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Can the Community Pharmacy become the gateway to integrated care in the NHS?

 

Blog headlines

  • What now for commissioning?
    3 December 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What now for primary care
    4 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • Boosting your resilience
    30 October 2020

    The last year has been a difficult one, who would have imagined last Christmas that we would have been in lockdown, with the NHS seriously tested by a global pandemic. So much change has happened and the resilience of people working in and with health and care services has been seriously tested. Resilience is our ability to deal with, find strengths in and/or recover from difficult situations. Its sometimes referred to as “bounceabiliy” – but bouncing in what way?

  • Link of the week: National Cholesterol Month
    23 October 2020

    Every month or week of the year seems to be an awareness week, October has more than its fair share.

  • New redeployment service offers talent pool of motivated, work-ready individuals
    15 October 2020

    People 1st International have shared some of the work they are doing to support people displaced from industries due to the Covid-19 pandemic. There is an opportunity for health and care services to benefit from this workforce.

  • Link of the week
    9 October 2020

    Article published in the BMJ looking at the ability of the health service to quickly bounce back to pre-Covid levels of activity and considers if it is desirable.

  • Virtual Consultations– the patient perspective
    2 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article.

  • Virtual Consultations– the patient perspective
    1 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article - Virtual Consultations– the patient perspective.

  • Celebrating innovation in eye research
    24 September 2020

    This week Julian Jackson from VisionBridge has shared a report on eye research.

  • Link of the week: Comprehensive Spending Review and Covid-19
    24 September 2020

    This week we are sharing a blog that outlines the funding pressures and uncertainties faced by the health and care system

  • Risk stratifying elective care patients
    10 September 2020

    This blog has been shared by MBI healthcare technologies. As services are starting to treat routine patients those on waiting lists are making enquiries as to where they are on the list, and if they are still on the list.

  • Link of the week
    4 September 2020

    This week the link we would like to share are reflections from physiotherapy students on placement at Alzheimer Scotland https://letstalkaboutdementia.wordpress.com/

  • Link of the week
    28 August 2020

    This week we would like to share a blog published on the Mind website about being a BAME health worker in the pandemic.

  • Remote clinical triage model
    20 August 2020

    This week we are sharing how a remote clinical triage model was implemented at Tollgate Medical Centre. This has been shared with us by Sarah Portway, a Nurse, and Clinical Services Manager at Tollgate Medical Centre.

  • Can the Community Pharmacy become the gateway to integrated care in the NHS?
    13 August 2020

    The NHS is a continually evolving innovative demand led public service the role of the Community Pharmacist is becoming the public face on a journey to the more responsible public engagement in the personal care of individuals and their family. There are currently over 11000 Pharmacies many are single or small chain service providers, while multiples occupy the urban shopping centres and more densely populated conurbations, the value of the rural High Street can’t be understated.

  • Crunch time for patient involvement
    7 August 2020

    There are new challenges for primary care, which could really do with patient input. Mike Etkind, chair of a PPG and founding member of his PCN’s patient group, recognises the size of the task clinical directors have managed over the last few months but identifies two particular issues where patients have a necessary and valuable contribution, that need to be addressed now – the 2020 vaccination programme and primary care from a distance- total triage, remote consultations, and the use of telemedicine.

  • Link of the week - Visionbridge
    31 July 2020

    The link we are sharing this week was submitted by Julian Jackson, Visionbridge.

 
 
Thursday, 13 August 2020

Can the Community Pharmacy become the gateway to integrated care in the NHS?

The NHS is a continually evolving innovative demand led public service the role of the Community Pharmacist is becoming the public face on a journey to the more responsible public engagement in the personal care of individuals and their family. There are currently over 11000 Pharmacies many are single or small chain service providers, while multiples occupy the urban shopping centres and more densely populated conurbations, the value of the rural High Street can’t be understated.

COVID 19 and “Lock down” is driving change to on line shopping and remote prescription dispensing. Use of IT and remote prescribing and dispensing for an ageing population and the development of more “out of town housing” is putting pressure on GP services at a time when new entrant numbers are falling and failing to match retirements, many rely on locums. Surely this and the drive for more “Self Care and personal responsibility” though OTC medications gives the Pharmacist an opportunity to use their skills and competencies to best advantage, yet weekly I see announcements about the closure of pharmacies or staff reductions due to loss of viability as a business.

Online shopping, working from home and other changing routines are heralding the demise of the of the High Street, the domino effect of closure of a Public House, Post Office, Library or Pharmacy can only reduce “Footfall” more rapidly leading to greater levels of isolation and exclusion particularly for the elderly and the infirm, in turn putting more pressure on the NHS. In the same way the other historic trade of the pharmacy is being denuded. This all adds up to question the continued viability of the Community Pharmacy.

Added to the foregoing the development of centralised robotic dispensing and vending style collection machines will reduce staff costs, free up storage and other space within the footprint of the pharmacy business. Empty space does not earn.

