Aberdeenshire CHP Pharmaceutical Care Service Plan › documents › nhs...Aberdeenshire CHP...

Aberdeenshire CHP Pharmaceutical Care Service Plan

January 2013

This document is also available in large print and other formats and languages on request. Please call NHS Grampian on 01224 551116 or 01224 552245 or

e-mail [email protected]

mailto:[email protected]

Aberdeenshire CHP Pharmaceutical Care Service Plan – Version 2 - 1 -

Aberdeenshire CHP Pharmaceutical Care Service Plan Contents Page No 1 Introduction to Aberdeenshire CHP Area 2 1.1 Geography 2 1.2 Population 3 1.3 NHS Grampian Strategic Vision for Primary Carers 5 1.4 Information Sources 6 2. Description of Primary Care and Pharmaceutical Service Provision in the

NHS Board Area 7

2.1 Overview of Pharmacy Services 7 2,2 Interface with other Provides 8 2.3 Core Services 9 2.4 Additional Services 12 2.5 Unscheduled Care 15 2.6 Accessibility of Pharmaceutical Services 16 3. Description of General Medical Service Provision in Aberdeenshire CHP 19 3.1 General Medical Services 19 4. Analysis of Pharmaceutical Needs within Aberdeenshire CHP Area 20 4.1 The Need for Additional pharmaceutical Services from Existing Providers 20 5 Planning and Action Plan 22


1 Introduction to Aberdeenshire CHP Area

1.1 Geography

Figure 1: Areas within Aberdeenshire


1.2 Population

Aberdeenshire has a population around 245,780 based on the 2010 mid-year population estimates which equates to 44.6% of the Grampian population.

By 2033 the population is projected to be 295,353, an increase of 22.3 per cent compared to the population in 2008. The population of Scotland is projected to increase by 7.3 per cent between 2008 and 2033. Aberdeenshire has a higher than average prevalence of people with specific long term conditions, namely dementia, obesity, hypothyroidism and chronic kidney disease. There is a lower than average prevalence of diabetes, COPD, chronic heart disease and stroke compared with Scotland, but cardiovascular disease rates are still poor compared with many European countries. Components of projected population change for Aberdeenshire and Scotland, 2008-2033 (2008-based projections)

25,000 20,000 15,000 10,000 5,000 0,000 5,000 10,000 15,000 20,000 25,000 0-4 5-9

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89

90 and over Aberdeenshire CHP – population pyramid ( 2010 mid - year estimates )

Number of Males Number of Females

5 year age bands

Data Source - National Records of Scotland (NRS).


Population growth of older people ranges from 40% to 185% in the over 75s in the next 12 years in towns and localities within Aberdeenshire, which must be factored into future provision. Immigrant workers need also to be planned for as numbers grow.

The Aberdeen City and Aberdeenshire Council Structure Plan highlights the requirement for 75,000 new homes in Aberdeen and Aberdeenshire. Significant growth is expected in the Stonehaven, Portlethen, Westhill and Inverurie corridor. Already 2,000 new homes have been approved in Portlethen. The effect on practitioner services is expected to be significant. Early work with the local authority is underway to ensure joint opportunities are explored and planning gain maximised, despite the current economic downturn

1.2.1 Age

Over the 25 year period, the age group that is projected to increase the most in size in Aberdeenshire is the 75+ age group. This is the same as for Scotland as a whole. Life expectancy is 79.7 years, compared to a Scottish average of 77.8yrs.

1.2.2 Sex Aberdeenshire GP Practice Population Charts as at 1st October 2012

(Practitioner Services Department) Age

Group Male Female Total Age

Group Male Female Total 0 To 4 6905 6643 13548 0 To 4 2.8% 2.7% 5.6% 5 To 14 13956 13100 27056

5 To 14 5.8% 5.4% 11.2% 15 To 24 14443 13229 27672

15 To 24 6.0% 5.5% 11.4%

25 To 44 30992 30877 61869

25 To 44 12.8% 12.7% 25.5%

45 To 64 35712 35073 70785

45 To 64 14.7% 14.5% 29.2%

65 To 74 11534 12006 23540

65 To 74 4.8% 5.0% 9.7%

75 To 84 5900 7182 13082

75 To 84 2.4% 3.0% 5.4%

85 Up 1698 3208 4906 85 Up 0.7% 1.3% 2.0% Total 121140 121318 242458 Total 50.0% 50.0% 100.0%


Aberdeenshire

20 15 10 5 0 5 10 15 20

0 To 4

5 To 14

15 To 24

25 To 44

45 To 64

65 To 74

75 To 84

85 Up

Age

Percent of the Population

Male Female

1.2.3 Ethnicity

The demographic information collected on a joint basis with the Grampian Racial Equality Council, suggests, that there are still substantial numbers of mostly Eastern European migrant workers and their families settling in Grampian (NHS Grampian Language Line Usage Monitoring Report, January to December 2011) with the most commonly requested ethnic community languages being Polish, Russian, Lithuanian, Mandarin and Latvian. The main areas of settlement in Aberdeenshire for recent migrant workers and their families is the Buchan coast around the Peterhead/Fraserburgh areas (Consultation Draft, NHS Grampian Equality) Outcomes 2012-16). The “NHS Grampian 2011 involvement and consultation events with the local ethnic communities in Fraserburgh and Aberdeen” report indicated the respondents had no difficulty in accessing community pharmacy services, but there were concerns about the lack of interpreting services.

