Health and Social Care Committee
Inquiry into the contribution of community pharmacy
to health services in Wales
CP 37 –
Welsh Food Alliance
What
changes do citizens want to see that would improve service user /
patient care?
Evidence
submitted by the Welsh Food Alliance
on behalf of a
Community Pharmacy community consultation
held on
19th September 2011 for presentation to the
National
Assembly for Wales, Health and Social Care Committee
Introduction
- This process could have been
assisted with a wider understanding of how to engage with service
user and carer perspectives on this important issue. This could
have been supported by factual information, for example, concerning
government expectations about service model changes arising from
the Wanless Report (2003); general financial pressures, including
erosion of profitability in the sector and increased productivity
pressure on pharmacists employed by multi unit operations. It is
noted that we briefly discussed the role of salaried community
pharmacists linked with Community Transport in rural and semi rural
areas.
- Since its inception the
Welsh Food Alliance (WFA) has recognised that nutritious food and
exercise have an important part to play alongside medication in
bringing about health and wellbeing. We are also well aware of how
drug companies support patient groups – or even set them up.
Over the past ten years we have organised consultations and
contributed to the Wales Wanless Review (2003), ‘Beyond the
Boundaries’ (2006) and supported a public consultation and
report on Medicines and Older People (2007). We welcome this long
over due Inquiry and submit views.
Method of work
in time available
- Receiving the call of
evidence, as some of us were departing on holiday, left a short
space on return to pose four questions set out in the attached
flyer to support your welcomed inquiry. This was not as
straightforward as expected, although we are fairly experienced in
seeking service user perspectives. Initially, WCVA assisted in an
attempt to communicate with rural, Communities First and National
Health, Social Care and Wellbeing Networks. This resulted in a
limited response, except from previous contacts. Even then six
people were unable to attend: awaiting treatment, without transport
or due to work pressures. An e-mail sent by Dr. xxxxx,
– National Service Framework for Older People, enabled
contact with Frank Hogg, several LHBs and two local authorities. We
attach a list of attendees and others who contributed by e-mail, or
by phone. The two questions we posed were the same as posed in the
above 2007 consultation: “What should be expected? What would
make it better?”
- Although most participants
had a good understanding of the NHS in Wales, the questions posed
assumed a fair degree of detailed prior knowledge and professional
intimacy with the Community Pharmacy and NHS reform. This is why we
invited Andrew Evans, the Welsh Assembly Government Community
Pharmacy Manager to brief us on the contract (attached) and to join
our event to answer factual questions on our first question, which
we found most helpful. This lack of knowledge may explain a
possible limited response from the public to your Inquiry. However,
in a survey undertaken of older people attending an Older
People’s Information Day at Newport Centre two years ago WFA
found that 90% of respondents listed ‘medicines
maladministration’ in the top two of ten NHS type issues
identified.
- In the time available at our
consultation we focused upon giving voice to public views and this
we report as below. At the end we summarise issues. We attach a
list of attendees, and publicly thank the Open University in Wales
for the provision of free accommodation and Dr Paul Walker a former
public health consultant with NPHS for chairing this event. The
various contributions have been checked with the various
individuals concerned. It is noted that some overlap with each
other, but we wished individual contributions to speak for
themselves.
Context
6.
Fortunately on the day of our consultation a
timely ‘There is no age limit in the fight for health’
letter appeared in the Guardian stating: “This week the
United Nations is bringing together world leaders to discuss the
global health crisis of non-communicable diseases (NCDs):
strokes, cancer, heart attacks, lung disease and
dementia
(Report, 17 September). These diseases are on the rise
like never before: by 2030, the
World Health Organisation (WHO) predicts that the top four killers in the
world will be NCDs. What is most striking is that their impact is
felt most on those over the age of 60”.
