National
Assembly for Wales
Health
and Social Care Committee
Follow-up
inquiry on the contribution of community pharmacy to health
services
Evidence from
Royal College of General Practitioners– CP 6
Royal College of
General Practitioners Wales
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Committee Clerk
Health and Social Care Committee
National Assembly for Wales
Cardiff
Bay
CF99 1NA
30 April 2014
RE: Follow-up
Inquiry into the contribution of community pharmacy in
Wales
Please find attached comments
from RCGP Wales on the follow-up inquiry into the contribution of
community pharmacy to health and wellbeing services in
Wales.
Yours sincerely
Dr Paul Myres
Chair
RCGP
Wales
Response to the follow- up inquiry into the contribution of
community pharmacy to health services in Wales.
The Royal College of General
Practitioners (RCGP) is the largest membership organisation in the
United Kingdom solely for GPs. It aims to encourage and maintain
the highest standards of general medical practice and to act as the
‘voice’ of GPs on issues concerned with education,
training, research, and clinical standards. Founded in 1952, the
RCGP has over 49,000 members, with around 1,900 in Wales, who are
committed to improving patient care, developing their own skills
and promoting general practice as a discipline.
The Royal College of General
Practitioners in Wales (RCGP Wales) welcomes the opportunity to
contribute to this inquiry.
- There has undoubtedly been slow
but steady improvement in the raising of public awareness with
regard to services available in community pharmacies through the
likes of the ‘Choose Well’ campaign, signposting from
the GP out of hours services and agencies such as NHS Direct.
Patients, however, still remain confused as to the services offered
by individual pharmacies and the level of signage is very variable
with a distinct lack of bilingual usage in some places.
- The delivery of the influenza
inoculation programmes through community pharmacies highlighted
service availability to the public. However, this would be enhanced
by joint planning with GP colleagues and a central stock and
ordering system.
- There does, however, remain
significant variation in the services available and the uptake of
locally enhanced services depends on the lead taken by the
individual Health Boards and the interaction within the local
community of primary care service providers. Facilitation by Health
Boards remains poor and service planning and discussion in locality
networks or clusters has been slow to develop but hopefully will
gain impetus this year with the QOF changes in the GP
contract and the need for Health Boards to promote locality
working. At present, in many areas there seems to be little
encouragement for community pharmacies to be involved in cluster,
network development.
- The long term use of locums
rather than resident pharmacists in some practices leads to slow
service development and should be discouraged.
- The vision of a ‘seamless
primary care’ service is still far from realisation. Inter
professional difficulties came to the fore with the aforementioned
influenza campaign with duplication of effort and patients being
‘targeted’ despite already having appointments booked
with their own GP surgery. Due to the impact of the service
change on GP surgeries, worries were created over being able
to offer a viable service with planning of stocks of vaccines and
running of clinics causing some friction between the professions.
Risks to dispensing practices were previously highlighted and still
remain a concern for many practices who appreciate that dispensing
was not meant to bolster other health service provision, but face
the reality that this is exactly what has occurred.
- Difficulties with I.T. and
access to records still exist and this leads to problems for the
Pharmacist and the GP as there is failure to update both ways. The
medication use review was seen as a way to cut down on wastage and
to contribute to a patient’s self management of
their condition with suitable health education advice being
supplied where appropriate by the Pharmacist. Sadly, the areas in
which this may have been most valuable, i.e. those in a ‘care
environment’ or patients resident in their own homes and
housebound, was not part of the requirement and therefore was
a missed opportunity. Duplication of effort and referral back
to GP for further input, advice and correction of prescribing did
little to improve relations
- The GP contract and QOF
framework required GPs to undertake medication reviews for their
patients on the chronic disease registers – sensible
co-ordination and acceptance of a single medication review,
wherever done, would have facilitated closer working practices.
However, where done sensibly and sensitively there has been benefit
for all: patient, GP and Pharmacist. RCGP Wales and the Royal
Pharmaceutical Society in Wales have called for a strategy to
enable improved sharing of patient information which is essential
if community pharmacy is going to work.
