Community Pharmacy- Non-Medical Prescribing Harry McQuillan Chief Executive Officer Community Pharmacy Scotland 1
Non-Medical Prescribing Use of non-medical prescribing is an underpinning key component of the first two services of the pharmacy contract Minor Ailment Service Public Health Service 2
Minor Ailment Service Minor Ailment Service commenced in July 2006. This service supports all 1209 pharmacy contractors to supply GSL or P medicines as appropriate for Minor Ailment Service 3
Minor Ailment Service Number of Items supplied on MAS monthly Drug Name Paracetamol 173,184 Items dispensed in Scotland, April 2007 to March 2008 Ibuprofen 65,589 Chloramphenicol 35,639 Malathion 34,314 Clotrimazole 32,359 4
Public Health Service Public Health Service Patient Services commenced August 2008 Smoking Cessation EHC Chlamydia Treatment 5
Public Health Service Patient Services Smoking Cessation Service supports supply of NRT and advice to patients Scotland wide Emergency Hormonal Contraception service supports supply via PGD of Levonorgestrel Chlamydia Treatment Service supports the supply of Azithromycin via PGD to positive patients and contacts Month December 2008 January 2009 February 2009 March 2009 Smoking Cessation No of Items EHC No of Items 4882 5376 53 6831 5411 37 9687 5564 81 13196 5981 74 Chlamydia Treatment No of Items 6
Unscheduled Care-CPUS Prescribing PGD to support the supply of most POM repeat medicines in the unscheduled care period. 5400 supplies are made monthly via this PGD 7
Enhanced Services-PGDs CPs supplying Steroids and Anti-Biotics to COPD patients in Forth Valley if required to minimise the risk of admission in the Unscheduled Care Period CPs altering Calcium and Vitamin D prescriptions according to patients taste preference in NHS Borders to support compliance and concordance with medication harry.mcquillan@communitypharmacyscotland.o rg.uk 8
Supplementary/Independent Prescribing Funding providing for training from Scottish Government Applications process supported by NES Courses provided by RGU and Strathclyde University A total of 527 pharmacists working across all disciplines of pharmacy have been trained 9
Supplementary Prescribing-Hypertension Bernadette Brown NHS Fife-Lochgelly Medical Practice established a pharmaceutical care clinic in 2003. The pharmacist was assigned half the practice's list of hypertensive patients - over three hundred people. In 2005, only 64% of the practice patients were below target blood pressure of 140/85. Four years later this proportion had increased to 94% of the patients. 10
Supplementary Prescribing- Substance Misuse Clinical Pharmacists providing support via Clinical Management Plans for the prescribing of Methadone, Buprenorphine, Suboxone and Naltrexone e.g. Stuart Notman NHS Grampian NHS Lanarkshire CPs supporting tapered withdrawal from Benzodiazepines using CMPs to support good practice in minimising the use of Benzodiazepines 11
Supplementary Prescribing- Anti-Coagulation Some Community Pharmacists providing Warfarin monitoring for patients requiring anti-coagulation. Once INR determined pharmacist is able to alter dose of warfarin using Clinical Management Plans Service active in NHS Fife, NHS Lothian 12
Independent Prescribing Independent prescribers are now starting to qualify Frequently working in areas they previously worked as supplementary prescribers. Barriers to prescribing include inability to prescribe most Controlled Drugs by Nurses and all CDs by Pharmacists CEL 2007 24 Pharmacist Independent Prescribers in primary care should not dispense their own prescriptions. This means the service does not easily lend itself to the traditional community pharmacy model. 13
Independent Prescribing-COPD Valerie Sillito-Boots the Chemist-NHS Grampian Supplementary prescribing and spirometry clinic for patients with chronic obstructive pulmonary disease (COPD) in Aberdeen. 3 General Practices close to the pharmacy credit Valerie with improving patients health, reducing doctors and nurses workloads, and boosting their QOF attainment for COPD and Asthma by as much as 50 per cent. 14
Implementation Lessons Improved support for non-medical pharmacist prescribers required now being given by NES Pharmacy. Each region now has a pharmacist to support newly qualified prescribers The NES pharmacists support newly qualified pharmacists to find areas to work in according to their competence and/or desired area of practice Ensuring Clinics can be covered in the event of absence or maternity leave-culture of buddying up required to ensure clinics are self sustaining. Need improved methods of data-sharing-it links such as access to GP record from community pharmacy not available. These links would help improve speed of data transfer to the patient record. 15
What Next? The Chronic Medication Service is the final cornerstone of the pharmacy contract. The service will support pharmaceutical care-planning and dispensing for 24-48 weeks depending on GP decision. Service aims to improve patient concordance and understanding of their medication. Linking Supplementary/Independent Prescribing in the long-term will be very useful as pharmacists may be able to intervene before referring the patient back to the GP eg BP monitored and elevated. Pharmacist could add a new drug or increase dose as appropriate prior to referral to GP. 16
What Next? Expansion of the Minor Ailment Service to become a Management of Common Clinical Conditions using Independent Prescribing/PGDs for POMs Supply of anti-biotics in unscheduled care period 17