- “An ageing population brings a new set of critical
health challenges. Alzheimer's
disease and other dementias, for example, affect
12% of those over 65 and more than 30% of those over 85. Over the
next two decades, the number of people aged 65 and older suffering
from diabetes is expected to increase by 134%. And then there's
cancer, which, according to one British study, is six times more
likely to affect women aged 60 to 64 than women aged 35 to 38.To
win the fight against NCDs, governments and stakeholders must come
together to create solutions that are appropriate for people of all
ages, with no age limits being set for good
health”.
An effective community based
approach
- Dr Gwyneth Briwnant Jones,
an experienced former Cardiff CHC chair writes: “Changes in
the health system are necessary if we are to have an effective
community based approach to fit the needs of today. The transfer of
essential funds from secondary/tertiary to primary, tertiary and
community services is necessary, in order to provide the
infra-structure for a good service, which focuses upon Patients and
service users within the community. This is the context
within which changes in Community Pharmacy will need to be
considered”.
- Hilda Smith who has served
on three CHC’s and District and Regional Health Authorities,
writes: “An effective community based approach would
require staff training, a change of use in premises and resources,
including the use of medication to provide a more explicit and
effective use of resources and possibly save money, but this should
not be the primary motive for change. We will then have community
pharmacy used effectively by patients and carers, with necessary
support and advice available. A saving on wastage, a growth in
health and wellbeing, less use of A&E Departments and
admittance to hospital and making sure the out of hours service is
effective and value for money. More information on drugs and usage
should be available, how they work, appropriate use, and reporting
of side effects and maladministration effectively carried
out”.
The Citizens
voice or lack of it
- Hilda Smith writes:
“It is no use having comments on schemes agreed, but we need
a way of looking ahead and not just basing change on the present
formulae. We get very little information from patients that change
the system. Lets now see if we can make a difference.
- Have we accurately tested
the use of drugs on older people? Are we more alert and careful
with children? I ask because the number of older people using
medication is growingly rapidly and in future will increasingly
take place in a mainly unsupervised home environment with the
emphasis upon community-based care. Could the increasing use of
medication have any connection with the growth in
Alzheimer’s? To the lack of evidence from older people
themselves to this inquiry and a growing inability to cope within
their own homes?
- Is there a connection
between medication and lack of exercise, socialisation and
stimulation, through to malnutrition due to loss of appetite? Is it
due to medication taken at different times of the day and the
dosage given? The incorrect, or lack of use of spacers (for lung
conditions), which means that medication is not having the benefit
intended? Do we assume and take for granted that as the body ages
so does the mind and people treated accordingly, when they may be
imprisoned by the side effects of medication? Is this the real lack
of dignity and care? Do we need to increase the study of
gerontology and make it an essential part of pre registration
training for all health professionals? Having said that I am
conscious that younger disabled people are living in the community,
as well as older people.
- How do we strengthen the
service user and carers voice in the expenditure of large amounts
of public money? Do we as a society repeatedly bury our mistakes
when they constantly recur without giving voice to those that
recover? It is significant that effective changes are only brought
about when a perceptive relative or carer, often a healthcare
professional, challenges the system and brings about
change.
- In the pre-registration
training of GPs is sufficient attention given pharmacology,
especially as this relates to people with multiple conditions? How
can this be addressed with the revalidation of GPs, alongside
extended knowledge of gerontology? With GP referrals should
diagnoses and treatment plans apply to referrals to specialised
units, using cross border referrals as necessary. Otherwise
effective use of this resource is only available to an
administrative district and not a region. From a regional
centre: effective training in use of new drugs and treatment could
resonate and develop in primary care. Effective Community Pharmacy
is a part of an overall system, as is research and development
informed by the service users experience”.
Reaching service users
- Our experience at WFA is
that the role of medication and its links with nutritious food and
social wellbeing are well known. People are interested and wish to
be involved. The survey we undertook with Mature Times in 2009
elicited 1200 replies with comments from respondents who provided a
stamped addressed envelope. People do wish to be interested and
involved, but our ‘pill cure all’ culture, with the
rise of the advertising industry, becomes predominant and impacts
on the attitude towards what is expected of community
pharmacy
- From this anonomised
survey evidence we know how medication affects a persons ability to
lucidly think, remember, write and record everyday events. A person
states “I could do this quite well prior to taking a
particular medication. After that it is if a fog descends, that
immobilises thought and action processes and a loss of
energy”. Another good reason for Medicine Use
Reviews!