1.2.4 Deprivation

The most deprived areas on the overall Scottish Index of Multiple Deprivation (SIMD) 2009 in Aberdeenshire can be found in Banff and Fraserburgh (Banff and Buchan), Peterhead (Buchan) and Huntly (Marr) (see figure 1). 52% of the Aberdeenshire population is classified as a ‘rural’ with 21% living in ‘small towns’ and 26% living in ‘urban’ areas (Tech doc p17).

1.3 NHS Grampian Strategic Vision for primary care services

The overall health of the people of Grampian is described in documents such as the NHS Grampian Health Plan 2010 and the vision for future service delivery in the Health and Care Framework. The Health Plan gives details of what the Board is trying to do to improve health and the way in which people are treated. It focuses on patient-centred, safe and effective working and Pharmacy is one sector of healthcare trying to achieve this Medicines continue to be the most common treatment provided by the health service


in NHS Grampian. Getting the most benefit from these medicines, and reducing the harm associated with medicines, is a core function of the Grampian Pharmacy Service. “ Pharmacy in 2020: Directors’ View outlines the vision for pharmacy, which would see patients registering with community pharmacies, akin to the way they are currently registered with GP practices for medical services. Community pharmacy would be a primary source of medicines information and would have a more clinically focussed role, with the majority being independent prescribers. Most community pharmacies would have dedicated space for other members of the health and social care team. Pharmacy assistants would be trained in health promotion as well as advising on minor ailments and general medicines and healthcare advice, pharmacy technicians will be checking technicians able to manage the whole dispensing process, and with pharmacists only performing clinical checks on prescriptions, releasing time for other clinical roles. All of this aims to provide better outcomes for patients, with improved compliance with medicines leading to efficiencies in the healthcare systems.

1.4 Information Sources

A key information source is the Phase One of the Pharmaceutical Care Service Plan and the Technical Document available at: http://www.nhsgrampian.org/nhsgrampian/files/Pharmaceutical_Care_Services_Plan_FINAL_May_2012.pdf http://www.hi-netgrampian.org/hinet/file/7629/PCSP_Tech_Info_&_Analysis_for_Staff_&_Contractors_FINAL_May_2012.pdf

ScotPHO Health and wellbeing profiles http://www.scotpho.org.uk/home/Comparativehealth/Profiles/2010CHPProfiles.asp) General Registrar of Scotland website which presents population and demographic information: http://gro-scotland.gov.uk/index.html The Scottish census website SCRoL http://www.scrol.gov.uk/scrol/common/home.jsp) Information and Statistics Division (ISD) website: http://www.isdscotland.org/qof/ The Scottish Government Urban/Rural Classification: http://www.scotland.gov.uk/Topics/Statistics/About/Methodology/UrbanRuralClassification. Information regarding deprivation may be sourced at http://www.scotland.gov.uk/Topics/Statistics/SIMD/

http://www.nhsgrampian.org/nhsgrampian/files/Pharmaceutical_Care_Services_Plan_FINAL_May_2012.pdf

http://www.nhsgrampian.org/nhsgrampian/files/Pharmaceutical_Care_Services_Plan_FINAL_May_2012.pdf

http://www.hi-netgrampian.org/hinet/file/7629/PCSP_Tech_Info_&_Analysis_for_Staff_&_Contractors_FINAL_May_2012.pdf



http://www.scotpho.org.uk/home/Comparativehealth/Profiles/2010CHPProfiles.asp

http://gro-scotland.gov.uk/index.html

http://www.scrol.gov.uk/scrol/common/home.jsp

http://www.isdscotland.org/qof/

http://www.scotland.gov.uk/Topics/Statistics/About/Methodology/UrbanRuralClassification

http://www.scotland.gov.uk/Topics/Statistics/About/Methodology/UrbanRuralClassification

