The art of automation in community pharmacy

Gary Paragpuri

 

Gary Paragpuri is the former editor of the Chemist and Druggist magazine. He is now CEO of the specialist consultancy firm called Hub and Spoke Innovations.

 

Hub and Spoke Innovations aims to help pharmacists and dispensing GPs grow their businesses and provide a better service for their patients through technology.

 

Their flagship product is the Pharmaself24, which is a vending machine for prescription medications. This product allows people to collect prescriptions from a community pharmacy at any time of day or night.

 

Tune in to the PIPcast below to find out how Gary is driving change in UK community pharmacy using this technology. We talked about the role of automation in community pharmacy and the seismic shifts in this regard but we also had a fascinating chat about Gary’s time as editor of C&D magazine. We talked about how the internet has revolutionalised publishing in the online and offline world.

 

 

 

To find out more about automation in community pharmacy get in touch by clicking here.

 

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Remote video consultation service for respiratory physiotherapy launched in Scotland

 

The first virtual consultation clinic in Scotland for patients receiving respiratory physiotherapy has begun operating.

 

Remote video consultations mean people in northeast Glasgow can now ‘attend’ appointments online rather than travel to attend hospital clinics. Accessing the service through an app from a phone, PC or tablet allows people to remain at home or work while getting support for their conditions.

 

With more people in the west of Scotland experiencing respiratory problems the new way of working is helping patients manage conditions such as inducible laryngeal obstruction, a group of disorders previously called vocal cord dysfunction, and bronchiectasis.

 

Milngavie resident, Helen McDougall, has been an outpatient with the respiratory physiotherapy service for 16 years.

 

“Being a patient of this service has changed my life,” she says. “I had just retired from my job as a primary school headteacher and wasn’t in good health. Over the last 16 years I’ve been working with Pamela and thanks to her I now have a different lifestyle. There aren’t many people who can say they’re fitter at 76 than at 60!

 

“When Pamela first mentioned the virtual clinics I hoped I’d be able to work the technology. However, it’s so well set out that I was able to easily follow it.

 

“I was initially worried about missing face-to-face contact as I’d built up a lot of trust with Pamela. The trust is still there over the virtual clinic as I’m still speaking to the same person and I still feel very good.

 

“I would recommend other people have their appointments this way. I had back surgery last year and couldn’t drive so this facility was wonderful. They’re trying to reach more people by doing this and I would recommend it to anyone. Respiratory problems are growing the West of Scotland and it’s great to get a service like this.”

 

The system also allows other family members to join the consultation using their own device from a different location. Introduced by the respiratory physiotherapy outpatient service, the new way of working is designed to meet a 25% rise in patient numbers over the last five years.

 

Pamela Vaughn, advanced clinical physiotherapist in respiratory medicine at NHS Greater Glasgow & Clyde, said:

 

“Video consultations mean we can see around 25-30% more patients compared to face-to-face appointments. These video consultations enable us to see more patients for check-ups or routine appointments without them having to come to us.”

 

Following positive patient feedback and an increase in consultations, funding for the project provided by the Scottish Government’s technology-enabled care fund has been extended from the original three-month period.

 

“People wait in virtual waiting rooms and join us from their home, work and even cafes,” explains Ms Vaughn.

 

“One of the key benefits for patients is that family members can also take part either together or remotely. It’s not unusual for a family member who lives elsewhere in the country or abroad to join in consultations.

 

“This new approach is part of the expanding use of video consultations across hospital and community services in NHS Greater Glasgow and Clyde.

 

“It’s something we’re now working to roll out across the rest of the Board area to enable us to see as many patients as possible. This means we can see patients within timelines set out by National guidelines, we struggled before due to the demand on our service.

 

“We only offer the service to patients who we feel are suitable and qualitative feedback from them is positive.

 

“Patients tell us they feel they are achieving the same outcome as face-to-face consultations. Feedback shows that patients find the system easy to use and have an appetite to use the system for future appointments.

 

“One key point is that they find remote consultation more convenient and it takes less time out of their day. It also means staff can deliver the service from anywhere and aren’t tied to any one NHSGGC facility.”

 

This story was supplied as part of our partnership with healthandcare.scot. 

