Pharmacy & Medicines Directorate News Getting the best from pharmacy services and medicines for better health and safer care"

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VOLUME 1 ISSUE 2 Pharmacy & Medicines Directorate News Getting the best from pharmacy services and medicines for better health and safer care" 27 th August 2015 Inside This Issue 1 Rosemary Parr

2M 1 Prednisolone 1 Upcoming Training Events 2 Duty of Care 2 Beclometasone/ Betamethasone topical Preperations 2 Don t Waste a Breath 3 Robotics in Community Pharmacy 3 Lets Focus on Eyes 4 Lumigan

Officer for Scotland, visited NHS Grampian and met with pharmacists and technicians.

1 VOLUME 1 ISSUE 2 Pharmacy & Medicines Directorate News Getting the best from pharmacy services and medicines for better health and safer care" 27 th August 2015 Inside This Issue 1 Rosemary Parr Visit 1 Scottish Government Invest 16.2M 1 Prednisolone 1 Upcoming Training Events 2 Duty of Care 2 Beclometasone/ Betamethasone topical Preperations 2 Don t Waste a Breath 3 Robotics in Community Pharmacy 3 Lets Focus on Eyes 4 Lumigan multidose eye drops 5 Medicines Shortages 5 Business Continuity Planning New Chief Pharmacist, Rose Marie Parr, visits NHS Grampian On July 24th Professor Rose Marie Parr, Chief Pharmaceutical Officer for Scotland, visited NHS Grampian and met with pharmacists and technicians. The visit was a fantastic opportunity for a number of staff from across primary care, secondary care and representatives of the Area Pharmaceutical Committee to meet Professor Parr and discuss key issues affecting pharmacy both locally and nationally. Scottish Government set to invest 16.2M in prescribing pharmacists. The Scottish Government has made a commitment to 16.2M of funding for pharmacist independent prescribers over the next three years. The funding will allow NHS Scotland to recruit around 140 full time equivalent pharmacists, with advanced clinical skills, to work directly with GP practices to support care for patients with long term conditions. We await further details as to how the funding will be allocated but this is really good news for pharmacy and primary care and for local pharmacists looking to develop opportunities for closer working with GP Practices. Prednisolone 10mg/20mg tablets Some pharmacies have reported difficulties sourcing prednisolone 10mg and 20mg tablets, which may be prescribed in response to Scriptswitch advice messages on GP practice systems e.g. a switch from 8 x 5mg tabs to 2 x 20mg is cost effective and reduces tablet load for patients. The higher strength tablets may be available listed under the brand name Pevanti as opposed to generic prednisolone. Upcoming Training Events Naloxone Training Tuesday 15 th September pm, Buchan Braes Hotel, Boddam, Peterhead Wednesday 16 th September pm, Room 402, Suttie Centre, ARI Wednesday 7 th October pm, Dunbarny House, Dr Grays, Elgin To Book on to Training Contact the Pharmacy and Medicines Directorate on or nhsg.pmu@nhs.net

PAGE 2 Duty of Care Community pharmacists are in a unique position, located at the heart of communities and providing ready access to the public to a healthcare professional, without the need for an

Community pharmacists can provide support not only in the supply of medicines /provision of healthcare advice directly to patients, but also through liaising with other healthcare professionals to

2 PAGE 2 Duty of Care Community pharmacists are in a unique position, located at the heart of communities and providing ready access to the public to a healthcare professional, without the need for an appointment. Community pharmacists can provide support not only in the supply of medicines /provision of healthcare advice directly to patients, but also through liaising with other healthcare professionals to sign-post patients to appropriate services. Recently we asked pharmacists to be alert to a patient repeatedly obtaining supplies of short acting insulin inappropriately through CPUS. The actions of this patient were discussed with the NHS Grampian Diabetes Service and it became apparent that the patient was not registered with medical services in Grampian and was not receiving local support to manage their diabetes. Due to the vigilance of a community pharmacist in Grampian, the patient has now been supported to register with a GP practice and, following review by the NHS Grampian Diabetes Service, is now prescribed and supplied with insulin through normal primary care routes, and will be further supported by the community diabetes specialist nurse team. This illustrates the vital role that community pharmacists can play in supporting patients to receive the best care for their medical conditions. We would encourage you to be vigilant to your patients needs, which may not always be explicitly expressed, and to fulfill your professional duty of care wherever the opportunity presents. Beclometasone/Betamethasone Topical Preparations There have been recent reports in Grampian of beclometasone dipropionate 0.025% cream having been prescribed and/or dispensed when betamethasone valerate 0.025% (Betnovate RD ) was intended. Beclometasone 0.025% is a potent corticosteroid preparation indicated for severe inflammatory skin disorders unresponsive to less potent corticosteroids, whereas betamethasone 0.025% is a moderate corticosteroid. A Scriptswitch message has been prepared to alert prescribers to the differences between the preparations. If presented with a prescription for Beclometasone 0.025% cream/ointment, community pharmacists should confirm with prescribers that this is the intended preparation before dispensing. Don t Waste a Breath As part of the NHS Grampian Don t Waste A Breath campaign to support patients with respiratory disease to get the most from their inhaler devices and to help reduce unnecessary drug waste, a website has been developed and is available at or by using the QR code below if you have a QR reader APP on your smart phone. Community pharmacy teams are encouraged to familiarise themselves with the website, so that they can direct appropriate patients to the sections of the website which will be of most interest to them. There are a number of web pages on the website including a video gallery showing good inhaler technique for a variety of devices, a link to GSK web pages to find a local pharmacy participating in the inhaler recycling Complete the Cycle project and a Hints and Tips page to help patients to get the best from their inhaler devices. A Facebook page and an NHS Grampian Twitter account have also been set up with links to the website.

