Pharmacists’ role in urgent and emergency care

 

Keith Willettby Keith Willett, NHS England’s Director for Acute Episodes of Care, and leader of NHS England’s Urgent and Emergency Care Review

The urgent and emergency care review is very clear about the number of points in the pathway where pharmacists can contribute.  Pharmacy is one of the most under-appreciated professional groups in terms of the impact they can have on urgent and emergency care.

If we start at the care pathway, there are things pharmacists can contribute, particularly around medicines optimisation and advance care planning for patients, such as how they want to respond to exacerbations in their illness.

General practice
As we get further into the urgent and emergency care pathway, when we look at consultations, there’s good evidence that bringing pharmacists into general practice enables them to take a lot of the load off doctors.  This is because a lot of the issues are around medications, such as side-effects, doses, changes that need to be made and so on, and that’s really important.

Telephone services
We have a big role for pharmacists within the telephone consultation component service of the NHS, that’s NHS 111 & 999. At the moment, only 1% of callers to the NHS111 phone line are referred to pharmacies – it can’t be that low, it must be higher than that, because the role of pharmacists is much greater than that figure suggests.

Clinical hub
Pharmacists can play a role in the services we might offer in the future to other professionals in the network.  We might have community nurses, paramedics or GPs, all of whom, as well as patients, may need to speak to a pharmacist. One of things we are very keen to see happening is pharmacists to be part of a network clinical advice hub.  If an out-of-hours GP is visiting a patient and there are medications they are not so familiar with, or there’s a combination of medications, or a medication change, they could talk to and get advice from a pharmacist.

Common ailments
Pharmacists train for a year more than a nurse, a year less than a doctor and have an immense amount of clinical knowledge which the patients could receive directly, particularly if you think about common ailments services.  We’ve heightened the role of the pharmacist in responding to winter pressures, but there’s a bigger role which could be taken forward which needs to be seen as part of the offer which we make to the public.

Future roles
In hospitals, we’ve already got evidence of the importance pharmacists have in the efficient delivery of care, whether that’s around medicines optimisation, the assessment or discharge of patients.  We are looking at pilots having pharmacists working in the A&E Department, in Medical Assessment Units and in Ambulatory Services, so I think the opportunities are enormous.

Read-write access to the summary care record
The core element of the SCR contains the medicines the patient is on, which is really important information for everyone in the pathway.

Ultimately, over time, we’d like to see an enhanced SCR that not only contains more information in terms of interpreting it when you are seeing a patient for the first time, but would allow the ability for clinicians to be able to write to it in the future.  For pharmacists to be able to access that becomes, I think, a completely sensible way to go.  There are issues to get over in doing that – access for pharmacists that are not on the NHS spine for example – but those are things which we recognise need to change.