http://www.scotland.gov.uk/Topics/Statistics/SIMD/


2 Description of Primary Care Pharmaceutical Service Provision in Aberdeenshire CHP

2.1 Overview of Pharmacy services Community Pharmacy Community pharmacy is probably better known to most people as ‘The local or High Street Chemist’. Historically the central role of the community pharmacy has focused on supply to the patient i.e. supplying patient medication in response to prescriptions or over-the-counter requests and providing advice on taking these medicines. The shift from this historical supply function to a more comprehensive Pharmaceutical Care Service has been occurring for a number of years. In Scotland, it was cemented in health policy with the publication of ‘The Right Medicine: a strategy for pharmaceutical care in Scotland’, in 2002. The strategy emphasised the role of pharmacists in delivering pharmaceutical care for patients with chronic conditions, improving access to Pharmaceutical Care Services in general, and prescribed and over-the-counter medicines in particular, and the pharmacist’s role in health improvement. In the year April 2011 to March 2012, over 8.5 million prescription items were dispensed in Grampian at a gross ingredient cost of almost £92million. For Aberdeenshire the dispensed items were over 3.6 million and the gross ingredient cost around £38.2 million. Community pharmacies are independent contractors who provide a service to the NHS in accordance with national regulation and locally-negotiated contracts. Community pharmacies are very accessible to individual patients and research in Scotland demonstrates that for the vast majority of people access to a local community pharmacy is good. Patients are seen regularly when they come in to collect prescriptions, and a ‘no appointment necessary’ service for giving advice on managing illness and improving health is always available. Pharmacy premises must be registered with the General Pharmaceutical Council, and supervised by a pharmacist. From these premises advice about and sale of Pharmacy Only (P) medicines, General Sales List (GSL) medicines, and health care products takes place. This activity is an important and increasing aspect of ‘self care’. Pharmacies have been identified by the Scottish Government as the future ‘walk-in healthy living’ centres for Scotland. There are 131 Community Pharmacies (‘Chemist shops’) in NHS Grampian, and of these 53 are in Aberdeenshire providing Pharmaceutical Care Services across the CHP. All provide NHS dispensing services under agreement with NHS Grampian. The 53 community pharmacies in Aberdeenshire can be subdivided into (a) individuals or partnerships with one outlet (14), individuals or partnerships with more than 1 outlet (28) or national multiples that generally have many outlets (11). All Community pharmacies are contracted to provide NHS Pharmaceutical Care Services and appear on what is called the Health Board Pharmaceutical List. As private contractors to the NHS, community pharmacies often also provide other goods and private services to purchase.


There are no national standards for the number of community pharmacies required to meet the pharmaceutical care services needs of defined geographical populations, as this will vary depending on local factors including the size, structure and health-related characteristics of the population served and existing infrastructure such as transport networks. There is no target number of community pharmacies, either nationally or within NHS Grampian.

2.2 Interface with other providers

Many of the community hospitals provide diagnostic and treatment services, some of which are staffed by secondary care colleagues, and some by primary care healthcare staff who have undertaken additional training. Some examples of this are Minor Surgery, where GP’s have been trained to perform vasectomies and this is now carried out locally, Diabetic clinics and ENT clinics where consultants come to the community hospitals, rather than patients travelling to Aberdeen. Where medicines are required, patients are required to take the consultant recommendations to the GP practice to obtain a GP10 prescription for dispensing at the community pharmacy/dispensing doctor practice. There is one example where the Hepatitis C nurse meets with patients in a consultation room in the community pharmacy. Community hospitals offer in-patient care, but without dispensary facilities, the prescriptions for discharge are provided by means of GP10 prescriptions that normally dispensed at the patients usual community pharmacy. This requires communication and co-operation between the community pharmacy, the ward staff and often patients relatives/carers/guardians. There is a consultation exercise underway relating to the integration of health and social care for adult services. This will have wide reaching implications for the CHP, but some examples of close working relationships between community pharmacy, primary care and local authority are already in place around supporting patients with managing their medicines and enabling them to remain independent in their own homes for as long as possible/practical with support. Community pharmacies often support patients by filling compliance aids (Monitored Dosage Systems), and many are involved with Medicines Management for Home Carers, where home care workers are trained to administer medicines to clients using Medicine Administration Charts and original packs of medicines. Community pharmacies provide a valuable service to care homes and often work closely with them to support medicines management. There is currently a national review of the care home contract. The current contract remunerates community pharmacy for providing advice to staff and residents as appropriate around storage and administration of both prescribed medicines and those used for minor ailments. There is scope for further involvement of community pharmacy that may include reducing medicine waste, medication reviews etc. In Grampian there is a project underway to dispense imatinib from community pharmacy or dispensing doctors that was previously only supplied from hospital pharmacy. This involves close communication between the consultant and secondary care pharmacy team with the community pharmacy. The community pharmacist undertakes to dispense an HBP prescription provided by secondary care and also to counsel patient on the


dosage, side-effects and action to be taken in the event of an adverse reaction. Support is available from the haematology pharmacist. Should the patient not collect a prescription for imatinib as planned the community pharmacy is obliged to contact secondary care. It is anticipated that similar projects involving different medicines will be provided in this way in the future. Community Pharmacy has developed links with Optometrists in recent years through the Eye Health Network where community pharmacies can supply certain medicines on the recommendation of the optometrist via a voucher scheme and work is ongoing around a referral form. Community pharmacy has some links with dental practitioners in that they will dispense both NHS and private prescriptions issued by dentists.

