pharmacy staff collecting prescriptions on behalf of patients.
This changed the flow of prescriptions and caused challenges in respect of communications between community pharmacies and gp surgeries. Steps to mitigate the issues that arose included the development of a regional pathway and the establishment of direct communication into gp surgeries from community pharmacies. a review of the current arrangements is being undertaken with the aim of issuing a revised pathway and guidance in the coming weeks.
Communication at the beginning of the pandemic, it quickly became clear that good and clear lines of communication would be of the utmost importance for everyone to be able to meet the challenges posed by COvID-19. Ironically, as the pandemic struck, community pharmacies were being connected to the HSC IT network.
unfortunately, the deployment rollout slowed significantly, thereby limiting the ability to communicate with community pharmacies and inhibiting the development of technology support to better enable pharmacies to respond to the pandemic.
use of hard-copy letters and utilising existing e-mail networks courtesy of Community pharmacy Northern Ireland (CpNI) and pharmaceutical Society of Northern Ireland (pSNI) were the work arounds and I very much appreciate these organisations for their support.
The main constraint that emerged in terms of the deployment was that many pharmacies had their IT systems on a Windows 7 operating system. In order to establish connectivity with community pharmacies, system suppliers and pharmacies were engaged to encourage deployment of Windows 10. It is anticipated this issue will be resolved and the vast majority of pharmacies are now connected to the HSC network, which will place us in a better position for e-communications for the future. This will also support new service delivery models. HSCB has, for example, secured access to a Zoom enterprise licence for community pharmacies in order to undertake video consultations and we are
encouraging this facility for smoking cessation consultations.
Through daily calls and collaborative efforts by HSCB, Department of Health and CpNI, we managed to organise and support services. HSCB also provided weekly eCHO Zoom sessions for all community pharmacists. These sessions, which quickly moved to a fortnightly basis, proved highly successful and ensured information sharing across the pharmacy community in Northern Ireland and we plan to re-institute these calls on a monthly basis from this month.
Services at the outset, there was an understandable anxiety amongst pharmacy staff in relation to the risk of transmission of infection and a demand for greater access to ppe. In the initial weeks of the surge, there was no immediate access to testing for pharmacy staff and lack of clarity in relation to requirements and supply of ppe leading to issues in relation to business continuity of some pharmacies.
Some additional services were constrained due to capacity and environment issues and decisions had to be taken quickly around standing down and/or limiting service provision.
The Oral Substitution Service (OST) delivered through pharmacies is vital in helping to manage addictions but, in the initial surge, due to the demands on pharmacies and restrictions in physical ability to supervise consumption of methadone or buprenorphine, the service was curtailed to the highest risk individuals. Discussions with addictions services have confirmed reconfiguration with revision of dosing frequency and use of different formulations to reduce the demand on pharmacies. Notwithstanding those changes, there remains a requirement for community pharmacy provision of this service. The current survey being undertaken will confirm the capacity available across pharmacies to deliver supervised OST and referral pathways will be established to move to revised arrangements by September 2020.
The pharmacy First (winter pressures) and Minor ailments services were stood down in March 2020 given the
need to protect staff and in line with the public health message to isolate if there are symptoms of persistent cough or fever. a reconfigured Minor ailments/pharmacy First service is being commissioned from this month with the aim of supporting self-care and reducing demand on other parts of the health and social care sector.
Moving forward, we have a funding package which will support the rebuild of pharmacy services for the remainder of 2020. This includes:
• Continuity of the emergency medicine supply service, which started in phase one of the pandemic.
• Services for smoking cessation and opiate substitution therapy, suspended during the initial phases of the emergency response, will re- commence
• an enhanced on-call palliative care service will be provided and a new service developed for care homes
• a ‘pharmacy First’ service will provide a consultation with a pharmacist for access to advice and treatment for common conditions, avoiding the need for the public to attend gp/Out Of Hours/emergency Department services.
• pharmacies will provide targeted advice and signposting through the Living Well Service for mental and physical health promotion
• a medicines delivery service for vulnerable groups.
as the most accessible and accessed health care venue before COvID and during COvID, pharmacies are a natural locus for the provision of health and well-being information and signposting to other services. The Living Well service was commissioned and delivered successfully in 2019/20 and provided a unique and valuable mechanism to reassure, support self- care and signpost the public to services as appropriate. With the rebuild of HSC service, it is anticipated this service could provide a helpful source of information for the public and a series of campaigns are being planned for delivery for the remainder of 2020/21.
Community pharmacies already provide private flu vaccination and, building on this facility, HSCB
commissioned a pilot in 2019/20 of flu vaccination through a number of pharmacies for health and care workers. This demonstrated that community pharmacies could provide additional access and capacity. given the constraints in relation to social distancing and ppe, the provision of flu vaccination in community pharmacy venues has been further explored through the survey of pharmacies and we plan to utilise pharmacies for the provision of flu vaccination for front line healthcare workers from October.
Care homes The need to support medicines management arrangements for care homes was recognised and to that end, enhancements have been made to the current contractual arrangements that are in place to align a dedicated community pharmacy to a care home.
During the period april to June, medicines stock boxes containing essential stock medicines for palliative and urgent treatment were offered to all nursing homes and a mechanism to replenish stock was established. During this period, a process was established for the reuse of patients own drugs in care homes. This provision was recently stood down and will soon be re-evaluated to inform further plans.
Oxygen supply to care homes was also recognised as an important issue and refinements have been made to the provision of oxygen to care homes. These will be maintained and kept under review for the remainder of the year.
The future HSCB is currently completing a survey of all pharmacies. This survey includes a review of current service provision and future plans and this is informing the commissioning arrangements for the rest of this financial year.
The Health Minister, Robin Swann, recently announced a £13.25 million funding package for community pharmacy for the remainder of 2020/21. This package is designed to help build on the great work that was carried out by community pharmacies during this COvID-19 pandemic and to ensure the sector is well prepared, should we find ourselves experiencing a second surge.
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