2013/14 - PHARMACEUTICAL CARE SERVICES PLAN

Transcription

1 2013/14 - PHARMACEUTICAL CARE SERVICES PLAN July

2 Contents 1.0 INTRODUCTION Purpose of Pharmaceutical Care Services Plan Information presented in PCSP Information sources DESCRIPTION OF CURRENT PHARMACEUTICAL SERVICES Pharmacy services Contractors & opening hours New contract applications & appeals under consideration Annual Prescriptions Dispensed Provision of Core Services Provision of Additional Services (National) Provision of Additional Services (Local) Independent/ supplementary pharmacist prescribing Interface with other providers Description of Core Services Description of Additional Services (National) Description of Additional Services (Local) Accessibility of pharmaceutical services DESCRIPTION OF GENERAL MEDICAL SERVICE PROVISION General Medical Services (GMS) Relationship with community pharmacy Dispensing practice...12 Appendix APPENDIX APPENDIX APPENDIX APPENDIX July

3 1.0 INTRODUCTION 1.1 Purpose of Pharmaceutical Care Services Plan The purpose of this Pharmaceutical Care Services Plan (PCSP) is to provide information on the pharmaceutical care services currently available within NHS Greater Glasgow and Clyde (NHSGGC). The information is also expected to aid the identification of any possible gaps in service where improvements may be required. This document should be read in conjunction with the Board s Pharmaceutical List. (See Appendix 1) In areas where possible improvement/development in services is identified, the Board s first consideration would be to address this through the enhancement of services provided by the existing network of contractors. Notwithstanding the above, the Board s Pharmacy Practices Committee considers all new applications for inclusion in the Board s Pharmaceutical List. These applications are subject to the provisions of the NHS (Pharmaceutical Services)(Scotland) Regulations 2009, as amended. The Committee takes this Plan into consideration when making their determinations. 1.2 Geography of PCSP NHSGGC is one of the largest healthcare systems in the UK and Europe. It covers square miles in West Central Scotland, containing a population of 1,210,254 (23% of the Scottish population). The Board spans a diverse geographical area with boundaries co-terminus with the territories of six local authorities, and parts of two other local authorities. NHSGGC has full responsibility for 6 Community Health (and Care) Partnerships (CH(C)Ps) and shared responsibility, with NHS Lanarkshire, for elements of the North and South Lanarkshire CHPs (see front cover). The populations range from approximately 79,200 in Inverclyde to 598,800 in Glasgow City. There are wide and stark variations in the deprivation levels of the 8 CH(C)Ps. NHSGGC includes 41% of the most deprived datazones in Scotland. These areas create their own social challenge with historically a hard to reach population, low income, low educational achievement, high unemployment and high crime levels all of which has an influence on health status. In April 2014, NHS Board boundaries with Local Authorities are to be harmonised across Scotland. At that time, the shared North and South Lanarkshire CHPs will transfer to NHS Lanarkshire. 1.3 Information presented in PCSP Information contained within this document covers current Community Pharmacy services including opening times, service descriptions and a summary of pharmacies providing these services. There is also information relating to provision of medical services, particularly in relation to the Board s only GP dispensing practice within Langbank. July

4 1.4 Information sources Information for the description of the NHS Board area is routinely available from a number of on line resources; ScotPHO Health and wellbeing profiles which provide a range of useful data at Scotland, NHS Board, CH(C)P and locality geographies. This plan was developed using CH(C)P geographies. (Available at files.asp) General Registrar of Scotland website which presents population and demographic information. Available at The Scottish census website SCRoL (available at which in the main provides social and demographic information and now reports on the 2011 Scottish census results. Other sources of clinical, behavioural and health indices data are available through the Quality and Outcomes data available from the Information and Statistics Division (ISD) website at this information is available at Board, CH(C)P and practice level. The Scottish Government Urban/Rural Classification provides a consistent way of defining urban and rural areas across Scotland and may be useful in description of NHS board areas. Information at NHS Board, Council and Council Ward areas is available at. ralclassification. Information regarding deprivation may be sourced at Scottish Health Survey (available at is also a useful source and will be available to cover the time period with reduced population sample size and no nurse visit data. Local information on the health of NHSGGC population can be found at the Director of Public Health Report (available at July