PAGE 3 Prescription for Excellence (PfE) Team Visit Grampian Members of the PfE Technology & Workforce working group led by Norman Lannigan, recently visited 2 of the 6 community pharmacies in

The visit was arranged to provide the working group with a direct opportunity to see how these pharmacy teams have integrated the robots into routine practice and to discuss with the pharmacy

3 PAGE 3 Prescription for Excellence (PfE) Team Visit Grampian Members of the PfE Technology & Workforce working group led by Norman Lannigan, recently visited 2 of the 6 community pharmacies in Grampian with dispensing robots in place, Bairds in Clifton Road, Aberdeen and Will s Pharmacy, West High Street, Inverurie. The visit was arranged to provide the working group with a direct opportunity to see how these pharmacy teams have integrated the robots into routine practice and to discuss with the pharmacy contractors whether the investment in technology had released staff to undertake more patient facing roles. As the robots in these pharmacies have different functionality and capacity there was also an opportunity to identify and discuss the challenges and benefits that each robot provided. Following the visit Norman Lannigan commented Prescription for Excellence set out a commitment to consider the place of robotics and other technology in assisting with releasing the time of community pharmacy staff to deliver pharmaceutical care. I am very grateful to Nicol and Galen and their fantastic staff who allowed me and other members of the team to see and hear from them real life experiences of how an investment in robotics has helped them to develop patient focused pharmaceutical care. I know that we returned home that day full of ideas and re-energised to ensure that the benefits of making use of dispensing technology are well understood and that a greater understanding will enable wider spread across community pharmacy in Scotland for the benefit of patients. Our work will involve setting up pilot projects of various configurations of robotics and other dispensing technology within community pharmacy practices and engaging a research team to fully evaluate benefits, assist in workforce and workflow redesign and most importantly to ensure that learning is widely spread. Our visit to colleagues in Grampian has contributed greatly to that objective and I hope that community pharmacy colleagues in Grampian might express an interest in participating as the project develops Let s Focus on Eyes Eye problems are a regular feature of the working life of the Community Pharmacist, but sorting out the urgent problems from the minor can be a tricky job. Since 2006 all eye tests have been free in Scotland and one of the aims of this scheme is to move anything beyond the superficial eye problems that Pharmacists can treat towards their community Optometrist instead. Optometrists should be the preferred port of call rather than the GP if you suspect the condition could be serious. What s an optometrist? Optometrists usually have 4 years under graduate training just on eyes as well as significant post graduate training. They are usually highly equipped all practices have powerful microscopes and cameras with lots of experience in using them and so can diagnose and manage a lot of eye problems without the hospital or doctor getting involved.