- Dr. xxxxx, – National
Service Framework for Older People enabled us to reach Frank Hogg,
from the Ceredigion Older Peoples Partnership (COPP). Frank writes,
"You will need to bear in mind that many older people do not have
computers. Other older people can only access electronic
communication through the library. Often it is necessary to book
the use of a computer the day prior to use, and use is often time
limited to one hour or even half an hour. Reading information on
screens takes time and is really inconvenient. Paper copies may be
down loaded, if the printer works, and contains paper, but then
costs 10p per page. Travelling, to and from the library by public
transport, has to be considered. Wet, cold days, make all this even
more problematical. Bus ‘shelters’ are often not very
good shelters and often lack seats. Lack of adequate notice given
in many documents, which seek a response, is therefore another
problem, because paper copies may arrive with very short notice
given for a reply, or even after the meeting concerned has taken
place!
18. Therefore the involvement and dedication of professional staff
is much
appreciated. They have the resources (transport, technology,
offices,
support, and funding etc). Elderly participants fund themselves,
lack car
transport, and lack communication equipment. Elderly people also
have a
more rapid attrition rate! However they really want to be involved
and to
play a part if only their difficulties are known, understood, and
reduced or
even eliminated. Older people have a wide range of experience and
expertise, and could provide a useful and helpful contribution to
‘Committees and Boards’ that consider their needs and
problems. A review of all such ‘Committees and Boards’
should be undertaken to try to eliminate overlapping and
duplication|”.
A Public Health
Practitioner and now service user view
- The key insights for Dr Paul
Walker were: “GPs and Community Pharmacists (CPs) to work
together to improve medicines use and reduce wastage and dangerous
polypharmacy. Having GPs and CPs based in the same building as
envisaged by Lord Dawson when he invented Health Centres in 1920 is
the key here. Because of the concentration of services that this
would entail however such a system would need to be supported by an
outreach pharmacy service particularly in rural areas. Better
community transport particularly in rural areas would also support
such a system”.
- “Medical training is
too much focused on diagnosis and not enough on pharmacology and,
very important, other non-pharmacological methods of
treatment”.
- “Standardisation of
the shape, size and colour of specific medicines is crucial in my
view to avoid confusion”.
- “A record of present
and past medication to be held by each patient in the form of a
booklet or smart card would be a great benefit”.
Communication
Between Pharmacists and GPs
- Ron Walton, a former CHC
member and former University Social Administration lecturer writes,
“The Medicine Use Review (MUR) is a valuable innovation to
help patients obtain maximum benefit from prescribed medicines and
also cope with side effects or complications of taking a number of
medications. Good communication between GPs and Pharmacists is
essential for the system to work well. Many patients will return to
their GP if they experience distressing side effects from medicine
and their GP is de facto reviewing both the clinical decision and
the use of the medicine. But GPs are not pharmacy specialists and
prescribing patterns are partially determined by experience and
habit rather than a detailed knowledge of the medicine or
alternatives.
- Patients’ awareness of
MURs is at a low level at present although some will have noticed
adaptations at their local pharmacy to create a consulting room.
Therefore GPs need to be pro-active in encouraging and referring
patients to their pharmacist for a regular MUR (particularly for
older people and those with multiple medications). Where a patient
independently requests an MUR at the pharmacy there needs to be
clear communication from the pharmacist to the GP. (Hilda comments:
should we have a requirement for MURs whenever a certain number of
prescriptions are dispensed?)
- The borderline between an
MUR (pharmacist) and a clinical review (GP) can be a very grey
area. It would be very useful for Local Committees of GPs to have
meetings with Community Pharmacists in their locality to develop
understandings and clear working arrangements for referral to MUR
and communicating the outcomes. This would aid the formation of
trust between the professions and, more importantly, reduce
medicine problems for patients and reduce medicines
waste.