5 2.0 DESCRIPTION OF CURRENT PHARMACEUTICAL SERVICES 2.1 Pharmacy services Contractors & opening hours In April 2013, NHSGGC had 314 community pharmacies located within its Board area contracted to provide pharmaceutical care services in accordance with their NHS Terms of Service. Details are provided within the Pharmaceutical List (see Appendix 1). Pharmacy contractors are required to provide services in accordance with the Board s Model Hours of Service, which are detailed below: Definition of Model Hours to Monday to Saturday Half Day Closing Up to 2 half days per week one week day and a Saturday afternoon, all from hours Full day Saturday Closing Not to be adopted routinely with any application considered specifically Lunchtime Closing 1 hour in the middle of the day Some pharmacies offer extended opening times both routinely, during Sundays and public holidays. Where Sunday and Public Holiday cover is not available, the Board makes arrangements to provide pharmaceutical care services to ensure that the general public has reasonable access to pharmacy provision. Information on the latter is available from NHS24 and the Board s Primary Care Emergency Centres, Acute hospitals and internet site New contract applications & appeals under consideration Current details of applications under consultation are available on the Board s website: Annual Prescriptions Dispensed During Financial Year 2012/13, community pharmacies in NHSGGC dispensed 24,504,471 items which is approximately 25% of all items dispensed in Scotland. Prescription item inflation averaged 1.9% since 2011/ Provision of Core Services In addition to the traditional dispensing service, all components of the Community Pharmacy Contract have now been introduced. All pharmacies are required to provide the four core pharmaceutical care services July

6 Minor Ailment Service Public Health Service. Acute Medication Service Chronic Medication Service A more detailed description of these services is available in Section Provision of Additional Services (National) A summary of the pharmacies providing services by CH(C)P are contained in Appendix 2. Please note that participating numbers are accurate as of 17 April Harm Reduction: The pharmacy team attached to Greater Glasgow and Clyde Addiction Services coordinates and monitors the development and delivery of Injecting Equipment Providers (IEPs) and related harm reduction services. Community pharmacies providing services are: o o 296 contractors currently offer supervised opiate substitution administration service; 61 contractors are currently Injecting Equipment Provider sites. Domiciliary Oxygen: Transferring to a single supplier for Scotland during March June Once transfer is complete, community pharmacies will no longer provide this service. Palliative Care: 71 contractors participate within the Palliative Care pharmacy network and currently offer a Palliative Care service, including an out of hours service. Advice to Care Homes: 55 contractors are contracted to provide advice to Care Homes. Stoma services: This service is provided by 312 pharmacy contractors and 3 appliance contractors. Unscheduled Care: 314 contractors have registered to provide repeat medicines to patients when their GP is unavailable. Emergency Hormonal Contraception: 308 contractors provide this service Provision of Additional Services (Local) NHSGGC pharmacies also provide other additional services, which are locally defined and negotiated services. A summary of the pharmacies that provide the main services by CH(C)P, is contained within Appendix 3. Please note that participating figures are accurate as 17 April Interventions for Long Term Conditions: These services focus on 4 areas identified as priorities for NHSGGC through Managed Clinical Networks /strategic planning groups. One area, Heart Failure, involves a community pharmacy component to the service and is available from 154 pharmacies. Compliance Aids: 283 pharmacy contractors provide the compliance aid service. July

7 Free condom service: The free provision of condoms is currently available in 123 pharmacies. Head Lice Management: This service was established before the introduction of MAS and is currently available from 176 pharmacies. Making the Most of your Medicines service. This has now been re-launched across the Board and pharmacies have been invited to register for the service.. As of 17 April 2013, 253 pharmacies had agreed to provide the service Independent/ supplementary pharmacist prescribing There are 57 pharmacists either trained or currently undertaking independent/ supplementary prescribing training within community pharmacy. Of these, 29 qualified pharmacists are currently actively prescribing, with the Board supporting 27 prescribing clinics in community pharmacy. Details of Community Pharmacy Prescribing Clinics are available at Appendix Interface with other providers The interface between community pharmacy and secondary care is an area of increasing focus as Scotland pursues its policy of shifting the balance of care. As models of care provision within the community setting continue to develop, it will not be possible to consider the need for community pharmacy services in isolation of the wider context of care provision by the NHS, local authority and third sector providers. Work continues with NHSGGC Pharmacy and Prescribing Support Unit (PPSU) to develop and maintain work streams across the interface between acute and community pharmacy services Description of Core Services Minor Ailment Service (MAS) Minor ailments can be generally described as common, often self limiting conditions. They normally require no medical intervention and are usually managed through selfcare and the use of appropriate products. 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. 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 General Practitioner in Scotland and be in one of the eligible groups for the service: people aged 60 years or over, those under 16 years of age, year olds in full time education, those with medical and maternity exemption certificates and those with income related exemptions. Currently (February 2013) 238,400 patients are registered for this service with NHS GGC pharmacy contractors. July