2.3 Core Services

All pharmacies are required to provide all 4 core pharmaceutical care services

• Minor Ailment Service • Public Health Service. • Acute Medication Service • Chronic Medication Service

A description of each service has been provided in the Technical Document developed as part of Phase One but is summarised below.

2.3.1 Minor ailment service (MAS)

Minor ailments can be generally described as common, often self limiting conditions. They normally require little or no medical intervention and are usually managed through self-care and the use of appropriate products that are available to purchase without a prescription.

This service aims to support the provision of direct pharmaceutical care within the NHS by community pharmacists. The service allows eligible people to register with the community pharmacy of their choice for the consultation and treatment of common self-limiting conditions with over-the-counter medicines, free of charge. The pharmacists advises, treats or refers the person (or provides a combination of these actions) according to their needs. A person must be registered with a Scottish GP practice and belong in a current exemption category to be eligible for the service. There is variation in the number of patients registered to each pharmacy to obtain treatment under the minor ailment service and also variation in activity of provision of treatments for minor ailments.


Aberdeenshire MAS August 2012

0

500

1000

1500

2000

2500

3000

Contractor

CP MAS Number of Patients Paid CP MAS No. of Line Items Paid

2.3.2 Public Health Service (PHS)

There are two patient service elements of the public health service. 2.3.2a Smoking Cessation Services

This service consists of the provision of a smoking cessation service comprising advice and supply of nicotine replacement therapy (NRT) and other smoking cessation products over a period of up to 12 weeks, in order to help smokers successfully stop smoking. There is considerable variation in the level of activity as shown in the graph below.

Aberdeenshire NRT items dispensed 10 11

0

200

400

600

800

1,000

1,200

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

Contractor

NRT

Item

s

A further development of this service is the supply of varenicline under a Patient Group Direction. 7 pharmacies in Aberdeenshire (Fraserburgh, Mintlaw, New Deer, Cruden Bay, Inverurie, Huntly and Newtonhill) provide this service with further roll out planned.


2.3.2b Sexual Health Services This service comprises of the provision of a sexual health service comprising the supply of emergency hormonal contraception (EHC) to women 13 years and above.

Where a contractor decides not to supply emergency hormonal contraception (EHC), they should give notice in writing to the Health Board and advise the Agency of their decision and ensure prompt referral of patients to another provider who they have reason to believe provides that service.

In addition, a pharmacist who chooses not to supply EHC on the grounds of religious, moral or ethical reasons must treat the matter sensitively and advise the client on an alternative local source of supply (such as another pharmacy, GP or sexual health service). There is one community pharmacy in the Peterhead area that has opted out of the provision of emergency hormonal contraception but there are alternative pharmacies within the town that are able to provide the service.

2.3.3 Acute Medication Service (AMS) The Acute Medication Service is the provision of pharmaceutical services for acute prescriptions.

The Acute Medication Service represents the provision of pharmaceutical care services for acute episodes of care and supports the dispensing of acute prescriptions and any associated counselling and advice.

2.3.4 Chronic Medication Service (CMS) The Chronic Medication Service is the continuity of pharmaceutical care of patients with long term medical conditions. CMS provides personalised pharmaceutical care by a pharmacist to patients with long term conditions. It is underpinned by a systematic approach to pharmaceutical care in order to improve a patient’s understanding of their medicines and to work with the patient to maximise the clinical outcomes from the therapy. There are three stages to CMS: • Stage 1. Reviewing patients medicines • Stage 2. CMS patient care record and plan • Stage 3 Serial prescriptions. All community pharmacies in Aberdeenshire are currently involved in registering patients with variable activity in Stage 1 and 2 that aims to formalise the pharmaceutical care given to patients. There is no simple measure to compare activity as community pharmacists do not have a definitive patient lists, unlike GP practices. Only one GP practice in Huntly, and 2 associated pharmacies are involved with serial prescriptions (Stage 3) as part of the Early Adopter scheme.


Scottish Government has recently announced plans to ensure that GP practices and Community Pharmacists are able to produce/dispense serial prescriptions by the end of 2013. The CHP will require to plan for this in conjunction with IT support services.

2.4 Additional Services

Additional services are those negotiated at individual Board level. They include a range of services and may not necessarily be available from all community pharmacies. Information on pharmacies providing these services and the geographical access to these services is provided in the Technical Document.