- Older people and those with
multiple medications are at greater risk of unanticipated side
effects and have medicines changed more frequently. It may be that
the suggestion of 12 months as the interval for an MUR is too long
for many of these patients and that a shorter interval would
benefit them (eg, six months, although some present felt this could
be shorter depending on a persons circumstances).
- Anecdotally, we observe
variability in the quality of MURs: one involving the pharmacist
completing a questionnaire when interviewing the patient, whereas
another involved a 15 minute conversation, following a 30 minute
delay, of what was thought to be a MUR, with no notes taken. How
will evaluation or professional revalidation support consistent
quality?
- At present the GP is an
important gateway to MURs. GPs should be encouraged to use this
service for the benefit of their patients. At a more general level
better communication between Community Pharmacists and GPs could
result in discussions about good standard prescribing practice and
contribute to enhanced and standardised prescribing in local
areas”.
Community
Pharmacy - market structure; MURs; Patient voice
28.
David Smith, a former
Wales lay member of the Council for Professional Regulatory
Excellence writes: “When considering community pharmacy we
need to recognise the role of exercise and nutritious food and how
this relates to medication; the need to move from dispensing to
diagnosis and treatment; and the potential conflict between ethics
and business.
- Large retail chains have
transformed the traditional perception of local independent
pharmacists. Changing industry structure means although the number
of pharmacies remains approximately the same, a good proportion of
pharmacists are employees of large companies. They also will have
company policies relating to the employment of locums, which has
been a point of concern.
- With government clawing back
anticipated profits companies are having to ensure employees
dispense an increasing volume of prescriptions in a limited amount
of time, and the issue of constant repeat prescriptions for people
with whom they have no face to face contact.
- Across the UK large chains
are reported to employ in excess of 55% of all Community
Pharmacists. Corporations, such as Boots, Lloyds, Asda and
Sainsburys have obligations to shareholders that could conflict
with public health priorities.
- In 2008 a review of
Medicine Use Reviews (MURs) found that chains had implemented the
service more rapidly, but also noted a weak negative association
between the levels of provision and levels of deprivation and long
term illness. Hence, our consultation was partly aimed at
Communities First areas, where examples of really effective Health
partnerships in shaping service provision are relatively rare (see
para 22.5 of a recent Government Communities First evaluation
16/2011).
- Evidence suggests that
asthma targeted MURs are beneficial; eg, see Portlock, Holden, and
Patel ‘A community pharmacy asthma MUR project in Hampshire
and the Isle of Wight’. Pharm J 2009;
282:109-120.
- If 53% of unused MUR
funds allocated by the Welsh Assembly Government are being used by
LHBs for other purposes, will greater ministerial direction be
given to target specific population groups, in areas, for example,
with high concentrations of frail older people?
- CHC’s should be alert
to public safety issues and the contribution of community
pharmacists as part of a system with necessary checks and balances.
I am unclear how establishing protocols to visit individual
pharmacies might be a good use of time, where the HQ’s of
multi unit operations drive internal consistency to protect their
brand, combined with the statutory professional inspection
arrangements.
- In the context of our newly
emerging NHS driven ‘Neighbourhood Care Networks’ a far
more significant development in one part of Wales could be the
establishment of Patient Participation Groups to help provide
meaningful citizen engagement in the context of planning, delivery
and evaluation of services.
- To inform the future of
Community Pharmacy it would be useful for (a) the Inquiry to
publish information about the structure of the pharmacy market in
Wales so that we are all clear where and how public money is being
used; and (b) for an appropriate representative and accountable
citizens body to advise the Minister and National Assembly members
on key issues relating to the equity, efficiency, effectiveness and
value for money and the implications for access, safety and quality
of patient care with the multiple chains operating in
Wales.
- The NAfW has an all party
Community Pharmacy Group. This appears to be a private conversation
between trade interests and elected representatives. Where is the
patients voice and how could this be supportive of public health
objectives? More widely, in terms of health professional regulation
and public protection / patient safety issues, the then CHC Board
made recommendations to the Minister in 2009 about how this issue
could be addressed”.
