‘Community pharmacy services were severely impacted from the beginning of the COvID-19 pandemic when public demand for prescribed and over-the-counter medicines soared,’ Professor scott continued. ‘The speed and scale of the public response risked overwhelming primary care in the early weeks and rapid changes were needed to protect services and staff and maintain access to medicines for the public. During the early stages of the first wave of the pandemic, community pharmacy staff capacity fell to below 70 per cent and rapid adjustments to premises were required to ensure compliance with infection prevention and control requirements.
‘There was also a greater expectation on community pharmacy to provide collection and delivery services for prescription medicines. early interventions were taken by the Department of Health (DH) and Health & social Care Board (HsCB) to ensure that community pharmacies stayed open to supply medicines to the public and to protect their staff. Interventions put in place included financial support, prioritisation of services, business continuity arrangements and changes to opening hours.
‘A new, commissioned service was rapidly established in order to permit emergency supply of prescription medicines in the event of GP practice or pharmacy closure. Appropriate training was devised and delivered via remote learning. During April 2020, a total of 262 community pharmacies participated in this new service and 2,223 supplies were made to patients.
‘During the COvID-19 pandemic it was important to ensure that GP Out of Hours (OOH) medical centres and COvID-19 centres had access to
sufficient palliative care medicines to meet patient need. Prior to COvID- 19, the Belfast Trust area had an on-call community pharmacy service. In addition, the Northern Trust area had a service provided by secondary care. A new on-call service for other areas was rapidly developed which was provided by community pharmacy along with a back-up service from their respective Trusts. In order to implement this initiative the level of service required had to be established and a service specification and protocol agreed. In addition, participating pharmacies had to be provided with relevant information resources and additional funding. In Belfast the existing on-call service was enhanced in order to prepare for a potential upscaling of need. Additional funding was added to the on call payment fund for the time period 16 March to 30 June 2020 and the one week on rota fee was temporarily increased.
‘During the pandemic the stay at home messages and large numbers of people shielding and self-isolating created an excess demand for medicines deliveries which community pharmacies alone could not manage. The community and voluntary sector stepped forward to help and provided an invaluable resource, co-ordinated by Community Development and Health Network (CDHN), which allowed the delivery of medicines to vulnerable, shielding or self-isolating people.
‘under this scheme 33,750 prescriptions were delivered across Northern Ireland from 252 pharmacies during the reporting period. By the end of August this had increased to 63,121 deliveries. A total of 120 community groups registered with Community Development Health Network (CDHN) to deliver this service. The groups were from a
Professor Mike Scott (left) with Seamus O’Reilly, Medical
Director, Northern Health and Social Care Trust at the signing of the Memorandum of Understanding with the Polish Society of Clinical Pharmacy.
broad range of backgrounds, for example, sports clubs, churches, community transport groups and charity groups (eg, Age Concern, Red Cross).
‘When it came to workforce, all pharmacists on the professional register were asked to consider if they had any spare capacity to assist in the pandemic response, particularly in community pharmacies. To facilitate engagement, a single point of contact was established for community pharmacist locums and other support staff. Interested individuals registered with the ulster Chemists’ Association (uCA), who subsequently matched staff with appropriate community pharmacies. A temporary pharmacist register was enacted in April 2020 by way of regulations, and all pharmacists who had left the register in good standing in NI over the last three years were reinstated to the register unless they opted out.
‘Dental services were scaled down due to the pandemic and an initiative was developed that enabled dental staff to assist with the surge in workload in community pharmacies. Foundation dentists and general dental practitioners received remote training to prepare them to work in community pharmacy and 31 were successfully redeployed. A number of standard Operating Procedures (sOPs) to support their work were developed.
‘Pharmacy undergraduates from both schools of pharmacy at ulster university and Queens university Belfast responded to calls for support from pharmacy services. Information provided by Queen’s university Belfast indicated that 148 of their students worked during the pandemic. The vast majority (80.3 per cent) of these students were placed in the community pharmacy sector.
‘In primary care, the skills of the General Practice Pharmacists were utilised in a range of therapeutic areas, for example, management of anticoagulation, diabetes, asthma and mental health. Whilst some of these areas would be routine business for the General Practice Pharmacist team, the innovation was that much of it was carried out remotely. Development of robust communication methods and networks were required to agree and facilitate implementation of
numerous changes in primary care and to enable the exchange of information. Novel methods, such as telephone, video conference and messaging systems were adopted for communication between healthcare professionals, while, in community pharmacy, a number of technological solutions for communication with patients were also used, for example, virtual consultation, use of adherence support apps and text messaging reminders.
‘We were also very aware that many patients were self-isolating and therefore could not attend a community pharmacy, and so a medicines management group was set up with relevant stakeholders to discuss and address any medicines related issues within the centres. This enabled safe and rapid access (within 24 hours) for each primary care Covid-19 centre to acquire a stock of over-labelled packs of medicines.
‘All in all, I feel that pharmacists throughout Northern Ireland provided – and continue to provide – a first- class service to their patients. Now that the second wave is upon us, I feel that the profession will once again demonstrate its first-class contribution to primary care.’
COMMENT
Cathy Harrison, Chief Pharmaceutical Officer This rapid review captures the changes to pharmacy services that were implemented in the Health and social Care service in Northern Ireland during the first wave of the COvID-19 pandemic. It is a powerful endorsement of the commitment and professionalism shown by pharmacists and pharmacy teams working in our hospitals, general practices, community pharmacies and support services. It is also a positive reflection of the support provided to the frontline pharmacy workforce by the Health and social Care Board and Department of Health and the benefits of partnership working with pharmacy professional and representative bodies and the community and voluntary sector. I would like to extend my thanks to all those who took the time to share their experiences, to everyone involved in the initiatives included in this review and to the Medicines Optimisation Innovation Centre for compiling the report.
PHARMACy IN FOCus - 7
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