8 Public Health Service (PHS) 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. To fulfil contractual obligations, contractors must complete both a payment claim form and submit a minimum dataset form. There is a national database to record smoking quit attempts and the figures for quits through pharmacy contribute to the Boards smoking cessation HEAT target. Sexual Health Services In NHSGGC, 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. A contractor may choose to opt out of this service on basis of personal, religious, moral or ethical reasons. Where a contractor decides not to supply EHC, they should give notice in writing to the Health Board and advise Practitioner Service Division (PSD) 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 NHS advice (such as another pharmacy, GP or sexual health service). Acute Medication Service (AMS) The Acute Medication Service is the provision of electronic prescription messaging between GPs, Community Pharmacy and PSD. 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 care plan Stage 3 Serial prescriptions July

9 Further Core Services information may be found from the following website: Description of Additional Services (National) Opiate Substitution Therapy This Service involves the dispensing and supervision of methadone, buprenorphine and buprenorphine / naloxone prescriptions. Pharmacy staff should be prepared to supervise the administration of both methadone and buprenorphine preparations. The Pharmacist or other suitably qualified member of staff will supervise the self administration of the substitute medication, ensuring the whole dose is either swallowed (methadone) or administered sublingually (buprenorphine preparations). Pharmacists must operate a safe system for dispensing and provide written and verbal information on safe drug use, safe storage for take home doses and other health related topics. Pharmacists should sign the Shared Care 4 way Agreement if in use in their area (The Shared Care Agreement gives consent to transfer of relevant information to promote patient care and involves doctors, pharmacists, key worker and patient). Injecting Equipment Providers The aim of the service is to reduce the transmission of blood borne viruses such as HIV, Hepatitis B and C and other infections and injuries, which result through drug users sharing or re-using injecting equipment. This provides substantial public health benefits for individuals, families and communities. Pharmacies are expected to have a private area for conducting the transaction, which involves giving advice and providing injecting equipment and related paraphernalia in a sealed pack. Pharmacy staff will also encourage service users to bring back used equipment in sharps containers for safe disposal. Only appropriately trained staff should provide the service. Domiciliary Oxygen This service is currently (May 2013) transferring to a single supplier for Scotland and should be complete by the end of June Palliative Care The pharmacies within the Palliative Care network maintain a stock of specific core medicines, provision of specialist advice and a support network to other pharmacies within their localities. Most participating pharmacies provide an out-of hours service for the dispensing of urgent prescriptions. Advice to Care Homes Pharmacies contract to provide pharmaceutical advice to Care Homes (up to a maximum of 5) on the storage, safe handling and correct administration of drugs/medicines. The pharmacist will make an initial visit and then subsequent visits at intervals of not more than three months. July

10 Stoma Services This national service was revised in April Pharmacy and Appliance contractors must now provide a range of services to patients requiring these products. This covers adequate and timely delivery to the patients home if required, provision of disposal bags, customising service and communication with the prescriber if there are any pharmaceutical concerns or unusual supply patterns. Unscheduled Care Community pharmacy is an important access route for people requiring unscheduled care particularly over weekends and public holidays. One of the mechanisms available to pharmacists in Scotland 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 does not have a medicines supply issue. Healthy Start Vitamins This is a national 12 month trial for the supply and distribution of Healthy Start Vitamins to support the healthier nutrition of pregnant women and young children who meet eligibility criteria. The trial commenced in June Description of Additional Services (Local) Intervention of Long Term Conditions: Heart Failure The Community Pharmacy Heart Failure Long Term Medicine Service requires pharmacists to provide structured support and education to their patients regularly (every 56 days). This involves basic symptom monitoring, basic education on medicines and condition, improving medicine adherence, encouraging patients to self manage and signposting patients who need help. Compliance Aids Funding is provided to contractors for the ongoing provision of Prescribed Medication Support Initiative. This was linked to assessment of patients and filling of compliance aid trays. Work is currently ongoing within the Board to examine the usage of MDS systems, the impact on community pharmacy workload and benefits for patient care. Free Condom Distribution Service Community pharmacies can participate in the open access component for the Free Condom service. This is primarily aimed at those of most risk of HIV or other blood borne viruses or unwanted pregnancy and the pharmacy element is mainly targeted as an access point for young people. Management of Head Lice Service The service aims to promote effective prescribing of Head Lice products through community pharmacies in NHSGGC. Infected patients will present for consultation with the pharmacist and on production of evidence of infection, an appropriate free July