Young
Carers
- Lindsay Haveland, Senior
Health and Social Care Facilitator, who WFA have worked with
previously on rural older peoples food issues commented by email:
“Young carers often complain that pharmacists will not allow
them to collect their parents’ medicines unless a
“responsible” adult accompanies them. This has
led to all sorts of problems. Perhaps there should be a
universal system for identifying young carers, similar to that used
for adult carers. Also, there is the aspect of, if a young
carer has an accident or is involved in a medical emergency, what
happens to the cared for, if services are not aware of the caring
responsibility?
Communication
issues
- Lindsay also writes:
“Locality working - I know some work is being done in the
Abergele area around making the taking of medication easier for
people to understand. This should be universal. There should
be better sign posting to support organisations, and this would
also work within the locality setting. Other issues
include:
- Those with a chronic
condition (such as coeliac syndrome) are given medicines containing
the ingredient, which exacerbates the condition.
- Pharmacists not being
informed when a patient on repeat prescriptions is 1) admitted to
hospital, 2) discharged from hospital, 3) left the area, or 4)
died. This does not include those whose medication is changed
by the hospital, but no note has come from the GP so that the
repeat prescription can be changed. This leads to
waste.
- The fact that pharmacists
are not supposed to fill drugs dispensers for patients, on the
grounds that they can no longer ensure the efficacy of the
medication.
- The fact that some patients
have very low literacy and numeracy levels, and this is
particularly the case of those on long term Incapacity Benefit (in
Rhyl a few years ago out of 450 + patients seen by a health
advisor, 75% had literacy and numeracy levels of Entry Level 1
– 3, chronological age between 5 and 9
years). (David Smith
comments: Health Literacy issues needs to extend beyond “time
to provide proper counsel” - see RPS Journal 20 August
2011).
Information made available to service
users.
- Frank Hogg writes about the
“specific problem of unreadable expiry dates. Boxes often do
have expiry dates, but all too frequently the dates are
‘blind stamped’ into the ‘shiny white’
paper end flap of the container opening.
- Following
conversations with other older people, I have found that many boxes
stored in older peoples homes had passed the appropriate date. The
medicines have more than one name, which adds to confusion, eg the
proprietary name, the medical name, and sometimes a generic or even
a Latin name. E.g. ‘Cardicor’ is also
‘Bisoprolol’ very confusing when both names are
used almost interchangeably. Older people usually have
several medicines taken in differing quantities at differing times
of the day and night. Dosset boxes help but do not eliminate the
problems. Some experience the onset of other problems such as
memory loss, isolation, and lack of sympathetic neighbours, or
visitors. Relatives, including children, may have moved away to
find employment, and may only return very occasionally.
- The
‘Discharge notes’ in some hospitals are
written quickly and sometimes under busy pressure by medical staff.
Sometimes those notes are duplicated or even quadruplicated, and
sometimes as ‘carbon copies’. The ‘patients
copy’ may be the 4th, virtually unreadable copy. These notes
are sometimes illogical, in a haphazard order and seem not to be
produced to be easily interpreted or understood.
- These issues require serious
consideration and I will ensure that this matter is raised with our
Local Health Board so that a proper formal investigation can take
place, perhaps jointly with Public Health Wales.
Rural
communities
- Trish
Buchan, Health & Social Care Facilitator, PAVO writes:
“For many years community high street pharmacies have
provided valued source of independent advice and support to people
in rural communities not least in delivering prescriptions. At
best they have been part of the extended informal local primary
care team; easily accessible on local high street and open at times
when the surgery is not. Many pharmacists lived in or near
communities in which they worked. This is probably still the
case in most areas but during the last two years I have become
increasingly aware of problems - some through personal experience
and others raised by Third sector groups. Issues that have come to
my attention are:
- Not
having sufficient stock to dispense full prescriptions. This means
people have to return to top up prescriptions and on at least one
occasion Tramadol was not available in the local pharmacy I am
aware that in one area the community have organised themselves to
take prescriptions to a neighbouring pharmacy six miles away as
they perceive this to be a long term problem.