Alexa the latest member of the NHS family

 

The NHS is collaborating with Amazon to provide health information from the NHS website through voice-assisted technology.

 

The technology will help patients, especially the elderly, blind and those who cannot access the internet through traditional means, to get NHS-verified health information, through simple voice commands.

 

Amazon’s algorithm uses information from the NHS website to provide answers to voice questions such as:

 

“Alexa, how do I treat a migraine?”

 

“Alexa, what are the symptoms of flu?”

 

“Alexa, what are the symptoms of chickenpox”

 

Officials from within the NHS say the technology has the potential to reduce the pressure on the NHS and GPs by providing information for common illnesses.

 

NHSX is set to look at ways of making more NHS services available to all patients through digital technology. The announcement is aimeed at supporting the commitment in the NHS Long Term Plan to make more NHS services available digitally.

 

Secretary of State for Health and Social Care Matt Hancock said:

 

“We want to empower every patient to take better control of their healthcare and technology like this is a great example of how people can access reliable, world-leading NHS advice from the comfort of their home, reducing the pressure on our hardworking GPs and pharmacists.

 

“Through the NHS Long Term Plan, we want to embrace the advances in technology to build a health and care system that is fit for the future and NHSX will drive this revolution to bring the benefits to every patient, clinician and carer.

 

Matthew Gould, Chief Executive of NHSX, said:

 

“The public need to be able to get reliable information about their health easily and in ways they actually use. By working closely with Amazon and other tech companies, big and small, we can ensure that the millions of users looking for health information every day can get simple, validated advice at the touch of a button or voice command.

 

“Part of our mission at NHSX is to give citizens the tools to access services and information directly, and partnerships such as this are an important part of achieving this.

 

Tayside tech solution nudges people to quit smoking for good

 

Rebecca Strong, a former pupil of Florence Nightingale, was matron at the Dundee Royal Infirmary during the 1870s.

 

Responsible for implementing Nightingale’s pioneering block apprenticeship regime for nurses, this way of teaching students was subsequently adopted across Scotland, the US and beyond.

 

Today in Dundee, a different but no less pioneering legacy in care is being constructed under the nurse’s name.

 

Jimmy Black – Dundee Voluntary Action’s communications officer for technology-enabled care – explains how Florence, a simple text messaging service, helps people in Dundee measure their blood pressure at home, and promotes smoking cessation.

 

Measuring blood pressure is one of the most common reasons for attending primary care appointments – over one in four adults in the UK have high blood pressure, taking up around 1.2 million appointments every year in Scotland.

 

“One thing in particular that we have been promoting recently is at home health monitoring with Florence,” Mr Black says.

 

“There is a national campaign to increase blood pressure monitoring at home, promoted by the Scottish Government and launched a few months ago. My colleagues in the Angus health and social care partnership won some funding from the Scottish Centre for Telehealth & Telecare to promote blood pressure monitoring at scale in Tayside, across Dundee, Perth and Angus.”

 

Mr Black’s colleagues have recently been praised for their efforts. An evaluation report commissioned by the Scottish Government, focusing on the use of Florence in Tayside, highlights that 448 people have been supported to monitor their health conditions at home, improving their care and preventing hospital admissions.

 

“It’s really, really simple,” Mr Black tells healthandcare.scot. “You have a blood pressure monitor at home and you take your blood pressure readings. All you then do is text in your results through a mobile phone to Florence – a computer system that receives the results and creates a chart which is then available for clinicians to look at.

 

“It does more than that though because it reminds you to do things, it sends you texts. For example if you are meant to take your blood pressure every week, it will remind you and when you submit results you will get a response either to say the results are okay or to say perhaps that your blood pressure has gone up a bit and you need to adjust the dose of your medicine for that day.

 

“These kinds of things will have been agreed in advance with the GP or clinician from the hospital so the patient knows what to do. If it rises in such a way as to cause concern, then an alert will be triggered, and the clinician will be alerted and somebody will contact the patient.

 

“The advantage of measuring blood pressure at home is not getting any white coat syndrome – you don’t need to get the bus to the doctor or get flustered trying to get to your appointment. You can avoid the factors that might make your blood pressure go up.