2.4.1 Substance Misuse

The provision of methadone dispensing is widespread across Aberdeenshire although not all community pharmacies provide this service, at least one in each community does, with the exception of Alford. Patients from Alford may be required to travel for daily dispense methadone, and in this area public transport links are limited. Insch has access to dispensed methadone, but not the “consume on premises” service, methadone is only supplied for patients to take home. These gaps in service are acknowledged, but the substance misuse populations in these areas are low. The doctors at Peterhead Medical Practice do not prescribe methadone, but an independent pharmacist prescriber in one of the community pharmacies does and this service has been well received. This service was developed in conjunction with the NHS Grampian Substance Misuse Service to address an identified gap in service. In order to improve the sustainability of this project, a second pharmacist is undergoing an independent prescribing qualification. In other areas where GP practices do not prescribe methadone, service users are able to access services in other locations, such as the Kessock Clinic in Fraserburgh or the Fulton Clinic in Aberdeen. Proposed changes to the community pharmacy methadone contract will see a move away from a mechanical dispensing process and aims to integrate community pharmacists into the multidisciplinary substance misuse team. The regular contact that community pharmacy has with patients will aid their clinical role and ultimately improve patient services and has the potential to increase recovery roads, as per the “The Road to Recovery: A New Approach to Tackling Scotland's Drug Problem” (Scottish Government, May 2008).

2.4.2 Injecting Equipment Provision

The use of such services is high in north, less in central and low in south Aberdeenshire, reflecting the relative populations of injecting substance misusers. Some service users within rural areas can be reluctant to use community pharmacies as they perceive a lack of anonymity in these small towns and villages. Needle exchange facilities have been reviewed and a new site identified for Ellon. Only one needle exchange services available in Banchory to cover the whole Lower Marr


area. This has recently been relocated to coincide with the community pharmacy that dispenses methadone with the aim of increasing awareness and uptake of the service.

2.4.3 Naloxone Kits

7 community pharmacies across Aberdeenshire provide naloxone kits under PGD and are able to provide advice about using the naloxone, Basic Life Support skills and signposting to other organisations for support. These are some of the same pharmacies that provide injecting equipment and are geographically spread across Aberdeenshire.

2.4.4 Blood Borne Virus Services

The Hepatitis C Nurse provides a testing, vaccination and treatment service from within a community pharmacy in Peterhead. This mirrors the service provided in other NHS Grampian premises such as the Kessock Clinic in Fraserburgh. There are 31/131 pharmacies across Grampian registered as current condom distributors, 17 of which are in Aberdeenshire. Following an exercise to identify community pharmacies that fall into either an area of high deprivation or an area which has a high teenage pregnancy rate and where there is no existing provision, one further pharmacy Ballater will be approached to ask if they are willing to provide this service.

2.4.5 Chlamydia & Gonorrhoea Testing

16 community pharmacies across Aberdeenshire provide kits for Chlamydia and gonorrhoea testing and are also able to supply treatment as necessary. There is generally one pharmacy in each of the larger towns providing a good geographical coverage of the service across the CHP. Information suggests that there may be a national roll out of this service and local changes may be necessary to meet the recommendations.

2.4.6 Participation in Out of Hours Rota

There are limited out of hours rota services that had been provided and some of these are not well used. The two Banchory community pharmacies rotate week about to open until 18.15 on weekdays except Thursdays to allow the local GP practice to offer later appointment times for the convenience of the significant number of commuting workers. The Peterhead and Huntly pharmacies have been advised that the rota service will cease as of 31st March 2013. The rota service in Fraserburgh remains in place, but will be reviewed in conjunction with the Chemist Contractors Committee, GP Sub-Committee and local general practices and currently operates between 4 community pharmacies (Sundays 12.00 – 13.00). N.B. In addition one Pharmacy in Inverurie opens on a Sunday between 12.00 and 13.00, and one in Portlethen is open 10.00 -18.00 but these are not part of an organised rota.


2.4.7 Palliative Care Network There are pharmacies in selected geographical areas across Aberdeenshire CHP that are contracted to keep an agreed list of medicines that may be required promptly for palliative care patients. The medicines include a range of oral and injectable therapies that facilitate continuation of treatment when there are dosage changes and/or deterioration of a patients condition e.g. the patient is no longer able to take oral therapy. There is work ongoing within Aberdeenshire to promote the use of “Just In Case Boxes” to provide anticipatory care to those patients whose condition may deteriorate, but this does not diminish the need for a network of community pharmacies able to provide palliative care medicines when required.

2.4.8 Travel Clinics

Anti-malarials can be supplied under PGD (patient group direction) by pharmacists in 5 locations in Aberdeenshire: Fraserburgh, Peterhead, Mintlaw, Inverurie and Portlethen. In addition travel immunisations can also be provided, again under PGD, by one community pharmacy in Inverurie.

2.4.9 Flu Vaccination Service Flu vaccinations can be administered by pharmacists after appropriate training and authourised under PGD. 13 pharmacies across Aberdeenshire provide this service to eligible patients and staff groups (Banff, Portsoy, Aberchirder, Fraserburgh, Peterhead, New Deer, Tarves, Turriff, Banchory, Portlethen, Newtonhill, Stonehaven , Laurencekirk and Inverbervie).

2.4.10 Medicines Management by Care at Home Workers

There are gaps in provision of Homecare Medicines Management across Deeside and Kincardine & Mearns that are being addressed, and changes to the service provision are being progressed in Buchan and Ellon. Monitored Dosage Systems (MDS) support appropriate patients in managing their own medicines. Most community pharmacists provide these. However, increasingly there are difficulties in accessing these for patients as the MDS are time-consuming to fill and some community pharmacies are capping the number they are willing to provide. The provision of MDS devices should be reviewed, in conjunction with Homecare Medicines Management programme.