- Discharge medication reviews
have been useful and ensure safety of the patients where this is
done effectively. However, in fairness, the problem still lies with
the quality of any discharge information provided by our colleagues
in secondary care. A computerised print out or electronic
communication to both GP and Pharmacist would greatly enhance
safety and continuity of care. These advanced services still retain
the potential for great benefit to the Health services and
patients.
- There is little to show that
locating appropriate services within community pharmacies could
provide an opportunity to reduce inequalities and support increased
access to services for those living in more deprived areas. Many
small GP practices are located in these areas and continue to try
and provide the bridging services required. We are not aware of an
audit of cost-savings for the NHS or any statistics showing
reducing pressures on other areas of the NHS. There is a lack of
evidence currently supporting the transfer of care from the
secondary to the primary and community sectors due to the
contribution of community pharmacies.
- Use of the
‘consulting’ room or protected area in pharmacies
allows for provision of enhanced services and these appear to be
popular with patients. Confidentiality and anonymity are usually
secured for the patient but this can lead to some fragmentation of
the holistic record and treatments for some patients. Smoking
cessation services are useful but notification to the GP needs to
be ensured in order to avoid further duplication of
work.
- The hope that the transfer of
some services from general practice to community pharmacy could
reduce GP workload has sadly not been realised. Minor ailment
services have been beneficial in allowing patients to see
Pharmacists initially and cut down on some of those approaching GP
services but follow up reviews and substitution of other service
requirements has ensured that any free time from this has rapidly
been utilised
- Emergency Hormonal Contraception
Service remains popular but needs to be seen as an educational
opportunity rather than simply a service provision if we are to
try and reduce sexually transmitted disease
and unwanted pregnancies that occur, especially among
younger women.
- Needle and syringe programmes
have been difficult to implement, with many pharmacies shying away
from the issue due to the security requirements. Similar problems
also occur with the supervised consumption of
methadone.
- Health promotion programmes need
to be carefully thought through to ensure public confidence. The
diabetes awareness campaign resulted in extra work load for
GPs but was successful in targeting previously
undiagnosed patients at risk. t On the other hand, the cholesterol
checking in pharmacies resulted in no risk profiling being
undertaken and patients opting to go to their GP to get their
medication (statins) rather than buy the over the counter
variety, resulting in much of this stock being unused. There
needs to be an holistic approach to the delivery of health
promotion services in primary care.
- Pharmacists remain poor at
identifying carers and their roles in regard to collecting and
dispensing medication. Recognition of those with hearing or
visual impairment seems to have improved but problems still occur
when dealing with patients with learning difficulties.
- Records of prescription repeats
should allow identification of failures to collect and notification
to surgeries where issues of concern may arise.
- Accessibility is still patchy in
many locations with a lot of pharmacies shutting in advance of the
local surgeries or not offering services during the out of hours
period. Greater clarity of an ‘on call’ community rota
would also ensure that patients had the opportunity to
access Pharmacists’ advice rather than using the GP out
of hours services or the local A/E department.
- The prescription delivery
service offered by many pharmacists is an invaluable community
service with many of the drivers becoming a ‘point of
contact’ for the elderly and housebound and many pharmacists
offering same day delivery, even late in the afternoon when
contacted by the GP.
- Our community pharmacy
colleagues do offer excellence in their roles– repeat
dispensing; the safe disposal of unused medicines or medication
waste; the promotion of healthy lifestyles; sign-posting to other
health professionals; support for self-care and clinical
governance; providing a high quality advice service to patients and
patients’ views on services are captured and their complaints
heard.
- We do believe that our
Pharmacist colleagues are dedicated, hardworking professionals
whose main aim is to provide the full range of essential services
to the best of their ability but that the expansion into advanced
and enhanced services is limited by capacity issues and needs more
Health Board support.
- In summary, there remains
significant variation in the services available throughout Wales.
The uptake of locally enhanced services depends on the lead taken
by the individual Health Boards and the interaction within the
local community of primary care service providers. The RCGP in
Wales is committed to improving collaboration between GPs and
Pharmacists to help maximise the contribution of community
pharmacy to health services in Wales.
Dr. M.A. O’
Donnell
Vice Chair (Policy
and Public Affairs)
RCGP
Wales
RCGP Wales is happy for this response to be made public.