My aspirations for the NHS Community Pharmacist Consultation Service

As the new Community Pharmacist Consultation Service goes live, English Pharmacy Board member Andre Yeung, a key developer of the earlier Digital Minor Illness Referral Service, offers his thoughts on how to make it a success.

How did the Community Pharmacist Consultation Service develop?

My good friend and colleague Mike Maguire and I actually started talking about this right back in the summer of 2014. Back then NHS 111 wasn’t really referring to community pharmacy – they mainly sent patients to GP services, walk-in centres or A&E departments. It got us thinking that community pharmacy could do so much more in this space if we only just connected the network up with NHS 111.

After our NHS Pharmacy Integration-funded pilot in December 2017 we’re now presented with a national roll-out this October. It’s taken some time to get to this point, and it took a little bit of convincing about pharmacists’ role, but I believe the future delivery of this service is really important for community pharmacy and the NHS. We’ve had over 28,000 patients referred into community pharmacies as part of our pilot and community pharmacists have done an absolutely astounding job of clinically assessing, advising, treating, managing and escalating patients within an integrated primary care system. 100% – we’re now the first port of call for minor illnesses here in the North East.

Why do you think the CPCS is so important?

My belief is that Community pharmacy developing a role in acute out of hospital care is more important than the sum of all other commission services that have been commissioned through community pharmacy.

Why? Firstly, because acute care is needed and appreciated by patients! Secondly, it doesn’t just disappear if pharmacy doesn’t do it so it’s needed by the NHS too. Thirdly, the size and scale of this is massive.  It seems to me a ‘no brainer’ that if pharmacy helps out our GP and nurse colleagues they too would start to argue that the right place for managing patients with minor illnesses is within community pharmacy. Pharmacy can provide patients with excellent access to services and because of our scale can take pressure off NHS colleagues as we head into the busy winter season.

What are the considerations that are needed to enable around a national roll-out?

It’s a big task to get the best out of this service. In some respects, this is business as usual for pharmacists, in others it’s completely different. I don’t think there’s been a more challenging service launch in the history of community pharmacy.  As of October 29th we’ll be connected to the NHS in a way that we haven’t been in the past. People will be monitoring and counting on our clinical interventions so we need to ensure the quality of what we deliver is of a really high standard across the board. If we can do that, and I believe we can, then this could be a seminal moment for our profession – a really positive turning point that leads to further developmental opportunities in the clinical arena. How great would it be to achieve amazing results with the spotlight on us like never before?

What message would you give to front-line pharmacists?

These are a few of my top things to remember about CPCS:

  • CPCS about YOUR clinical assessment in the pharmacy. Get the info you need and make your own professional clinical judgement as NHS 111 have only done a triage based on what the patient has reported on the phone. A great clinical assessment keeps the patient safe, is rewarding for the pharmacist and importantly helps patients get well as they have the right plan in place.
  • Three most likely outcomes of your assessment will be a) you can help the patient, b) you need to escalate the patient or c) you can’t help the patient but you don’t need to escalate.
  • Safety net every patient: advice on when to act and how to act if things don’t improve or get worse.
  • Keep decent clinical notes in the IT system, for patient benefit and yours.
  • When you escalate in hours, most times you’ll need to speak to the GP not the receptionist. You’ll be escalating because you have a clinical concern so it’s only natural you’ll want to communicate this to the receiving GP – it’s both helpful and courteous to do so! Out of hours you’ll be going back to NHS 111 via the healthcare professional line so be prepared to request a referral or support from the clinical assessment service.
  • Reflect on your practice. If you need some additional training then sort this out as part of your CPD.

What are my aspirations for the future of the service?

Initially, this is about community pharmacy the sector maximising this opportunity. It’s about us ‘knocking this out of the ballpark’ so to speak. That’s my main aspiration!

If we achieve this then the NHS have already outlined an opportunity to work with GP referrals into community pharmacy for minor illnesses.

In the future, what would be good would be some additional training, access to some POMs and some basic equipment (oximeters, BP monitors, thermometers etc.).  This will allow us to see other types of patients as our functionality increases. Why not see patients with suspected UTIs, with impetigo etc? I know my colleagues at the Royal Pharmaceutical Society will be pleased to hear me say that I think the roll out of Pharmacist Prescribers will eventually come on the back of all of this work. We’ll need them as we do more and more in this domain.

It’s all very exciting! Caveat to all of the above? We MUST deliver this first phase of the service well.  Organisations need to support our front line pharmacists and pharmacy teams to deliver quality. They absolutely have the capability to do it, they’re amazing, but they will need our help and support to make it happen!