2.4.11 Domiciliary Oxygen It was noted in the Phase 1 Plan that domiciliary oxygen provision from community pharmacy is not available in the Alford area, and was identified as a gap in service that warranted investigation. However, the new national contract was introduced during November/December 2012 whereby domiciliary oxygen is delivered to the patients home via Dolby Vivisol with community pharmacies ceasing to provide the service. A short term resilience plan is likely to be put in place to ensure oxygen cylinder provision via a very limited number of community pharmacies in the unlikely event that Dolby Vivisol cannot meet required timescales for providing a service e.g. due to adverse weather or


where there are prolonged power outages. This service will be withdrawn once it has been shown that it is no longer required. Additionally it is proposed a small number of portable oxygen concentrators are held by a limited number of strategically located community pharmacies who are part of the palliative Care Network for those limited number of patients who are acutely unwell and are hypoxemic but for whom hospital admission to would be unwise e.g. end of life care, frail elderly care home residents etc.

2.5 Unscheduled Care Community pharmacy is an important access route for people requiring unscheduled care particularly over weekends and public holidays. One of the tools available to pharmacists is the National Patient Group Direction for the Urgent Supply of Repeat Medicines and Appliances. Community Pharmacies can also use Direct Referral to local Out of Hours services where the pharmacist feels that the patient requires a more specialist consultation with a different healthcare professional Outwith the core working hours of 0900 to 1700 hours Monday to Friday (commonly referred to as out of hours); there is wide variation of the availability of Pharmaceutical Services Most of the pharmacies in the towns of Aberdeenshire will provide pharmaceutical services on Saturdays for all or part of the day. Pharmaceutical services are not available in Cruden Bay, Fyvie or Braemar on Saturdays. Community pharmacies in Aberchirder, Crimond, New Pitsligo, Portsoy, Strichen, Kemnay, Kintore, Newmachar, Old Meldrum, Tarland, Torphins and Newtonhill close early (generally around lunchtime) on Saturdays. On Sundays patients would generally have to travel into Aberdeen as very few community pharmacies open, and those that do are often only open for short periods of time (30 mins or an hour is typical). Dispensing doctors are closed at weekends. A small number of pharmacies are open into the early evening on weekdays, to correspond to the local GP practice consulting times. At times or on days (including public holidays) where pharmaceutical services are not accessible, advice can be sought from NHS 24, a range of treatments can be provided by nurses in the Minor Injury Units in some of the Community Hospitals and emergency medical care is provided via the out-of-hours GP services (G-MED). GMED staff can provide medication to treat a patient in an emergency or can issue a prescription to be dispensed on the next working day when the pharmacy is open.

2.5.1 Pharmacist Prescriber Clinics There are currently 7 pharmacist independent prescribers and 5 supplementary prescribers working within Aberdeenshire. 9 of them are not currently involved in prescribing clinics. There are two substance misuse clinics (Peterhead and Inverurie) and one asthma/COPD clinic (MacDuff). A further pharmacist independent prescriber has undergone training to provide resilience to the substance misuse service and potentially increase the capacity of the service in Peterhead. The NHS Grampian substance misuse service values the contribution community pharmacist prescribers offer and would be keen to develop this service further where appropriate. A further two


pharmacsts have completed their independent prescriber training and discussion is underway to identify potential options for prescribing clinics to be started. The funding for the pharmacist prescriber clinics is agreed annually, and therefore at this time funding is only guaranteed up until the end of March 2013.

2.5.2 Keep Well Project (Fraserburgh only)

The Keep Well programme aims to reduce health inequalities in cardiovascular disease by increasing the rate of health improvement among high risk groups, aged 45-64, living in the most deprived communities. A number of models have been used to deliver health checks and offer appropriate interventions and/or referral/signposting to NHS and non-NHS Services e.g. Third Sector. Community pharmacy staff in Fraserburgh have been trained through the Keep Well Programme to deliver health checks. They work with the GP practices in Fraserburgh to identify eligible patients then carry out health checks to patients that respond to the Health Check invitation. They provide appropriate Health Promotion advice and support and refer patients to a variety of local groups, including back to the GP practice, for interventions to improve health. They have also developed links with the Aberdeeenshire Public Health team to maximise opportunity for delivery of health promoting initiatives and prevent duplication of effort. Over the next three years much of this activity will directed at defined vulnerable groups e.g. substance misuse clients, homeless people, members of the travelling community and carers.

2.5.3 Prison

HMP Peterhead currently has medicines and pharmaceutical products supplied via Community Pharmacy through a national prison contract. Health Services to prisons are now the responsibility of the NHS and the contract for the provision of medicines to the current prisons and the future Grampian Community Prison will be reviewed by NHS Grampian in conjunction with other Health Boards.