 

“The measurements are then reckoned to be much more accurate, so that’s good for the patient and it means your blood pressure is likely to be monitored more regularly over a longer period and the results will be more typical. One of the killer statistics for this is that 1.2 million GP appointments in Scotland alone are just for blood pressure monitoring and if we could cut a large portion of those and get better results, that would be a massive boost because it would enable resources to be freed up to deal with other more pressing matters.”

 

Florence has also been deployed to help Dundonians stop smoking, monitor their diet and prepare for surgery.

 

“Florence reminds you about not smoking and sends you motivational messages and you send reports of your progress back: you develop a relationship with Florence and although she is just a computer, people go on to feel that it is more than that. It’s a way of keeping in touch with human beings as well because there are human beings at the other end and that’s comforting for people to know.

 

“One of the early uses of Florence in Dundee involved cystic fibrosis patients who could use it to keep a track of whether they were eating enough to maintain their weight at a healthy level.

 

“…Florence reminds patients of some of the things they need to do before they get into hospital for surgery and it has been saving time for the theatres in Stracathro – staff there have seen fewer missed appointments as a result of people being ready before they come in.”

 

An independent charity supporting third sector organisations to improve their resilience and services, Dundee Voluntary Action holds a contract with the Dundee health and social care partnership to promote technology-enabled care.

 

The contract, Mr Black explains, “is about finding new ideas that further the Scottish Government’s agenda [around technology-enabled care] and taking these ideas back to Dundee and try and get people to be enthusiastic about them, because it’s very hard to create change.

 

“It’s difficult when people are under pressure and delivering services – they don’t have time to get their heads up and look around and see the new methods that are coming in. But none the less, we have to change. The realistic medicine agenda that Dr Catherine Calderwood put forward is in part about changing to meet the needs of our ageing population; more care is required and current resources are stretched already.

 

“We have seen problems with GPs for example, in not being able to find enough to keep surgeries open – we had a closure not all that long ago in Dundee. With all of that, its necessary to find new ways of working. With Florence, people take charge of their own healthcare and to a certain extent how they manage their conditions. It helps them gather information so they can do this and also means clinicians have better information to work with.”

 

This story was supplied as part of our partnership with healthandcare.scot. 

Pharmacy Anywhere’s Highland success

 

“We started with a problem”, Clare Morrison, who is clinical health lead at NHS Highland, explains. “NHS Highland is a remote and rural health board, it covers 40% of the landmass of Scotland yet only has 8% of the population so it is a large area which is sparsely populated, and this really brings a couple of problems”;

 

It has long been the mantra of those working in health and care services in Scotland that living in a remote or rural area should not deprive an individual of their right to access high-quality healthcare services. Now the innovative Pharmacy Anywhere initiative is bringing clinicians closer to being able to square the circle of ensuring that patients, whether they live in Torridon or Tongue, can access the services they need.

 

It’s doing this by using technology to overcome the vast distances and let residents access high-quality support from their pharmacist.

 

Although the area’s remoteness attracts so many visitors to the Highlands every year, healthcare has had to innovate to overcome the challenges of geography. The first problem, according to Ms Morrison, speaking at the Celtic pharmacy conference earlier this year, is recruitment.

 

“Recruiting pharmacists to work in rural areas like that is really hard and yet we do recruit some, but the nature of the workload means they spend a lot of time driving between communities…which really is such a waste of clinical capacity at a time when we are stretched as a profession.”

 

NHS Highland’s senior clinical quality lead and NHS Near Me lead outlined a journey that began with securing charity funding for the new venture from the Health Foundation in January 2017, followed by three months of planning and then small-scale testing.

 

Ms Morrison reflected: “It seems quite strange to me now looking back, but at the time what we were doing just had not been done before, that remote access in and remote consulting…Now to me, this feels routine but back then it was really, really new.”

 

Remote access and consultations

 

Previously, collaboration with dispensing practices had involved pharmacists physically working in a practice.

 

“We know dispensing practices supply the medicines but often don’t provide the pharmaceutical care and expertise that a pharmacist can provide…what we tried to do was take that model and approach of regular annual medication reviews that had been provided by pharmacists in dispensing practices, and provide it remotely rather than in person”, Ms Morrison says.