For over 25 years I have been involved in many facets of “Patient Representation” Community Health Council through to HealthWatch, besides provision of a new Acute Hospital, Ambulance Trust Public Governor, Fit to Practice Review I have for 10 years been the Lay Member of the PHE HLP Task Group. I have also been active in the development of a Rural Local Plan Review (Localism ACT). The next big leap in health provision will almost certainly be a National Standard Minor Ailment Service. Where will such a service operate from?

The final paragraph of the 1948 NHS leaflet indicates that Health Centres will be opened in the future instead of GP practicing in their surgeries. Many are a long time coming, and practices are still run from former domestic premises or are in a conservation area, the later applies to many pharmacies as well expansion and relocation in the same site has already taken place or is impossible. New sites often have to be out of the centre of the community

I put together a kaleidoscope of experiences, as they say in no particular order:-
Proposed Minor Ailments Service
Lack of development space
To many inappropriate visits to A&E
Ageing population
Overcrowding of outpatient clinics
Lack of further development space on hospital sites
Merger of CCG’s
Introduction of GP Networks
Digital Health in Primary Care, Video Consultations
Hyperacute Cardiovascular Stroke Centres
Pacing clinic COPD and Diabetes management of stabilised patients
ECG, INR, Retinopathy, Dermatology and Audiology
Public Access Defibrillators
Availability of SCR’s on line
Carbon footprint
Decline in public Transport services
Greater emphasis on Self Care and taking greater responsibility for personal health
No one knows what the long term demands of COVID 19 will be
Identifying mental health issues
Recruitment and retention
Career structure

No doubt the reader will add more!

I said above I had been the Patient Representative member of the HLP Task Group, Level 1 has been achieved “HLPs will be embedded in the Community Pharmacy Contractual Framework, as of April 2020.” Level 2 is being defined.

Community Pharmacies are recognised (Pharmacy First) as the first port of call (After 999/111 for trauma and non-life threatening emergencies). The use of “Freed up space” could provide new services in the community. Many of the planning time and constraints of new build would not apply as pharmacies are established health service delivery premises.

So where is this leading?
I would like to see rapid advancement to an additional level that I name HLP Level 4.
I note SHPN 36 part 3 – Health Facilities Scotland, but go further.

I advocate the commissioning of this Level 4 service, premises remuneration being set through the District Valuer according to local costs and a form of capitation according to services provided. An initial one off payment for fitting out and staff training.

The premises enhancement would consist of:-
An accessible discreet waiting area 2/3 chairs, display screen for health promotion controlled from a central source (No commercial advertising) unisex toilet with specimen pass through. Waiting patients should be visible from the pharmacy work area. An accessible interview room; table and 3 chairs, EMIS (or other system IT), Wi-Fi for both patient and clinician access.
A consulting room equipped for purpose depending on selection of services offered.

Hand wash PPE and infection control, clean and dirty facilities, lighting and ventilation, assistance alarm, ligature proof and an alternative exit as appropriate throughout. If there is not already a Public Access Defibrillator available 24/7 in the locality one should be included in the development.

A nationally controlled computer system with printer able to print standard ailment guidance information as required including large print if required (including the leaflet in every medication package) this should also be available in GP Surgeries, A&E and other appropriate places. Selected information should be down loadable to the Patients phone or Laptop etc. This would also remove the need of many posters and leaflets while insuring everything is up to date.

There needs to be a system of alerts when medications with contra indications are on the same script including precautions such as “avoid sunlight” “depletes vitamin......”

I see the development of a career structure, Nurses, Paramedics and Social Care workers becoming part of the Pharmacy team. The creation of a new role of “Pharmacy Support Worker” these would work across the Network. Their function being to set up specialist equipment, clean, maintain and storage after use, BP and BMI, chaperone, ensure the patient has the right information and understands the medications purpose. Home visits to encourage lifestyle changes, observe medication/appliances storage and advise on consumption/use.

Appointment booking centralised across the Net-Work, GP’s able to book urgent appointments between routine consultant reviews. Community and Social Services work allocation should also be controlled from this function. Hospital outpatient consultants and support when necessary could then be attached to one or more Networks according to work load. This would then create free space on the hospital sites. Reduce parking requirements at hospitals and reduce risk of cross infection

While the principle of “walk in” must be maintained the majority of use should be by appointment set up by need of a consultant review, GP & 111 referral. With IT advances diabetic retinopathy services, and audiology maintenance services could be brought in instead of being in a transit van with two plastic chairs in the car park, no doubt there are other services this applies to. A larger more diverse community team will enable more home visits, better medication management.

I contend that this will:-
Improve the integration of Pharmacy into a holistic community care system.
Be a “Greener” more efficient and less stressful experience for the patient.
Enable GP’s to make better referral choices for newly diagnosed patients.
Provide a space for live video consultations with remote consultants with additional skills.
Ensure the continued viability of the Community Pharmacy
Expand and make better use of NHS Estate without incurring excessive development and new build costs.

Of course this is only a start. Is this a gate that needs pushing open?

Author: Robin Kenworthy