11 supply of suitable treatment will be provided via registration and consultation as part of MAS (when the patient meets MAS criteria). My Medicines (MMyM) The MMyM Medicines was recently extended to cover all community pharmacies and hospitals within the NHSGGC area. The MMyM concept aims to bring a number of benefits to the management of patient s medicines as they transfer between secondary and primary care. It links pharmacists in the community and hospital settings into a systematic approach to pharmaceutical care across the whole patient journey; enhancing the quality of pharmaceutical care provided post discharge. 2.6 Accessibility of pharmaceutical services The purpose of this section of the plan is to describe the current availability of NHS pharmaceutical services within NHSGGC and CH(C)P areas where appropriate. Full details are provided within the Pharmaceutical List (See Appendix 1). The Pharmaceutical List provides details of opening hours, those pharmacies which provide extended opening hours and availability of pharmaceutical services. The Pharmaceutical List details national and principal locally negotiated services only. While it is recognised that community pharmacies may provide extra services for their patients, these are not considered for planning purposes. July

12 3.0 DESCRIPTION OF GENERAL MEDICAL SERVICE PROVISION 3.1 General Medical Services (GMS) The locations of general medical services across the Board s area are shown in Appendix 6. Information about the practice that, under the direction of the Board, provides dispensing services is detailed below. 3.2 Relationship with community pharmacy The relationship between pharmaceutical and medical services remains strong. The location of GP practices before pharmaceutical control of entry had a significant influence over the geographical location of community pharmacies. However, applications for new contracts now must be processed and considered in accordance with Pharmaceutical Regulations. 3.3 Dispensing practice Where those providing GMS have been requested by the NHS Board to provide a dispensing service, such services should be included as part of the NHS Board s provision and assessment of need within the pharmaceutical care service plan. Within NHSGGC, there is one dispensing practice, which is located within Langbank and is a branch surgery of a medical practice located in Kilmacolm. Schedule 5, paragraph 44 (1) of The National Health Service (General Medical Services Contracts)(Scotland) Regulations 2004, as amended, makes allowance for an NHS Board to request a GMS practice to dispense medicines, but only in certain circumstances. These circumstances, where the Board, after consultation with the Area Pharmaceutical Committee, is satisfied that a person, by reason of distance or inadequacy of means of communication or other exceptional circumstances, will have serious difficulty in obtaining from a pharmacist any drugs, not being scheduled drugs or appliances required for his treatment under these (GMS) regulations. July

13 Appendix 1 Pharmaceutical List (dated 5 April 2013) See attached Pharmaceutical List for details July

14 APPENDIX 2 Overview of existing National Additional Services (dated 17 April 2013) CH(C)Ps /Contractors West Dunbartonshire Opiate Substitution Therapy Needle Exchange Palliative Care Advice to Care Homes Stoma Provider Unscheduled Care EHC Inverclyde Renfrewshire East Renfrewshire Glasgow City North East Glasgow City North West Glasgow City South East Dunbartonshire South Lanarkshire North Lanarkshire TOTAL July

15 APPENDIX 3 Overview of existing Local Additional Services (dated 17 April 2013) CH(C)Ps /Contractors Heart Failure 1 Head Lice Compliance Aids Medicines Management West Dunbartonshire Inverclyde Renfrewshire East Renfrewshire Glasgow City North East Glasgow City North West Glasgow City South East Dunbartonshire South Lanarkshire North Lanarkshire TOTAL Condom Scheme July

16 APPENDIX 4 Overview of Community Pharmacy Prescribing Clinics (April 2013) Number of Clinics Topic of Clinic 1 Asthma & COPD 1 Asthma/COPD - Nursing/Care Homes 1 Asthma/Smoking Cessation 1 Contraception 3 Diabetes 1 Housebound Patients 2 Hypertension 1 Oral Contraception 1 Polypharmacy 14 Smoking Cessation (Varenicline) 1 Substance Therapy July

17 APPENDIX 5 Medical List (dated 8 April 2013) See attached Medical List for details. July