2.6 Accessibility of Pharmaceutical Services

It is recognised that patients often access pharmaceutical services close to their place of work or on a public transport route, with easier access than their place of residence. The majority of Aberdeenshire residents can access Core Pharmaceutical Services within a 20 minute travelling time (see map page 22). Those residents who are outwith a 20 minute travelling time may have access to dispensing services provided by dispensing doctors, not the wider pharmaceutical services provided via community pharmacies. Dispensing doctors can provide access to prescribed medicines in areas of low population density where it would be unlikely for a community pharmacy to be financially viable. There are also individuals who live in isolated rural areas who would be required to travel for more than 20 minutes to access services. Some community pharmacies also have arranged collection points remote from their own premises. They will deliver dispensed prescriptions on specific days of the week. These


are currently operating in Hatton, Maud, Boddam, Cumineston, Echt and Johnshaven. Two of the dispensing doctor servies also use delivery points at Lumsden (remote from Rhynie Practice) and Strathdon (extended opening hours). The “Essential Small Pharmacy Scheme” is intended for contractors who have a steady state of dispensing low volumes of prescriptions and is a minimum of 2 miles from the next nearest community pharmacy. It provides an allowance to those pharmacies that are providing essential services to communities in areas where access to the nearest alternative pharmacy would present patients with considerable difficulties. There are 10 Essential Small Pharmacies in Aberdeenshire located in Aberchirder, Strichen, New Pitsligo, Tarves, Fyvie, Kintore, Torphins, Tarland, Braemar and Newtonhill.

2.6.1 Core opening times

Most pharmacies are open Monday to Friday between 9am and 17.30. The exceptions are community pharmacies in small rural towns who continue the tradition of half day closing one afternoon each week, and the two pharmacies in Huntly that close at 17.00 hours. A small number open earlier and close slightly later. Only one pharmacy, situated within a supermarket in Portlethen is open until 20.00. Three small rural community pharmacies are closed on Saturdays and one community pharmacy in a larger community pharmacy is also closed, but pharmaceutical services can be accessed at other premises in the town. Just over a quarter of pharmacies close around lunchtime on Saturdays. Generally other community pharmacies within the same town or a community pharmacy in the next closest town are open on Saturday afternoons. Community pharmacies are generally closed all day on Sunday, with the notable exceptions being Inverurie having one pharmacy with restricted opening (12.00 -1300) and another supermarket pharmacy in Portlethen open 10.00-18.00.


2.6.2


2.6.3 Premises Standards

The General Pharmaceutical Council (GPhC) is responsible for the regulation of pharmacists, pharmacy technicians and pharmacy premises. They have recently issued new ‘Standards for Registered Pharmacies’ (September 2012), one of which relates specifically to the physical environment of the pharmacy: Principle 3: “The environment and condition of the premises from which pharmacy services are provided, and any associated premises, safeguard the health, safety and wellbeing of patients and the public.” The responsibility for meeting the standards lies with the pharmacy owner and the GPhC are developing a new way of inspecting pharmacies to ensure that they are being adhered to. The GPhC also state “The standards can also be used by patients and the public so that they know what they should expect when they receive pharmacy services from registered pharmacies.”

3 Description of General Medical Service Provision in Aberdeenshire CHP 3.1 General Medical Services

In addition to community pharmacy services in specified areas where there is a serious difficulty in accessing dispensed medicines from a pharmacist, NHS Grampian has contracted General Practitioners (GPs) to provide a medicine dispensing service to some, or all, of their registered patients. Aberdeenshire has 7 dispensing doctors, 5 of which are in rural areas with no community pharmacy provision to serve the local area.

3.1.1 Relationship with Community Pharmacy

Community pharmacy services are mostly provided to smaller communities by an unopposed pharmacy that has close links with the local GP practice, the larger towns having two or more community pharmacies linked to one or two GP practices. Because of the closely defined communities there are generally good relationships between the two. Of note are the many commuters who will access community pharmacies close to their place of work, or close to their travel route and inevitably the links between the GP practice and these more distant community pharmacies are generally weaker. The redesign of community pharmacy services to bring them under the management of the CHP teams will, in time, serve to strengthen the links between pharmacy and GP practice and ultimately with other community pharmacies within the CHP Areas.

3.1.2 Dispensing practices

NHS Grampians’ Primary Care Integrated Management Group agreed that a review of dispensing doctor service should be undertaken. In areas of where there is difficulty in patients accessing dispensing services, the review should be undertaken in the understanding of the wider primary care services. The process should seek to understand the benefits and risks to the holistic service to patients from any change or variation of the service provision and should involve Aberdeenshire CHP. The context of the locality and communities should be central to this.


4 Analysis of Pharmaceutical Needs Within Aberdeenshire CHP Area Phase One of the plan assessed basic geographical access to services. There are a number of major housing and infrastructure developments to come in Grampian and these will impact on the need for pharmaceutical services.