Asking patients using pharmacy services what they need

by Stephanie West, RPS Regional Liaison Pharmacist

In our previous blog, Nicky Gray spoke about the ‘strength and authenticity’ of relationships between stakeholders as central to successful integrated working. The same holds true when engaging the populations we serve. Promoting a positive patient experience of health and social care services, through providing integrated out-of-hospital care for patients, is a central aim for PCNs.

Community pharmacy has firm foundations to build upon. The National Healthwatch Report 2016 found that:

  • Three quarters of people say they would go to a pharmacist, rather than a GP, to get medication for a minor illness.
  • Over half would go to a pharmacist to seek advice for a specific minor illness or injury.
  • A third of people would consider using a pharmacy instead of visiting a GP for general medical advice.’

Community pharmacy was also the healthcare service of choice for ‘traditionally harder to engage groups.’ Significantly, the report found that participants ‘trusted the pharmacist’.

Asking patients

One thing that strikes me is – how are patients being consulted and educated about the increasing clinical services delivered by pharmacists? How is the patient voice being captured?

GP Practices have engaged with patients through Patient Participation Groups for many years, to make sure ‘that their practice puts the patient, and improving health, at the heart of everything it does’ These could be a useful forum to capture patient views on new ways of accessing care from the wider PCN team. If you are part of a group focussing on the role of pharmacists in the practice, please get in touch.

Community pharmacists have to conduct an annual patient survey. This focuses on traditional services and advice-giving and could be developed to raise awareness of different clinical services. 

The Berwick Review called for the NHS to ‘Engage, empower, and hear patients and carers at all times’. NHS Trusts have patient and public engagement strategies, recognising the importance of capturing patient views. There are opportunities to do this, many trusts will have patient representation on their Medicines Safety Committee, but can we engage them more widely as strategies for pharmacy and medicines optimisation are developed across Integrated Care Systems?

Shared decision-making

Liberating the NHS: No decision about me without me  focussed on shared-decision making. How are pharmacists ensuring that patients are fully involved in decisions about their own care and treatment? How is pharmacy linked with local communities, groups and networks? NICE Guidance identifies Shared decision-making as ‘an essential part of evidence-based medicine’ and the NHS Patient Safety Strategy 2019 commits to: ‘Commission shared decision-making (SDM) training for clinical pharmacists moving into PCNs, to work with patients with atrial fibrillation (AF) on anticoagulants’.

Get in touch

Our new System Leadership Resource section on ‘Culture Change’ includes a focus on meaningful engagement with local people. If you have a case study showing how you have improved health outcomes or developed a service through patient engagement, shared-decision making and/or co-production we would like to share your insights so please do contact us.


 


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Setting the standards for information sharing

by Stephen Goundrey-Smith, RPS Pharmacy Informatics Advisor

We are moving towards better integrated health and care in the UK. As part of the drive to support this, new pharmacy services are useful for helping people with long-term and complex conditions to stay well in the community and take their medicines properly. This in turn means people are able to take more control of their own conditions and manage them better from home, with the support of professionals when needed. However, this system can only work if it is supported by good information sharing. Read more Setting the standards for information sharing

Mental Health – awareness counts, action matters.

by Sarah Steel MRPharmS, RPS Wales Policy and Practice Co-ordinator

Sarah Steel MRPharmS, Policy and Practice Coordinator

Over recent years, mental health has become something of a global conversation, a buzzword, a hashtag. Remove the stigma. Break the silence. Be open, talk, share.

Awareness is fantastic, conversation is progressive but how we act is what matters. An episode of mental illness is frightening, frustrating and isolating. As a pharmacist and a patient I have seen mental ill health from both sides and both are scary. People involved on both sides are often scared about the same things. What is ok to say? How do I act? How do I not make this worse? Awkwardness can be destructive.

Admitted to hospital, as a patient in crisis it was exhausting being asked again and again by different people what medication I was taking. No, I didn’t bring with me the third lot of meds that my doctor has prescribed that right now aren’t helping me feel better. I desperately wanted to get better, but I especially wanted and needed to be treated as a person, recognised as a person at a time when I felt so much less than that.

Read more Mental Health – awareness counts, action matters.

My experience as an RPS English Pharmacy Board member

Sharon Buckle is Vice Chair of the RPS English Pharmacy Board and a Pharmacy Manager for Boots.

In June 2012 I was delighted to be elected onto the English Pharmacy Board. I was so honoured and so determined that we would be a bold, decisive and happening board, making a difference for our Profession.

