In my view, the chronic medication service (CMS) is a necessary step towards securing a future role for pharmacists within the community pharmacy setting.
There are two sides to CMS. There is the repeat supply of medicine via serial prescriptions, and the clinical side of the service in which community pharmacists provide pharmaceutical care for the patient. Both have merit. However, neither side has reached its full potential yet.
With this in mind I presented a positive take on CMS at the recent Scottish National Seminar focusing on the clinical side of the service.
Based largely on the findings of the National Review of Asthma deaths 2014 (NRAD), I decided to exploit the unprecedented access to patients I have as a community pharmacist in an attempt to deliver some clinical returns. Many asthma deaths are preventable, so I set about creating a simple plan to first find and then enhance the support of people with asthma who had not engaged with my local general practice team.
Relationships and co-operation are key to the success of any multidisciplinary service. I did a number of searches of the surgery asthma list, kindly facilitated by the practice team and my GP colleagues.
I generated three searches:
1. Patients who had been prescribed salbutamol in the previous 12 months and/or had a diagnosis of asthma who had failed to attend their annual asthma review in the practice in the previous 12 months.
2. Patients prescribed more than 12 beta-agonist inhalers in the previous 12 months.
3. Patients prescribed oral prednisolone in the previous 12 months.
I used these searches in the community pharmacy setting to identify, intervene and conduct a mini asthma review with patients. I found a significant number of people who would benefit from further support in improving the management of their asthma. As part of the CMS service, I fed back my findings to the practice team so that they could be recorded in the patient’s record.
I should make it clear that the patients who did attend the surgery regularly were extremely well managed locally. However, if the patient did not choose to attend the practice,the surgery team are in a tricky position if they intend to support these patients.
My CMS pilot was a success because I observed that the person with asthma was required to visit the pharmacy to collect their reliever medication.
There has been much talk recently of pharmacists working in GP practices. I think this, along with any other scheme that utilises the unique skill set of the pharmacist, is an excellent idea. However, I am much more in favour of the profession encouraging pharmacists to work in pharmacies to deliver clinical returns for patients and be paid for doing so accordingly.
I am now in the final stages of planning independent prescribing clinics to support, among other groups, people with asthma within the community pharmacy. Combining these clinics with the CMS case findings that I have described above will hopefully mean that my clinical list will be comprised largely of people who cannot be reached by the GP practice team. Therefore I am not duplicating the good work that already takes place. On the contrary, I am going after the people with asthma that require additional support.
I am hopeful that by taking the best bits of community pharmacy, like unprecedented access, and combining them with a little basic clinical work, I can deliver positive results for patients.