Q&A


this might be when there are serious complaints, concerns or other clinical incidents. thankfully, community pharmacy services provide excellent services most of the time and we have recently evidenced this through analysis by a piece of research conducted by the market research company Millward Brown.


Based on their sample, 75 per cent of the population in northern Ireland used a community pharmacy in the previous twelve months and 95 per cent rated the service provided as good or excellent.


WItH tHE IntRoDUCtIon of tHE QUAlItY ASSURAnCE VISItS, Do YoU SEE tHE BoARD tAKIng A MoRE AUtHoRItAtIVE Roll toWARDS PHARMACY? HoW DoES tHIS SIt WItH tHE RolE of tHE PSnI? IS tHERE REAllY A nEED foR tHE DoUBlE VISIt?


the HSCB holds a ‘contract’ with community pharmacy contractors for the provision of general Pharmaceutical Services. the terms of Service are set out in the Pharmaceutical Services Regulations (northern Ireland) 1997.


As the commissioner of health and social care services, HSCB is expected to provide assurance in respect of the safety and effectiveness of services that it commissions.


HSCB pays over £470m per year to community pharmacy contractors for the provision of service but, until the establishment of the assurance visit process, there was no mechanism to provide an ongoing assurance that services were being provided in line with terms of Service.


the Pharmaceutical Society, as Regulator, registers pharmacies and sets out minimum professional standards for pharmacies. However, the Society is not reviewing HSC community pharmacy service provision as part of its regulatory function.


We recognised that there was a gap in the assurance mechanism and over the past three years have been working with community pharmacy representatives to establish the Assurance framework.


the Assurance framework should not be seen as a de minimis approach where the commissioner is seeking to apply a pass/fail to a particular requirement. Rather, it should be seen as a building block within the pharmacy quality system.


Recently, I had the privilege of meeting with the some of the late Mrs Ethna Walsh’s family to discuss with them what the service has learned and what steps have been taken to reduce the risk of another prednisolone – propranolol dispensing error. they were reassured that the profession was embracing the learning arising from this tragic error and took some comfort to see that the Assurance framework process highlighted this specific issue.


WHAt DEVEloPMEntS Do YoU SEE foR SERVICES WItHIn CoMMUnItY PHARMACY In tHE fUtURE? WIll tHERE BE ExtEnSIon on CHRonIC DISEASES CoVERED BY MURS, Eg, HYPERtEnSIon. oR tHE ExtEnSIon of tHE nUMBER of MYMS AnD MURS AlloWED BY EACH PHARMACY? In YoUR oPInIon, WHY Do nI PHARMACIStS lAg BEHInD tHEIR gB CoUntERPARtS In tERMS of tHE RAngE of SERVICES tHAt tHEY CAn PRoVIDE?


there is much that we should be proud of in community pharmacy practice in northern Ireland. for the future we need to build on the positive practice that we have and address the issues facing the population.


Minister has recently given her go- ahead for the development of a new community pharmacy contract framework. Work is ongoing to develop the arrangements for new and revised services and I remain hopeful that we will see a successful conclusion.


Do YoU SEE AnY ADVAnCEMEnt In tHE nEAR fUtURE foR ECR In CoMMUnItY PHARMACY? WHAt IS DElAYIng tHIS HAPPEnIng?


the Electronic Care Record surfaces a range of patient records through a web browser. given that such information will be highly confidential there are technical and governance issues to work through to establish the roll-out.


We have tested ECR within a number of community pharmacies in the northern lCg area as part of a pilot and we will be evaluating this in the coming weeks.


technically, as community pharmacies are outside the HSC It network, we need to establish a secure connection so that ECR can be view securely. the mechanism that we will use relies on a secure connection from community pharmacy broadband into the HSC network and authentication via a crypto-token. We are planning on this deployment in the coming months.


WHAt IS YoUR PoSItIon on MDS tRAYS? CoMMUnItY PHARMACIStS SPEnD HUgE AMoUntS of tIME PREPARIng tHESE tRAYS foR oUR PAtIEntS, WHo ABSolUtElY REQUIRE tHEM In oRDER to REMAIn At HoME. tHIS InVAlUABlE SERVICE KEEPS PEoPlE oUt of HoSPItAl, WHY HAS tHE PAYMEnt foR tHESE BEEn DIMInISHED So MUCH tHAt WE noW ARE PRoVIDIng tHESE At A loSS?


the evidence shows that medicines adherence is a huge issue and requires a multifactorial approach. I recognise that MDS is one of many solutions which can be beneficial to some patients.


However, I see many problems with the current provision. there are clear differences in the quantity of trays provided by pharmacies that cannot be explained by the types of patients that are being seen by pharmacies.


We see some pharmacies providing MDS to large numbers of patients which puts a massive strain on the pharmacy and increases the level of risk. Dispensing into a MDS tray is technically a very time-consuming and challenging thing to do. HSCB receives notification of serious incidents and increasingly we see that MDS has added a layer of complexity which has contributed to the event.


the evidence shows that non- adherence can be intentional or non-intentional. MDS does not deal with intentional non-compliance - this requires structured questioning, advice and potentially intervention by carers.


PHARMACY In foCUS - 51


the evidence also shows that the complexity of the medicines regime will affect adherence - therefore a full clinical medication review is required to address complexity issues before consideration of the use of a compliance aid.


It just doesn’t make any sense to invest much time and effort into providing a MDS tray if the medicines that were prescribed and dispensed could have been simplified or even stopped to begin with.


MDS trays may be a solution for some patients but obviously, if the medicines are not solid, oral dosage forms that can be dispensed within an MDS, then other solutions are required.


HSCB has provided £4m to community pharmacy contractors in block payments in recognition of the valuable work that community pharmacy provides in respect of medicines adherence.


AnD on A lIgHtER notE


WHAt IS YoUR fAVoURItE fIlM AnD WHY? I have several, so it depends on what mood I’m in - the Mission, Schindler’s list, Apocalypse now, Shawshank Redemption, the godfather, Pulp fiction, the English Patient - all of these have great stories, casts and great cinematography.


YoU ARE AlloWED to InVItE tHREE PEoPlE (PASt oR PRESEnt) ARoUnD to YoUR HoUSE foR A DInnER PARtY. WHo Do YoU InVItE AnD WHY? Mother teresa, nelson Mandela and John lennon – I think it would be a very interesting evening.


WHAt lEgACY Do YoU WAnt to BE REMEMBERED foR, In tHE PHARMACY WoRlD? I am not interested in legacies – I’m interested in making things better now and for the future. •


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