STALWART


hypertension than through general practice. this gave me a clear indication that countries like canada are now overtaking us and reinforced by belief that we need to continue on the path of service development. other examples of how community pharmacy is changing is seen by the number of countries were vaccinations are now routinely taking place in the community pharmacy setting. Ireland have been at the forefront of community pharmacies delivering flu vaccinations to at risk groups and are now firmly part of the national flu Vaccination programme.


What about the role of practise-based pharmacists?


‘for me, at this moment in time, I personally think we are focussing too much on putting practice-based pharmacists (PBPs) into surgeries – and thereby diverting money away from community pharmacy. In my view, PBPs are currently filling the important administrative role of managing repeat prescriptions. they are helping ease the work of gPs, however they are not in many cases seeing/managing patients. gPs have had to take on the responsibility of repeat prescribing and medicine management in recent years as they are no longer able to delegate to unqualified staff, and rightly so. I would argue though that we need to be supporting patients, helping them manage their conditions in the community setting, keeping them heathy and involved in their own self- care. In this way we can help reduce the number of patients attending gPs and help ease pressure on the primary care sector. Maybe it’s about balance, but community pharmacy could end up in the same situation as gPs, whereby the sector could become, and some would say already is, overwhelmed with the same issues of lack of funding and increasing demand.’


In addition to the changing role of the community pharmacist, raymond also believes that nI can learn much from how other EU and commonwealth countries address specific healthcare issues.


‘one major issue that is creating debate across the globe is that of access to codeine-based products,’ he continues, ‘and the fact that many are available on an over-the-counter basis is exacerbating the problem.


‘In 2016, australia introduced a new real-time recording and monitoring system for medicines containing codeine. Perhaps unsurprisingly, the system – MedsaSSISt – was developed in response to concerns over patient safety relating to these medicines and as an effective alternative to requiring patients to have to go to the doctor to get a prescription for these products.


‘MedsaSSISt is a clinical decision support tool, which has a focus on patient care and patient pain management support pathways designed to help pharmacists identify patients who are at risk of codeine dependence. It facilitates access to suitable referral pathways to support patients to better manage their pain and enhance health outcomes.


‘Basically, MedsaSSISt allows the pharmacist to assess the therapeutic need of a codeine medicine for a patient in accordance with the current practice for the supply of pharmacist only medicines (PoM).


‘the pharmacist will then ask for a photographic Id and seek consent to record the Id number in the system which is protected, controlled and operated by the Pharmacy guild of australia. It is only the unique number on the photographic Id that is recorded in the system. the system does not record other details such as name, date of birth and address.


‘the pharmacist also records the name and the quantity of the requested codeine medicine and reviews any previous purchases of codeine medicine.


‘If a supply is made based on therapeutic needs, the reason for use and recommended duration of use will be recorded in the system. If the pharmacist decides it is not therapeutically appropriate to supply a codeine medicine, they will explain the reason for this decision and may provide further clinical information or recommendations to support the patient’s health. this will also be recorded in the system.


‘What this basically means is that in australia, if you go in to a pharmacy to buy co-codamol, or any codeine- based product, it’s recorded in a national database. It’s not like here, where you can go around various pharmacies and buy several packets at a time.


Raymond on a recent visit to a hospital pharmacy in Botswana


I personally think we are focussing too much on putting practice-based pharmacists (PBPs) into surgeries – and thereby diverting money away from community pharmacy


‘that’s what I mean about nI’s presence on the EU and global stage being a ‘win-win’ situation. We are certainly contributing in terms of outreach and engagement, but we are also gaining experience and knowledge from schemes such as the australian one described above. these connections have helped keep pharmacy in nI on the global map.


‘Issues such as the opiate addiction have to be addressed on a global basis. It’s the same with Valproate. In January this year, the EMa Prac recommended changes to the way women of child bearing potential suffering from epilepsy and on Valproate should be managed. It is known that Valproate is as harmful as thalidomide was considered in the 1970s.


‘approximately ten per cent of babies born to women taking Valproate will have malformations, and up to 40 per cent will have neurological and developmental problems. however, Valproate cannot just be stopped during pregnancy, and epilepsy needs to be managed very carefully through to full term. Pharmacists have a major role in ensuring women are aware of the risks and the need to be participating in a pregnancy prevention plan as part of their treatment. despite the fact that restrictions were put in place by 2014, recent research has shown that around 1000 women in france were still affected last year. Pharmacists need to be engaged more in


discussions with patients about risks. research carried out by Mhra indicated that only five per cent of women received information from pharmacists on the need to avoid pregnancy while taking Valproate.’ on the question of MUrs, raymond would like to see some changes in the way these are delivered.


‘MUrs don’t allow us to ask questions and discuss issues with patients who don’t suffer from asthma or diabetes. In my opinion, it would be more sensible to allow us to be in a position to have conversations with patients with a number of conditions were we know there is a need for support and a more intensive input. other conditions include epilepsy, patients on Methotrexate, cardiovascular conditions and Parkinson’s disease. It could be we have to focus on certain conditions, but with a flexibility to intervene in other conditions, some which are often not given the focus need to support patients. Ultimately, I would like to see pharmacists being in a position to alter medication and record this on the patient’s record. this could be done within guidelines and would help patients manage their condition and ease the pressure on the gPs.


‘Much has changed over my time as a community pharmacist, and much is still to be done, but the profession as a whole is more recognised as being the experts in medicines. community pharmacy needs to continue to evolve to ensure we are part of the future.’


PharMacY In focUS - 59


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