 

“We used two forms of telehealth”, she explains, “the first one was remote access to patients’ medical records, so this allowed the pharmacists from a laptop to have full read and write access.

 

“I think it’s fair to say that when we started, vision anywhere wasn’t up to scratch in terms of what we needed it to do…The vision anywhere team were fantastic and worked with us and we managed to get it working”.

 

Video consulting via the attend anywhere platform was used, and, in light of connectivity issues that exist in some areas, telephone calls were used where a video link could not be established.

 

“In the initial phase we developed a process so we had a clear written process for how the consultations should be delivered, and that was jointly developed by the pharmacists who were involved in this and the GP practices.

 

“The process was to start off with the GP practice staff identify the patients who were due a medication review; some GP practices just for patients when their annual review was due, and one actually picked out the most complex patients to maximise the benefit of pharmacist input.”

 

GP practices would contact patients to offer appointments and explain the different options of a video or telephone consultation.

 

Another consequence of patients living in remote rural locations is a higher reliance on purchased medicines. A lack of community pharmacy facilities has meant many increasingly purchase some of their medicines online.

 

Clare Morrison explained: “The medication review process was very much based on the NHS Scotland seven-step framework but we had a real focus on purchased medicines as well. People who don’t work regularly in dispensing practice don’t realise patients in these areas just don’t have access to community pharmacy at all.

 

“They do rely on the internet to buy their medicines so it was really important for us to ask patients about every single medicine, including those they had bought on the internet.

 

Reviews can result in advice on purchased medicines, reductions, increases or alterations in prescriptions and referrals to other members of the general practice team for extra support.

 

“So the results”, Ms Morrison went on, “As a six-month pilot with ten pharmacists, the uptake was pretty high: 85% of patients who were offered an appointment accepted.

 

“We did have 57 refusals and telehealth was the reason for 36 of those; not one single patient despite the fact they had never had a pharmacist support before refused because it was review with the pharmacists.

 

“I think that shows just how much the public and the patients and these practices value the support that they were getting in the pharmacists.

 

“94% of consultations used telehealth successfully. In the early days, we did have a lot of problems with internet connections…interestingly since this pilot’s been done there’s been quite a massive improvement in the fibre broadband coverage in Highland and I suspect we would get very different results if we did it now.

 

“The consultation methods did end up being more telephone-based but I think that’s okay. I think we did definitely identify that there are values in improving and using video because, for example, patients could hold up their medicines and staff could see them. We recognise the value but at least they were getting a pharmacist input, which they weren’t normally getting, by phone.”

 

70% of patients who took part required some sort of clinical intervention – “a massive number”.

 

In terms of the savings, the licence for the software used to provide the service was £1980 a year, compared to the £8,400 approximate cost of a pharmacist delivering the same service in person by driving to different practices across the Highlands.

 

“Patient acceptability [of the service] has been positive,” Ms Morrison says, before extolling the benefits for staff.

 

“Enabling us to provide care to remote locations in this way is just fantastic; it provides a better work-life balance for pharmacists. These are teams who suddenly find they are not spending all their time driving and that’s a really big thing.”

 

An improved patient experience

 

“Thirdly, it provides a more responsive and sustainable service. In terms of responsiveness, we provide medication reviews when patients are referred rather than waiting until the next time the pharmacy team was going to be in the GP practice.”

 

“If we get a referral we can dial into the patient’s records immediately, and the service becomes so much more sustainable because if one pharmacist is off sick and something urgent still needs to be done somewhere else, we can act remotely and provide a replacement service.”

 

“The project comes with two caveats” the audience at the Celtic conference was informed. “Caveat number one is that telehealth isn’t suitable for all consultations. Some patients will need in-person appointments and we have to recognise that”.

 

“Caveat two relates to the video consulting part – not every person is as addicted to smartphones as we are, so remember they may need some support.”

 

Initial reactions informed the adoption of a single point of entry into the system, as Ms Morrison says:

 

“What patients really hated when we started off was having one service for diabetes and one service pharmacy and one service for respiratory and so on where patients had to enter in a different way for each condition. That was really hard for patients – they got confused, they got the wrong place and they gave up.