- Using
different sources of generic drugs. This confuses people because of
variable colours, size, shape, etc.
- Very
limited other stock in pharmacies –the best pharmacies
provide a valuable sources of commodities not available in other
shops.
- Use
of locums.
- Bad
weather has prevented pharmacist from traveling to work. This is
problematic when there is only one pharmacist working. It impacts
on people e.g. such as those using methadone (business
continuity and winter contingency plans could be tightened
up).
- There
have been issues about volunteers, carers including young carers
picking up prescriptions –a code of practice would be
good
- There
have been really positive developments by Community Pharmacies
including delivering prescriptions to peoples' homes, health
promotion initiatives and blood pressure checks.
- Basically, Communities Pharmacies are and have been a
fantastic resource for rural people. There are opportunities for
extending roles, e.g. supporting self-care but it is important
to ensure that the core pharmacy service is maintained at a high
quality”.
Carers and
community pharmacies
- Lindsay Haveland, Senior
Health and Social Care Facilitator: “re: carers and
community pharmacies. …There are a few carers centres in mid
and South Wales that have pharmacy projects working to help
champion carers in much the same way that is being done in GP
surgeries but it is very patchy. Anything we can do to plug the gap
and make it easier for carers both in identifying them and ensuring
pharmacists are more carers aware has to be explored. Have attached
some background research into why strengthening this link is so
important.
http://professionals.carers.org/health/articles/identifying-carers-through-pharmacies,860,PR.html
BME
communities
- Anna Ros-Woudstra,
Development Officer - Swyddog Datblygu, Ethnic Minority
Communities First Team, Cardiff, writes: Effective
Community Pharmacy could be a good thing for BME
communities. Especially with the following:
- Bridge the gap accessing health services
- Medicine Use Reviews that are appropriate to different
cultural and related health needs, which engage with local
community organisations
- Improve trust and information with regards health issues/
health professionals. Eg, ensure pharmacy staff can
reflect the make up of the locality in terms of ethnicity and
languages.
- Make sure
people know that information and services are available and how
they can use them – do not assume people know how to use the
services or what to do with the information
- Address communication issues re the colour, size, shape,
etc of medication and varied cultural needs of different
communities
- Prevent auto-medication and passing on medicines –
inform about side effects
- Health checks and signposting to other health
providers
- Links
with grassroots BME community organisations to inform, promote new
models of health service planning and delivery
- Participate in community health events.
- It is
important though, that in order to engage with the BME communities
that the Community Pharmacists are prepared to go to the
communities, have information chats within their community venues
and help bridge the gap that way. As an example: BME communities in
Butetown were not using the blood pressure services within their
local pharmacy, but when somebody from the local pharmacy attended
an event providing health checks they had big queues – many
BME community members where not aware they could go to the pharmacy
to take the test.
- They
are several health projects/reports that has very explicit
recommendations around local and culturally appropriate health
services, such us:
- The Inverse
Care Law in Action? A primary and community Health Care Needs
Assessment For Butetown and Grangetown wards in Cardiff-
2006
- Nicola
Hughes – (2008) Inequalities in Health Fund – HeartLink
Project- Hearth diseases and diabetes action in BME in South West
Cardiff- Final Report 2008
- Welsh
Assembly Government (2005) Health ASERT Programme Wales. Enhancing
the Health Promotion Evidence base on Minority Ethnic Groups,
Refugees/ Asylum Seekers and Gypsy Travellers.
- Butetown
Speak Out Be Heard – Community Consultation Report 2010,
Butetown Communities First.
- “Barefoot” Health workers project – Final
Report 2002-2007 – Inequalities in Health Fund. Sue Torner
– Sept 2007.”
Supply and
delivery of medication
- Linda Rollings RMN,
Service Manager, St Luke's Healthcare, Hillside, Ebbw Vale,
writes: “At this Hospital we use a local pharmacy for
the supply and delivery of medication. We have a service level
agreement that states that the pharmacist completes an audit on a
monthly basis on each of our three units. We are about to
open another hospital that will, in time, have four units.