If I could sum up in 3 words what is required of a board member, I would cite three characteristics:

  • Passionate
  • Persistent
  • Pragmatic

I made 3 pre-election pledges:
1/ to push for the sharing of patient records with pharmacists
2/ to fight for decriminalisation of single dispensing errors
3/ to raise the profile of pharmacists with Government, politicians and medics

In 2018 we are well on the way to delivering all three! Read more My experience as an RPS English Pharmacy Board member

Revalidation for pharmacy professionals

By Nigel Clarke, Chair, General Pharmaceutical Council

Over the past three years, the General Pharmaceutical Council has done a great deal of work on professionalism – how to ensure that the standards we set support professionalism; and, as important, how to assure patients and the public that registrants are upholding these standards and keeping up with their knowledge and skills, and with new developments in the professions.

This work has coincided with a period of change in the pharmacy sector – changes in the healthcare landscape, the role of pharmacy and the expectations placed on pharmacy professionals; and changes in the core knowledge and skills required to deliver safe, effective, person-centred care.

As a part of this effort, we have engaged with members of the profession, with patients, and with other healthcare professionals to hear their views on professionalism, and, in particular, how they can be assured that pharmacy professionals have up-to-date knowledge and up-to-date understanding of issues affecting healthcare, pharmacy and the way care is delivered.    Based on their feedback, and underpinned by the findings in the pilot programme we undertook last year to test our approach, we have proposed to introduce revalidation for pharmacy professionals.   That proposal is the subject of our recent consultation on revalidation.

.    Our approach aims to do away with exhaustive record keeping and ‘tick-box’ exercises – which many registrants felt were no longer fit for purpose, and the public find hard to equate with professional development – and introduce a more thoughtful approach to ensuring that professional development is not just documented, but embedded in practice.    Our proposal incorporates peer discussion, and reflection on the GPhC’s standards for pharmacy professionals and registrants’ individual practice to provide meaningful reassurance to the public that real learning and improvement are taking place.

Among the key changes we are proposing with revalidation are: reducing the number of required CPD records from nine to four; conducting a peer discussion with a colleague or someone who understands your work; and writing a reflective account detailing how you are meeting one or more of the standards for pharmacy professionals. We are also proposing that, rather than ‘calling’ records periodically for review, the GPhC would require them to be submitted annually; with a small sample (about 2.5 per cent) randomly selected for review.

This approach is designed to underpin the professional approach of pharmacists and pharmacy technicians, and reflects too the way in which other professions are now engaging in revalidation. It is based upon the view that a consistent pursuit of improvement in practice is the best way to ensure ongoing high standards within pharmacy, and with it greater safety for the public and patients. During our initial pilot, this approach has been widely supported by the professionals who took part.

I would encourage all pharmacy professionals to weigh in with their views on our proposal.  Have there been any points or considerations that we’ve missed?  Are there any changes that we need to make?  Are there emphases that we’ve not properly understood?

And while it is likely that the final plan will not come into effect until 2020, pharmacy professionals can and should begin to prepare themselves now for the inevitable changes that will come from this effort.

As a start, I would encourage all registrants to read the new standards for pharmacy professionals, which sit at the heart of the proposals for revalidation.   Understanding the standards and thinking how they can and should be embedded in practice will be an important best practice to embrace in preparation for revalidation when it comes into effect.

Registrants can also begin to talk about their practice with their colleagues and peers.  The idea of a ‘peer discussion’ may feel daunting at first, but many of our pilot volunteers realised they were already having these kinds of conversations, albeit informally, and that the candid insights and advice they received helped to improve their practice.    So, I would urge you to reach out to colleagues and peers, or perhaps tap into the resources available to pharmacy professionals, such as the RPS Faculty, and start these conversations.

Revalidation will be an important step for the pharmacy sector and for the GPhC as its regulator.   Aside from assuring the public that pharmacy professionals are maintaining high standards of practice and improvement, our revalidation proposal represents our commitment to regulating in a way that is flexible, that supports professionalism and that is fit for today’s pharmacy and healthcare environment.  I look forward to sharing some of the feedback we hear from our consultation when I speak at the RPS conference in September.   I hope to see you there.

Opportunities in community pharmacy

By Valerie Sillito, Community Pharmacist

When I qualified , a long long time ago…. pharmacy was all about supply i.e. making powders, compounding creams by the kg, hand filling capsules and many other arcane activities. If a local GP actually asked me for my opinion I was more likely to have a heart attack, never mind come up with a useful suggestion. Of course the BNF only ran to about a 100 pages and the drug shelves were relatively empty (we didn’t have a drug database as this was the handwriting era!).