 

“To make it easy for patients we developed a single point of entry. Our system works by starting a video call, patients are then greeted by a real person who transfers the patient to the clinical service they are attending.”

 

So successful has the initiative been, that what started off as a charity funded project has led to the establishment and integration of an NHS service.

 

“Pharmacy Anywhere led to the establishment of NHS Near Me – a video consulting service for all outpatient appointments in NHS Highland. We have 19 different clinical specialities now providing appointments with this way and patients either have an appointment at home because we recognise connectivity issues and we have put the kit in for patients to use in local NHS clinics.

 

Feedback from patients frequently highlighted the importance of time saved if a remote consultation could be carried out, often giving them more time with loved ones. Before embarking on this project, Ms Morrison said she thought “telehealth was second best…but actually, it’s not. For a lot of patients, this is the preferred service”.

 

This story was supplied as part of our partnership with healthandcare.scot. 

NHS Skype use prevents thousands of avoidable hospital trips

 

A scheme in Tameside, Greater Manchester run by NHS doctors and nurses using Skype to help older people get faster care has reduced avoidable ambulance call-outs and helped people stay out of hospital.

 

In the last two years, they have prevented 3,000 avoidable visits to A&E and freed up 2,000 GP appointments by solving problems via Skype, meaning elderly people get the right support in their own home, avoiding the disruption and in some cases distress of an emergency hospital trip.

 

Working together and with patients, carers and local groups, health leaders in the area have developed:

 

  • The digital health and community response teams helping avoid unnecessary admissions.
  • The ‘Extensivist team’ – GPs and clinicians working closely with high need patients reducing A&E attendance by 58% within the cohort of patients that the team sees.
  • A £1.3m funding boost to the voluntary sector to provide 2,500 social prescribing referrals a year.
  • Home First, led by their Integrated Urgent Care Team seven days a week to help people get home in a timely way once medically fit.

 

The scheme is part of a programme of integrated services being rolled-out across the country as part of the NHS Long Term Plan, with smart use of technology enabling quicker, more personal care delivered as efficiently as possible.

 

Prof Stephen Powis, NHS England Medical Director, said:

 

“Putting every person’s individual care needs at the centre of joined-up services, supported by smart technology, is the heart of our Long Term Plan for the NHS. What matters most to every patient and their family is that they get the right treatment, at the right time, so integrating services – across communities and between councils, carers and hospitals – is not only good for the people we care for but a more efficient use of NHS resources.”

 

Peter Grace, a registered nurse who works taking calls in the digital centre, said:

 

“By setting up a direct link between services and the doctors and nurses at the hospital’s digital health team, we were able to offer guidance, advice and reassurance as well as being able to see the patient on Skype. Extending this to housing wardens, working with the council, has taken the project to the next level as now we can also help with issues in sheltered accommodation such as falls.”

 

Steven Pleasant MBE, Chief Executive of Tameside Metropolitan Borough Council and Accountable Officer for NHS Tameside and Glossop Clinical Commissioning Group (CCG), said:

 

“One of the most important changes to how we operate in the Tameside integrated care system is that we can risk share. We can move money round to support other organisations make savings around areas like prescribing and free up investment for preventative care. But it’s our culture that has changed – it’s about working as one team with no emphasis on the organisation you’re employed by – and empowering the workforce with permission to innovate. We’re totally open to change and with the back-up of an extensive leadership training programme we’re striving to develop the next generation of leaders from every level all the organisations.”

 

Trish Cavanagh, Chief Operating Officer at Tameside and Glossop Integrated Care NHS Foundation Trust, said:

 

“The strategic plans we have developed are aimed at improving access to care for people and looking to provide care in more innovative ways – including using technology to support this. In some circumstances, this reduces the need for people to attend the hospital but they are still able to access expert advice in a timely manner.”

 

Jon Rouse, Chief Officer of the Greater Manchester Health and Social Care Partnership, said:

 

“Tameside’s pioneering work is an example of what happens when you bring together teams from the NHS, local authorities and care home providers and give them the freedom and resources to develop new ways of doing things. Greater Manchester has a long history of collaboration between the 10 council areas. It is that focus on working across organisational boundaries to best serve the needs of ordinary people that will help them to live independently as long as possible and receive care when they need it.”