When reviewing the summary of structure and enhanced services
I wondered how do you ensure the value and standard of all the
services that a pharmacy may offers, within his/her pharmacy,
whilst having commitments to independent hospitals”.
Care
Pathway
-
Sue
Dryburgh, Planning & Commissioning Assistant (Older People),
Monmouthshire County Council writes: “ Our comments on Monday
were based around the service user’s/carer’s knowledge
about the medications being administered, their side effects and
the implications of not taking as directed. In addition the
problem of hospital discharges (Andrew Evans did say that this was
being addressed this year but it still doesn’t take away the
problem of the first couple of days at home without input from the
GP surgery or pharmacy and with a bag full of medication –
particularly a problem if the service user is elderly and
confused). We would also like to highlight the level of
responsibility expected from poorly paid and not always
sufficiently trained care workers and the importance of involving
the care agency responsible for administration in the
MUR?”
Communities Firstperspective
-
David Napier writes: I speak on behalf of
some of the communities within Caerphilly County Borough as
a Communities First Health and Wellbeing Officer.
Of course do not speak on behalf of all Communities First
staff. The main
grudge has been the lack of pharmacies in the north of the borough
in particular, but also including Trinant in the east. Although it
is recognised that the infirm/house-bound etc can have a delivery
service there are many others who may not have the transport to be
able to get to a pharmacy, as the transport system is not the best
in the area.
- There is
also an issue regarding the timing of satellite doctor's surgeries
and although a separate issue it does have an affect on the issue
at hand, in that if it is difficult to see a GP then they are more
inclined not to bother going and even if they then do get a
prescription that lethargy and the bad transport system fuels their
lack of attendance at future GP appointments and thus the picking
up of any prescription.
- Whilst the
feasibility of a peripatetic pharmacist may not be to the benefit
of what is after all a business concern something should be
possible to alleviate the issues in these areas.
- The other issue I raised was regarding the prescription
waste audit. One of the issues was that I wanted to know if they
asked the rational for any wastage i.e. did they forget to take
medicine, take the wrong medicine (due to possible change in
shape/name) or took medicine but 'felt better' after only taking
half of the prescription and so on. Without this knowledge
government cannot surely make informed judgement of what is actual
'waste', and thus begin to know how to prevent such waste in
future. Whatever the outcome, the recent meeting has prompted some
ideas for a few projects
- Summary:
`these observations are a summary of detailed discussion in a
wide-ranging conversation and email contributions, which have been
listed in no particular order. It would have been interesting if
organisations representing the views of the public we seek to serve
and using public resources had been able to research and publish
patient views on a very important issue.
- As stated by Dr Gwyneth
Briwnant Jones “Changes in the health system are necessary if
we are to have an effective community based approach to fit the
needs of today. The transfer of essential funds from secondary /
tertiary to primary and community services is necessary, in order
to provide the infra-structure for a good service, which focuses
upon Patients and service users within the community. This is
the context within which changes in Community Pharmacy will need to
be considered”.
Conclusions
- We need to review medical
services to ensure that the focus is upon the patient and the
community. This includes:
·
Improved
communication between GPs and Community Pharmacists.
·
Ensuring that
consistent MURs are undertaken to ascertain the effectiveness of
the treatment, especially in the case of older people and disabled
service users who may have a combination of medications.
·
Medicine Use Reviews that are appropriate to
different cultural and related health needs, which engage with
local community organizations.
·
Provision of
clear pathways for the acquisition, receipt and safe use of
medicines, particularly for older and disabled service
users.
·
Assurance that
health professional revalidation supports the above.
·
The role of
salaried community pharmacists, linked with Community Transport in
rural and semi rural areas.
·
Neighbourhood
Care Networks across Wales embed Public and Patient Engagment at an
early phase when considering ‘promoting more cost-effective
prescribing in selected groups of medicines’.
Hilda Smith and David
Smith
23 September 2011