So, if you were to ask me then what the opportunities in the future might be I suspect it would have been a very limited list.

Now community pharmacy has come on in such leaps and bounds I hardly recognise myself. To name but a few activities: supply of EHC, NRT, treating UTIs and Chlamydia, CPUS (community pharmacy urgent supply) substance misuse services, flu vaccinations, medication reviews, warfarin clinics and those are just the ones under PGDs (patient group directives). Many pharmacies now also offer private services, i.e. the patient has to pay up front, for travel vaccinations, HPV and meningitis B vaccinations, erectile dysfunction and hair loss treatment to name but a few and a very recent innovation has been a sore throat service with treatment if required.

Read more Opportunities in community pharmacy

Patient safety first

By Robbie Turner, RPS Director for England

The publication of the first report by the Community Pharmacy Patient Safety Group is a welcome development which should be applauded.

Bringing together representatives of community pharmacies large and small they have demonstrated a real commitment to openness, transparency, and in learning from each other to improve the safety of the people they serve.

Transparency

The use of real life examples as part of the report has, unsurprisingly, led to a focus on the aspects that have gone wrong in the past rather than the work being done to prevent these happening again. This was always going to be a risk for the group but they took a decision that the real life examples helped to demonstrate why they have made some of the recommendations they have. I think this was a good and brave decision.

If we are to continue to improve the safety of services we provide as pharmacists it is essential that we are able to share our mistakes and discuss how we, as a profession, think they can be prevented from happening again.

The future

The work of the Community Pharmacy Patient Safety Group is an important step towards a safer future for our patients and the public.

To really deliver a future where pharmacists and their teams can be open and transparent when they make honest mistakes we need to remove the fear of being automatically criminalised for reporting dispensing errors.

The Royal Pharmaceutical Society believes that the move to decriminalise single dispensing errors is long overdue and is lobbying hard to ensure this is delivered as soon as possible by the government.

Choose Pharmacy

Jodie Williamson MRPharms
Jodie Williamson MRPharms

by Jodie Williamson MRPharmS, Pharmacist at the Royal Pharmaceutical Society

In November 2015 the Royal College of General Practitioners (RCGP) Wales claimed that we need 400 more GPs in Wales by 2020 to avert a crisis in our NHS. We are frequently told about the crisis facing GPs. But did you know that many health problems can be resolved without the need for a GP appointment? Your local pharmacist is there to provide advice and support for a number of common complaints and in some cases, they can even provide treatment on prescription or free of charge.

There are a number of pharmacy services available across Wales. It’s worth Find your local pharmacy services, and using your pharmacy as your first point of contact for any non-emergency medical needs. Here’s a round-up of just some of the services on offer across Wales:

Choose Pharmacy

This service has been developed to help relieve pressure on GPs. It gives pharmacists access to a summary of a patient’s GP record, provided the patient gives their consent for them to view it. This improves patient safety and allows pharmacists to treat minor conditions through the Common Ailments Service (CAS). This allows you to see your pharmacist for a long list of common conditions, including hayfever and conjunctivitis, and you will receive advice and any necessary treatment free of charge. It is currently available in more than 220 pharmacies in Wales and the Welsh Government has made funding available to roll it out to all pharmacies in Wales by 2020.

Stop Smoking Services

All pharmacists are able to provide advice and support to those wishing to stop smoking, and in many pharmacies quitting aids such as nicotine patches, lozenges and chewing gum are available free of charge through the smoking cessation services available.

Triage and Treat

If you live in Carmarthenshire, Ceredigion or Pembrokeshire, or are even visiting the area on holiday, you can access the triage and treat service. It is available in a number of pharmacies across the West Wales area, offering treatment for a range of low level injuries and potentially saving you a trip to A&E or the doctor. The list of injuries that they can treat includes:
• Minor cuts and wounds
• Sprains and strains
• Eye complaints e.g. sand in the eye
• Removal of items from the skin e.g. splinters or shell fragments
• Minor burns including sunburn.
You can get advice on managing the above injuries from any pharmacy, but this service enables pharmacists to offer additional onsite treatment.

Emergency Contraception

You don’t need to see your GP for emergency contraception (often referred to as the morning after pill). It is available to buy over the counter from most pharmacies, and many pharmacists are also registered to provide it free of charge following a short consultation to make sure it is appropriate for you to take. This will be done in a private consultation room and you don’t need to tell anyone else what you are there for – just ask for a private chat with the pharmacist.
At a time when the NHS is under enormous pressure, think about visiting your local pharmacist first – if they can’t help they will be able to refer you to the best person for your needs.