The following are just a few examples of how the work of community pharmacists is expanding across the UK.
Local coagulation testing in Essex
Contact: Surinder Singh Kalsi, Pharmacist, Kalsi Pharmacy, Barking
The service: When the local PCT was inviting bids for an anti-coagulation drugs monitoring service, Community Pharmacist Surinder Singh Kalsi put in his bid in collaboration with two GPs. They won the bid and started the service in March 2007.
Why was it needed?
Anti-coagulation monitoring was previously carried out in hospital clinics, but there were frequent problems with GPs not getting results sent through, as well as patients finding it difficult to make the clinic times. Patients on anticoagulant medication need frequent blood tests, often weekly, and not turning up for an appointment can have serious consequences for their health. “We offer patients convenient, flexible appointment times, six days a week. We also run two lunchtime clinics in LIFT (Local Improvement Finance Trust) centres and two further clinics in GP surgeries, which will soon include a third clinic. We’re also doing home visits for those patients who are not mobile,” says Surinder.
Positive feedback: The most recent patient evaluation survey received a 97% satisfaction rate. Patients particularly praise the convenient appointment times, speedy service and efficiency of the system. The GPs are happy too. “Before we took over the service, GPs used to complain that results were not passed on from the hospital clinics quickly enough, or sometimes not sent at all. We send a report to the patient’s GP immediately after each testing and this helps to ensure the patient’s condition is kept stable,” explains Surinder. “We now get invited to the PCT cluster meetings and this gives us the opportunity to air our case in front of the decision makers. GPs are now contacting me for advice on their patients in terms of antibiotic prescribing and choice of other treatment options for other conditions too.”
Prescribing better patient care in Devon
Contact: Karen Acott, Superintendent Pharmacist and Partner, Wallingbrook Health Centre, Chumleigh, Devon
The role: Karen Acott is the fi rst pharmacist to become a partner in a GP practice. “We have a lot of elderly people in our area for whom access to a pharmacy is difficult, so we have a dispensary set up at the surgery,” says Karen. “The GPs were spending a lot of time on medicines reviews which didn’t make the best use of their skills and time. It made sense to have a pharmacist on board to do this for them.”
How it works: All the patients in the practice who are on repeat medication have a medication review once a year. “The doctors still do the more complex medicine reviews such as for cancer patients or mental health patients, but otherwise the doctors will refer any patients with medication queries or problems to me,” explains Karen. “The doctors will often call on me to give advice on medicines queries they have and I also get most of the pain control referrals as this is my specialist area.” Karen also runs a weekly diabetes and epilepsy clinic and briefs the doctors on the latest drugs studies and new National Institute of Health and Clinical Excellence (NICE) medication recommendations.
Breaking new ground: “I think pharmacists should be using their specialist skills in a variety of environments and I’d like to see more of them taking steps to qualify as independent prescribers and use these skills,” says Karen. “I’m often called to give advice to other independent prescribers across the country and invited to participate in Governmentled focus groups, which is really worthwhile as I’m able to give them a realistic and hands-on view of what pharmacists can contribute to the health service.”
Keeping patients out of hospital
Contact: Pam Grant, Medicines Management Pharmacist, Bournemouth and Poole PCT
The problem: Many older people with long-term conditions such as Parkinson’s, type II diabetes and Alzheimer’s have problems taking their medication correctly and the result of this can be hospital admission or moving into a care home.
The solution: In 2002, Pam Grant started developing a medicines management support scheme in Poole. The scheme was designed to help vulnerable patients avoid a hospital stay and remain independent for longer. In 2004 she put a business case to her PCT, presenting data which showed that one in six of the patients she helped had avoided hospital admission. The service was set up in 2005, with three part-time technicians supporting her and 29 pharmacies participating in the scheme.
How it works: The medicines team visits each patient that is referred to them and takes over the ordering of their medicines on a 28-day cycle, as well as providing information and advice, which helps ensure better compliance. “For patients who find it difficult to remember which tablet to take and when, we use specially designed blister packs, with the day and date on each blister. For partially sighted patients we also use dispensing devices, which have an alarm that sounds when it’s time for the patient to take their medication. The device is linked to a call centre, so if the patient doesn’t take their medicines, we’re automatically alerted,” explains Pam.
Is the scheme successful?
Data from 2004 and 2006 shows a reduction in emergency admissions to hospital of 18% and 25% respectively among the patients using the service. In 2006/2007, the service made savings of over £25,000 in prescribing costs. The service only needs to prevent a two-day stay in hospital for each patient managed by the team to cover the running costs.
Preventing medication errors and hospital re-admissions
Contacts: Harriet Lewis, Trafford Pharmacy Network, Trafford PCT; Margaret Ledger-Scott, Chief Pharmacist and Clinical Director Medicines Management, Durham and Darlington NHS Foundation Trust
The problem: When patients are discharged from hospital there is a risk of a communications failure between hospital staff and health professionals in the community, which can result in confusion over medication taken in hospital and that taken at home. Two pharmacist-led schemes have helped to overcome these issues.
Faxing medication summaries: When patients are discharged from Trafford General Hospital, a summary of their discharge medication is faxed to the patient’s pharmacist as well as the GP. “We set up the scheme because we found that the discharge summaries sent from hospital to GP weren’t being acted on quickly enough, so changes to a patient’s medication made in hospital weren’t being followed through,” says Harriet Lewis. “This kind of new service helps to establish the position of the community pharmacist within the wider healthcare team. Pharmacists are the last safety point at the end of the patient care line, and they should be included in the communication links across the interface.”
Treatment booklet: At Darlington Memorial Hospital, the pharmacy team has designed a booklet which is given to patients on discharge and records all aspects of hospital treatment received, including medication. Twelve months after initiation of the project, less than 2% of patients who had been discharged from hospital with a booklet had experienced medication errors. Hospital re-admissions were reduced by 71% “Patients using the booklet became more responsible for managing their own healthcare – they understood what their medicines were for, why they were taking them and they queried any changes,” says Margaret. “The booklet does not only record medication but also risk factors, test results etc. – showing our pharmacists now have a more holistic approach to patient care.”