4.1 The Need for Additional Pharmaceutical Services from existing providers

4.1.1 Opening Hours The opening hours of community pharmacies generally seem to provide reasonable access to pharmaceutical services, but there is no evidence to support this. The CHP should investigate options for assessing patient satisfaction with access to pharmaceutical services.

4.1.2 Serial Dispensing Two pharmacies in Huntly are involved with the Early Adopter Phase of serial dispensing, which is part of the Chronic Medication Service. During 2013 this should be rolled out across the CHP, so that all GP practices are able to prescribe using serial prescriptions and all community pharmacists are able to receive electronic messages for the serial prescriptions allowing them to be dispensed. This should be carefully planned within the CHP to make most use of local knowledge and area networks.

4.1.3 Primary Care Organisation Redesign As part of the wider PCO redesign General Medical, Optometry and Dental Services independent contractors moved from an NHS Grampian centrally managed service to one where the management was devolved to the CHP. Pharmacy remains the only independent contractor that remains under a central management arrangement. In order to provide a cohesive approach to healthcare provision it is planned to move pharmacy into a similar CHP managed service. Clearly some aspects, such as certain contractual arrangements for example, will require to be consistent and therefore require co-operation and agreement from all 3 CHP’s.

4.1.4 Pharmacy Clinical Lead Roles In line with the other General Medical, Optometry and Dental independent contractors there is a desire to have Pharmacy Clinical Leads. These posts will require to be created and individuals developed to perform these roles. Funding proposals have been created and the CHP’s will be required to recruit suitable community pharmacists to fill these posts. Aberdeenshire CHP plans to have 4 such posts, 2 to cover Buchan, Banff & Buchan and Formartine and 2 for Garioch, Marr and Kincardine &Mearns. A job description and appropriate advertisement and recruitment processes required. The funding of these posts will initially be supported by the Pharmacy Champions monies, but may require to be additionally supported by Aberdeenshire CHP.


4.1.5 Future services The Pharmacy Directors’ 2020 vision suggest there will be a significant increase in the numbers of independent prescribers who will prescribe for patients with stable chronic diseases in partnership with their general practitioner (GP). To achieve this greater numbers of community pharmacists will require to undertaken appropriate training courses and funding arrangements put in place. In order to undertake such clinical roles there would be a requirement to share medical information currently held by the GP practice. Electronic data sharing, perhaps in the form of a single shared record could be required. To facilitate this process patients could be required to register with a community pharmacy, similar to the way patients are currently registered with general practice. This is likely to involve changes to the national community pharmacy contract and would require changes to IT systems. Many community pharmacies already have consultation areas, but potentially in the future more of these areas may be required. This could require redesign of the pharmacy interior or even relocation to more appropriate premises. Clearly these developments will require organisational change within each community pharmacy to free pharmacist time to develop these roles. Some of the pressures of dispensing could be managed by Accuracy Checking Technicians (ACT’s). Again, thought needs to be given to meet their educational requirements taking cognisance of the this accreditation will take. There would also be cost implications to providing this training that will require to be addressed. Community pharmacies will eventually be subject to a contract review process similar to the one GP practices currently undergo. Discussions are ongoing as to what performance measures might be used during this process. All of these changes will require a major reorientation for patients, who will increasingly use their pharmacy as first point of contact.


5 Planning and Action Plan Topic

Actions Timescale

CMS - serial dispensing Implementation plan to be developed

ISD to enable all GP

systems Phased roll-out across

Aberdeenshire to allow prescribing/serial dispensing in collaboration with NHSG IT Facilitators

Mid Jan 2013 End of Jan 2013 End of Dec 2013

Community Pharmacy Clinical Lead

Develop a role profile Recruitment process to be

agreed Additional financial support

to be considered as required and contingency plan developed to provide ongoing funding should pharmacy champions funding be withdrawn

Development of individuals

to meet the requirement of the post(s).

Jan 2013 End of March 2013 • End of March 2013 • Longterm

Interpretation services for ethnic minority groups

Investigate the potential for installing “Language Line in Fraserburgh and Peterhead

June 2013

Investigate options to assess patient satisfaction with accessibility to community pharmacy services

Discuss with Clinical Effectiveness team

May 2013


Topic

Actions Timescale

Medicines Management for Care at Home Workers

Roll out service to areas that do not currently provide the service

Change to MAR charts in

areas not currently using

December 2013 • December 2013

Care Homes Investigate the options for providing a service to care homes using Community Pharmacies

June 2013

Varenicline Supply under PGD

Roll out of service to other community pharmacies

March 2014

Dispensing doctor review PCIMG to lead review in conjunction with CHP

March 2014

Aberdeenshire CHP Pharmaceutical Care Service Plan › documents › nhs...Aberdeenshire CHP...

Documents

Transcript of Aberdeenshire CHP Pharmaceutical Care Service Plan › documents › nhs...Aberdeenshire CHP...