Pharmacists can help deliver urgent care

Dr Clifford Mannby Dr Clifford Mann, President of the College of Emergency Medicine

The College of Emergency Medicine  is established to advance education and research in Emergency Medicine. Amongst a range of activities, the College works to ensure high quality care by setting and monitoring standards of care, and providing expert guidance and advice on policy to relevant bodies on matters relating to Emergency Medicine.

As President of the College, I have been working to tackle the serious challenges facing emergency medicine. These challenges are adversely affecting the performance of our Accident and Emergency Departments across the UK and Ireland.

The key challenges in A&E centre on rising demand for our services at a time when the workforce is not growing fast enough to keep pace with the volumes of patients who attend. On the demand side, we know that around 2m patients who attend A&Es each year in England could be seen by colleagues in primary care if there was sufficient capacity there.

We know that pharmacies can help with a range of common ailments and minor injuries, such as aches and pains, uncomplicated cystitis, colds and skin rashes. These kinds of health matters lead to around 57 million GP consultations a year, and people turn up at A&E with them too. We could save a lot of time if these patients needing urgent care for common ailments went to the pharmacy instead. Anything that helps reduce the pressures our GP colleagues face will in turn ease the pressures on A&E, so pharmacists can certainly help there.

On the workforce side, there has been a continued trend to doctors and consultants leaving the UK to work abroad. Whilst we have recruited more doctors this year into Emergency Medicine it will take some time before that extra capacity is fully trained and so we are facing a continued workforce challenge. This has meant a reliance on locums to fill gaps and this needs to change. We need to find ways of helping address the work-life balance of Emergency Physicians and we are talking to the BMA and NHS employers about that.

Pharmacists can also make an impact contributing to efforts to speed the flow of patients through hospitals. All too often ‘Exit Block’ is seen in A&Es as they fill up and there isn’t enough capacity in the hospital wards to allow patients to be admitted. We have made some videos explain Exit Block here.

A contributory factor to ‘Exit Block’ can be when patients are waiting for their medicines from the hospital pharmacy before they can be discharged from hospital wards. As part of the multi-disciplinary team pharmacists can make a real impact on improving discharge and transfer of care into community settings.

Another area where pharmacists can help in A&Es is with many older patients, who have complex needs in terms of multiple medications. Pharmacists helping in the A&E with drug charting and advice will help the hard pressed Emergency Physician with the often complex drug packages needed for the frail elderly. This will also help reduce the risk of prescribing errors and means that there is merit in having trained pharmacists in the ED.