CONTRACT


• Travel vaccinations and travel health advice


• Influenza programme


• At-risk and age group programme (shingles, pneumococcal, hepatitis B)


It is the introduction of a new pharmacotherapy service, however, which will be particularly exciting for pharmacists. The service, which will evolve over the three-year transition, will see pharmacists and pharmacy technicians becoming embedded members of the core practice clinical teams and taking on responsibility for:


• Core elements of the service, including: acute and repeat prescribing, medicines reconciliation, monitoring high-risk medicines


• Additional elements of the service, including: medication and polypharmacy reviews and specialist clinics, such as chronic pain


In order to illustrate the successful part that community pharmacy can play in primary care, the contract focussed on a case study from NHS Highland, in which both pharmacists and pharmacy technicians have already developed an increased, specialised role


In Caithness, pharmacist prescribers are embedded in the primary care MDT. One pharmacist, who works in a GP practice with 5,447 patients, has taken over all the medication reviews that were previously provided by the practice GPs, and completed a total of 2,811 medication reviews in an 18-month period. This includes re-authorising repeat prescriptions and transferring suitable patients to serial prescribing. They also triage all daily acute requests, carry out all medicines reconciliation for hospital discharges and clinic letters and manage individual patients requiring more intensive medicines input, such as dose titration of a pain medicine.


Caithness pharmacists also provide domiciliary medication reviews for patients in care homes and patients receiving care at home, thereby reducing the number of visits required by GPs. The pharmacist input has resulted in a marked reduction in GP time spent on medicines-related activities, enabling them to focus on other activities.


Patient response has also been overwhelmingly positive, with one GP commenting that ‘having an in-house


pharmacist has shown many benefits for patients including reducing polypharmacy, being able to monitor more closely patients on high risk medications, and supporting patients though medication changes after hospital discharge’.


RESPONSE


Perhaps unsurprisingly, the terms of the new contract have been widely welcomed by pharmacy’s professional bodies.


Dr John McAnaw, Chair of the Scottish Pharmacy Board, believes the contract provides the next step in enhancing the role of the community pharmacist in primary care.


‘On behalf of the Board and the Royal Pharmaceutical Society in Scotland (RPS in Scotland), I welcome the £12 million in 2017/18 for the GP Pharmacy Fund as part of the new GMS contract,’ he said, ‘building on previous Scottish Government initiatives and funding through ‘Prescription for Excellence’. This aligns with the recent strategy document ‘Achieving Excellence in Pharmaceutical Care’, and gives recognition to the unique contribution pharmacists make to improving patient care.


‘The RPS in Scotland strongly believes that patient care can be improved through greater collaborative working between GPs and pharmacists, and indeed with the wider health and social care team working across their local communities. The new contract will ensure that patients see the most appropriate practitioner for each episode of care.


‘It is important that pharmacists recognise they have professional autonomy for their area of expertise, working alongside GPs and other members of the primary care team. Professional accountability must remain within the pharmacist’s own jurisdiction and we are therefore pleased to see this autonomy explicitly stated in the document.’


While welcoming the contract, however, Dr McAnaw said that he would also be keen to hear more detail on some of the elements in the proposed contract and that he also looked forward to having further discussion with the Scottish Government to ensure that it continues to best support its members and the pharmacy profession in Scotland for the benefit of patients and the public.


Areas where he felt further dialogue would be helpful include:


• The descriptors of the outlined pharmacotherapy services, which contain some anomalies. The RPS would also like further reassurance that the need for flexibility, determined by local circumstances, will be taken into account.


• The new contract appears to have been developed in isolation from the community pharmacy contract, where a more collaborative approach could potentially have further improved patient care and outcomes as well as efficiencies. An opportunity to align the two contracts over the next few years will hopefully be possible.


• While RPS supports the changes COMMUNITY


PHARMACY SCOTLAND


We note with interest the conclusion of the discussions around the GP contract. It is encouraging that the direction of travel in Scotland is consistent – with recognition of the essential role of the wider healthcare team in the delivery of primary care in future.


GPs are crucial partners in the delivery of the health and social care vision, but their skills and expertise must be best utilised along with


LAURA REED, HEAD OF PROFESSIONAL DEVELOPMENT, NUMARK


These services recognise the pharmacist expertise in medicines and also support the development of the Independent Prescriber role as detailed in the ‘Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland’ document published in August 2017. Importantly, the proposal also makes reference to the role of all three areas of pharmacy – community, GP practice- based and hospital, and that they all link together into an integrated pharmacotherapy service.


As well as these areas we believe there are also further opportunities for pharmacy. For example for in community treatment and care services, we believe there are opportunities for pharmacy around other services such as ear syringing – there is already interest from some


proposed around the data controller role, it is urging a greater sense of inclusiveness across all health professions when the Scottish Government develops national standards for e-health governance.


It is intended that, by the end of the transition period, ‘GP pharmacists’ will deal with acute and repeat prescribing and autonomously provide pharmaceutical care through medication and polypharmacy reviews.


Each of the 31 HSCPs (Health and Social Care Partnerships) in Scotland will develop a Primary Care Improvement Plan to outline how these services will be introduced before the end of 2021. •


the skills and professional expertise of others –such as community pharmacists.


We will enter into discussions with partners and Scottish Government around the next steps to see how community pharmacy build on the new ways of working already happening including the Pharmacy First concept. We will also look to areas such as information sharing to understand how the community pharmacy network can be enabled to support patient care further.


pharmacies to set up these services especially in England where they have been decommissioned from CCGs and with the right training this could be another opportunity for pharmacy in Scotland.


It is important that pharmacies now begin to develop the skills and confidence to adopt this clinical role and we as Numark will be looking at how we can support our members to make this change.


SCOTTISH PHARMACIST - 11


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32