4 PAGE 4 How do I refer someone to an optometrist? It is best if the patient sees their regular optometrist, especially if it is a contact lens issue. If you are concerned that they might have a serious problem, ask them to contact their usual Optometrist straightaway. If they have had symptoms for some time or if it is a minor condition they should still contact their optometrist, but they might not be seen immediately. You could always pick up the phone to their regular Optometrist and tell them you have one of their patients and you are concerned. What conditions should I tackle myself as a Community Pharmacist? It is difficult diagnosing conditions without being able to examine carefully, so superficial conditions should be all the pharmacist should attempt to manage e.g. dry eyes, infective conjunctivitis, viral conjunctivitis, allergic conjunctivitis, styes and blepharitis. If you think that the problem the patient is presenting with isn t one of these 6 things, then they should be referred to their Optometrist. Remember, if you start treatment and it doesn t appear to be getting better, then they should see their Optometrist. Are there any obvious things I should look out for? The superficial problems rarely give a lot of pain, so if the patient is very uncomfortable, then pass them on. Sensitivity to light can mean that the iris inside their eye is inflamed and is another warning sign. If vision is badly affected, that could indicate a problem with the inside of the eye. So watch out for pain, sensitivity to light and vision problems. What s the Eye Health Network? The Eye Health Network is a network of 50 practices across Grampian that work together to ensure that the patient is seen in a timely fashion- so if it s urgent they work together to see the patient same day, for non urgent things, by fitting them in to their practice schedule. If the patient presents to a member of the Eye Health Network then that practice will help take care of the patient. Are there any Independent Prescribing Optometrists? There are a few, but the training is quite long and protracted not to mention expensive. There will be more over time, but currently there are only small numbers in the community- but you might well see prescriptions coming in more and more in the future. How can we help Optometrists? Optometrists are often busy with their own emergency presentations, so if Pharmacists could treat the superficial problems it would ease the workload and help make sure there is space for the urgent patients- so keep dealing with the superficial problems like you always would. Optometrists might also suggest to the patient to see a pharmacist for one of the minor ailment scheme medications. Optometrists might even use a referral form to pass the information on to you. Are Optometrists open 7 days a week? Some are and some aren t, it s best to be aware of what goes on in your area before you need them - why not introduce yourself to your local Optometrist? Reminder - Lumigan 0.3% multidose eye drops have been discontinued Pharmacists are reminded that the ophthalmology department is happy for any patient currently treated with Lumigan 0.3% multidose drops to be switched to the 0.1% drops when their current treatment becomes unavailable. In their experience, they have not come across any issues with the patients they have switched over already. The manufacturer states that the 0.1% has equivalent efficacy to the 0.3% which is confirmed by the EMEA report, see: Link. Patients should not be advised to increase the number of drops they use when switching to the lower strength. See recent Impact newsletter for full article.

5 PAGE 5 Communication of Medicines Shortages to GP Practices It is recognised that community pharmacists currently spend a disproportionate amount of their working day sourcing medicines that are in short supply for a variety of reasons. This is frustrating and continues to be raised at national level. However, the difficulties in accessing some medicines can also impact on both GP practice staff and patients e.g. Practice staff workflow interrupted by frequent telephone calls from community pharmacists to highlight that prescribed medicines are unavailable / GPs need to prescribe an alternative GP workflow interrupted to clarify with community pharmacist what options are available for patient, which may include writing a new prescription Patients experience delays in receiving prescribed medicines or interruptions to current therapy/changes to prescribed drugs To inform and facilitate the action required of a GP to address the unavailability of a prescribed medicine and to thus minimise the impact on both the practice and the patient, GP practices have requested that all community pharmacists routinely provide the following information when they contact the practice about unavailable drugs: Name and strength (and brand if relevant) of drug that is unavailable Estimated time for that drug to become available again (e.g. within a few days, long term unavailability, no information) An alternative(s) that the community pharmacist can readily supply if possible or An indication that there is no obvious alternative available Where a drug is unavailable, patients should not be asked to return to the practice to seek an alternative. Communications about difficulty in supply of medicines to a patient, other than a situation which can be resolved within a timeframe that is appropriate to the indication and acceptable to the patient, should be directly between the community pharmacist and the GP. Business Continuity Planning As part of assurances to Scottish Government that Health Boards have assessed and considered the contingency plans for working under pressure e.g. from severe winter weather or influenza pandemic, an emergency planning exercise is due to be undertaken in NHS Grampian. This will test the plans that the Health Board has in place to see if they are fit for purpose and have considered all the issues likely to affect the delivery of health services. As part of this exercise, pharmaceutical service delivery will be tested and this will have an impact across all aspects of pharmacy from acute services through to community pharmacy. As a requirement of the Civil Contingencies Act, businesses are required to have an up to date and tried and tested Business Continuity Plan (BCP) in place. We would encourage you to ensure that your plan has been reviewed and is fit for purpose, and remind you that the Director of Pharmacy can, at any point, ask you for a copy of your plan, in order to assure NHS Grampian that pharmaceutical services can continue to be delivered even when businesses are under extreme pressure. Pharmacy Contractors should, as a matter of course, provide an electronic copy of their BCP to the Pharmacy& Medicines Directorate at nhsg.pmu@nhs.net, where it will be held for reference. There are many examples of BCP templates freely available, but if you need help in identifying one suitable for your business, please contact Liz Kemp on e.kemp@nhs.net.

Pharmacy, Medicines and You. Principal Pharmacist Pharmaceutical Services Deputy Director of Pharmacy and Medicines Management

Pharmacy, Medicines and You. Principal Pharmacist Pharmaceutical Services Deputy Director of Pharmacy and Medicines Management Pharmacy, Medicines and You Wendy Robertson Liz Kemp Caroline Hind Principal Pharmacist Pharmaceutical Services Principal Pharmacist Pharmaceutical Services Deputy Director of Pharmacy and Medicines Management