKCPA) primary care development group
  • The Primary Care and Community Care Pharmacy Network (PCCPN)
  • The Prescribing Support Pharmacists Group (PSPG)
  • The United Kingdom Prescribing Advisers’ Group (UKPAG)
  • A Council member
  • A member of The Society’s staff, in an advisory capacity

I was elected to chair the group and will be assisted by Sue Lunec (pharmaceutical adviser, Redditch PCG) as Secretary and Adrian Kennedy (“Strong Pharmacy” manager, Boots the Chemists) as Treasurer.
During the year, the group is to hold an open seminar on a topic linked to the development needs of primary care pharmacists and the Society’s strategic objectives. This is likely to take place in spring, 2001. The group has been asked to produce a proposal on future group structures within primary care pharmacy for consideration by the Council. This is to include proposals on ways of working with the Society’s Community Pharmacists Group, Hospital Pharmacists Group and the Society’s headquarters.

I think this will be a useful forum for primary care pharmacists from a variety of backgrounds to interface with the Society and its Council, and Primary Care Pharmacy will keep you posted on future developments.

Richard Seal
Pharmaceutical adviser, Birmingham health authority

Working with the industry

The Royal Pharmaceutical Society has produced guidance for primary care pharmacists on working with pharmaceutical companies.
The guidance, which was issued in July (PJ, July 29, p158), was produced because pharmacists involved in influencing prescribing in primary care groups, local health groups and local health care co-operatives are likely to have greater contact with the industry than was previously the case.
The guidance includes a section on dealing with company representatives. It highlights the benefits of having an appointment system for seeing representatives, avoiding bias towards one company by appraising all information carefully and suggesting an appropriate level of hospitality that should be accepted from companies.
Sponsorship is also covered, with examples of the sort of initiatives that might be discussed and the recommendation that details of all sponsorship are recorded by each PCG.
Collaborative working with the pharmaceutical industry can be useful, the document states, for example, in the support of educational activities and projects, and in providing access to more information about products than is available from any other source. This interaction is likely to increase further as independent and dependent prescribing develops.

Checklist for managing stroke patients available

A checklist that highlights risk factors that should be monitored regularly in patients who have had a stroke has been produced for use in primary care by the Action For Stroke group.
The checklist, which has been produced in the form of a laminated A4 size card, also summarises current recommendations made by national bodies for managing stroke patients, including use of anticoagulation, lipid-lowering therapy and treatment of hypertension, the group says.
Ms Margaret Goose (chief executive of the Stroke Association) said of the checklist: “It is vitally important for GPs to take an active interest in preventing secondary strokes. This easy-to-read checklist will be useful in busy surgeries and will help re-emphasise the important role that practices have in the care of people who have had strokes.”
The Action for Stroke group is supported by an educational grant from Sanofi-Synthélabo and Bristol-Myers Squibb.

Forthcoming events

PCCP network conference
The Primary and Community Care Pharmacy Network, which used to be known as the Community Services Pharmacists group, is holding its annual conference in Wolverhamptom on October 2 and 3.
The conference has the theme “Reality and tomorrow” and includes sessions on the development of electronic prescribing, the implications for pharmacists of the transition from primary care groups to primary care trusts (PCTs) and childhood immunisation.
Pharmacists wishing to attend should contact Cath Jackson tel 01782 552784 or fax 01782 713310.

Community pharmacy and primary care trusts: looking to the future
The health services management centre at the University of Birmingham is running a one-day seminar at the Birmingham Botanical Gardens on October 11, which is for “everyone involved in the management and development of prescribing within primary care groups and trusts”. Topics covered will include: the relationship between pharmacists and general practitioners; the current and future role of pharmacy in PCTs and whether PCTs should purchase and dispense drugs.
Booking forms are available from Ingrid Leeman at the health services management centre, tel 0121 414 7050 or fax 0121 414 7051.


Primary care course update

Since the publication of the article “Postgraduate courses for pharmacists working in primary care” (PCP, June 2000, p73), the University of Leeds has supplied details of a course in prescribing management, which are as follows:
Division of academic pharmacy practice, University of Leeds

Course title — Postgraduate programme in prescribing management in primary care

Type of course — Part-time modular course with practice-based work in between study days

Target audience — Primary care group/primary care trust/practice pharmacists, general practitioners, practice nurses

Duration of course — PgCert 1 year, PgDip 2 years, MSc 3years

Entry requirements — Degree in pharmacy, nursing or medicine and current registration with professional body. Students must be working in general practice

Qualification on completion — PgCert, PgDip, MSc


Next entry date — Autumn, 2001

Cost — PgCert £1,180, PgDip £2,360, MSc £3,540. However, there is no cost to students working in Northern and Yorkshire Region

Contact person — Dr Catherine Lowe (course director), Mrs Jackie Nunney (course organiser) Telephone: 0113 3926737 Email: c.j.lowe@leeds.ac.uk, j.m.nunney@leeds.ac.uk

Content summary — The essential aspect that makes our course different is an emphasis on the management of change. Therapeutic knowledge alone is insufficient to influence prescribing, we need to appreciate the influences on prescribing and how to manage them to sustain lasting change. The course is flexible and allows students to select modules that are appropriate to their requirements

Correction The telephone number for Mrs Bev Oakden, one of the contacts for postgraduate courses offered by Keele university in our article on postgraduate courses for primary care pharmacists should have read 01782 584207 (PCP, June 2000, p75).

Aqueous cream may be “cheap” but is it always appropriate?

Pharmaceutical advisers to primary care groups are inappropriately recommending aqueous cream as the emollient of choice “because it is cheap” — advice which should be rejected, according to the Skin Care Campaign.
The campaign, which is an alliance of groups, including UK national dermatology patient organisations and health professionals, wrote to chief executives of PCGs on August 16 to express its increasing concern about the advice to give aqueous cream, saying that it “strongly recommends that GPs should reject such advice.”
In the letter, the Skin Care Campaign says that aqueous cream can be useful as a soap substitute but that most people find it unsatisfactory as an emollient both because of its consistency and because “substantial” numbers of people, especially children, are sensitised to it.
The campaign says that GPs should be prepared to give patients the opportunity to try a range of emollients to find those that suit them the best.


New e-mail address for editor (Panel)
Readers wishing to contact Sheena Macgregor by e-mail, should note that her address has changed. Please send all e-mail correspondence to sheena.macgregor@borders.scot.nhs.uk.