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


Blog headlines

  • 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.

  • Links of the week
    23 July 2020

    This week we are sharing two articles with you.

  • Link of the week
    21 July 2020

    The blog is from the perspective of the Company Chemist Association's Chief Executive Malcolm Harrison.

  • Link of the week
    9 July 2020

    This week we are sharing a blog from the NHS Confederation’s “NHS Reset” looking at the work of Healthwatch, the role of volunteers in supporting patients being discharged from hospital and the importance of the community.

  • Virtual education sessions on spinal cord injury from Spinal Injuries Association
    2 July 2020

    This week Karen Mikalsen from the Spinal Injuries Association shares some information on their work and events for healthcare professionals.

  • Guest blog:Karen Chumley
    25 June 2020

    Thank you to Karen Chumley for a second blog –this time on the local use of an Electronic Palliative Care Coordination system during the Covid-19 pandemic. Karen is the Clinical Director and Deputy CEO at St Helena.

  • Link of the week
    19 June 2020

    This week's link of the week is article by Yasmin Khanagha published in Nursing Times – Why we need to open the conversation about racism.

  • Guest blog: Dr Karen Chumbley
    12 June 2020

    This week we have a guest blog submitted by Dr Karen Chumbley, clinical director and deputy chief executive at St Helena (https://www.sthelena.org.uk/)

  • Social care to become lifestyle brand
    16 April 2020

    Social care is to get a new brand identity as the government seeks to reverse the perception that it is the poor relation of the NHS.

  • Blithering Covid-19 bulletin plays vital role
    2 April 2020

    To fill a gap in the market for timely and relevant Covid-19 information, Martin Plackard, director of global crisis communications at NHS Blithering introduces his latest initiative to reach out to stakeholders during the outbreak.

  • Social distancing the Longstay way
    27 March 2020

    We asked Sir Trevor Longstay, chief executive of the NHS Blithering University Hospitals Foundation Trust and commander-in-chief of the Blithering Covid-19 Taskforce to give us some practical tips on social distancing. Here he shares some of the lessons learned over four decades of leadership – not all of them relevant or epidemiologically sound

  • Nothing left to shift: fears grow over NHS paradigm supply
    12 March 2020

    The government has issued a stark warning that stocks of paradigms and other basic supplies could soon run out if NHS managers continue panic-buying.

  • Matt Hancock’s diary – a week of levelling up
    27 February 2020

    Taking personal charge of global pandemics is one of the perks of this job. I’m referring to coronavirus, of course, and I’m booked to appear on Sky News to talk about it.

  • Exceeding your expectations: the Blithering staff survey
    20 February 2020

    Staff at NHS Blithering feel listened to “at least once a year” and report that their expectations of taking part in surveys have been “met” or “exceeded” in the past 12 months.

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