Report reveals extent of hidden value of community pharmacy

 

A report commissioned by Community Pharmacy Scotland published today has quantified the ‘ART’ (Advice, Referral and Treatment) of pharmacy within the community pharmacy network in Scotland.

 

The report estimates that community pharmacy teams in Scotland give advice to people accessing their services 2100 times every hour. Extrapolated over a week this equates to 84,000 advice only consultations. The study estimates therefore that community pharmacy teams in Scotland conduct advice only consultations 1.67 times every hour.

 

Pharmacy Sites 1 2 3 4 5 6 7 8
Total Advice 37 78 146 84 85 85 80 62
Hours Open 53.5 47.5 50.5 40.5 41.5 62 55 51
Advice Per Hour 0.69 1.64 2.89 2.07 2.05 1.37 1.45 1.22

 

Table adapted from the ART of pharmacy report.

 

Although the pharmacist was found to be the pharmacy team member giving advice most often, the pharmacist advice only interventions account for less than half of the total contacts in the study.

 

Staff Role n %
Pharmacist 305 46.4
Technician 61 9.3
Counter Assistant 269 40.9
Student 22 3.3

 

Table adapted form the ART of pharmacy report. (n=657)

 

Across Scotland, eight community pharmacies were selected for inclusion in the study. The study sites were sought to represent the diversity of community pharmacies based on several factors: relative deprivation of the pharmacy postcode, urban and rural locations of the pharmacy, and whether the pharmacy was independent or part of larger multiple groups. The results from these eight pharmacies were then extrapolated to estimate Scotland wide activity in the community pharmacy network.

 

Other key findings in the report include:

 

  • Over 80% of people are completely satisfied with their community pharmacy experience.
  • 90% of people want GPs and pharmacists to work closer together for their benefit.
  • Around 60% access their community pharmacy due to their relationship with the pharmacy team.
  • 41% of people would go to their GP if the pharmacist was unavailable.

 

The most common reason for accessing the services of community pharmacy was to collect prescribed medication (60.3% of visits), followed by buying medicines (23.3% of visits), seeking medical or health advice (13.7% of visits) and general shopping (2.7% of visits).

 

The authors of the report concluded the following:

 

“Community pharmacy in Scotland is highly regarded by the patients that access their services and provides alleviation to general practice services. Perceptions of both the service and interactions with staff were highly reported and the staff-patient relationship appears to be at the cornerstone of patient experience.

 

“Instances where advice-only is the outcome of patient consultation should receive greater recognition in its contribution to the services community pharmacy provide due to the time it occupies and the staff knowledge demonstrated therein. The service provides full satisfaction to most of those who access it, despite a limited public knowledge of the capacity and diversity of community pharmacy.”

 

In a statement released today Community Pharmacy Scotland commented:

 

“Community pharmacy teams have forever known that they dispense advice and refer on to other parts of the healthcare system with no way of knowing the scale of that impact. This study highlights the significant role community pharmacy teams play in encouraging self-management and acting as a touchpoint for Health and Social Care at the heart of the community as a key component of the primary care team.

 

“As well as the headline statistics we also have a report that has experience of team members and the public through case studies. The diverse range of individuals highlight community pharmacy’s impact in terms of lived experience. These are individuals that are supported in communities throughout the country in pharmacies every day. They value their relationship with community pharmacy.”

 

Professor Harry McQuillan CEO of Community Pharmacy Scotland said:

 

“CPS is delighted with the report which demonstrates the clear value of community pharmacy team. The report allows us to highlight this value with key decision-makers. NHS Pharmacy First Scotland will only add to this report in terms of data.

 

“This report, alongside this new service, should support further development of Pharmacy First so that the right person can receive the right care in the right place, with that place so often being the pharmacy at the centre of the individual’s community.”

 

“CPS would like to thank everyone who contributed to and helped produce the report the report.”

 

 

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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. 

Drug users need compassion, not custody

Westminster committee hears voices of Scots with experience of addiction during an inquiry into problem drug use.

 

The current approach of criminalising people who use drugs is making the problem worse and needs to be drastically overhauled, an influential committee of MPs has been told by Scots with personal experience of addiction.

 

Westminster’s Scottish Affairs Committee is investigating problem drug use in Scotland, including whether the Scottish Parliament needs more powers to deal with rising drugs deaths. Drug-related deaths are at the highest level on record in Scotland, outstripping England and many European countries.

 

Meanwhile, the Scottish Government and the Home Office are locked in a standoff over whether to allow a safe injecting facility in Glasgow. Supporters say the facilities, which are used in Canada, are proven to save lives but the UK Government has refused to change the law to allow such a move.

 

At an evidence session held last week, witnesses said prison sentences were harming, not helping, people who use drugs.

 

Hannah Snow, a 26-year old from Aberdeen who grappled with misuse and addiction for 13 years and who has been abstinent for the past 18 months, said:

 

“I experienced custodial prison sentences for supply of a controlled substance, so selling drugs, and possession of drugs, is not a deterrent — for me, anyway; I can only speak for myself.”

 

She continued: “What benefits are you getting from sending a known drug user into prison to do a drug sentence, who will get released to do the same thing? Enforce an order that has to put them through a recovery-based programme, instead of putting them into a criminal procedure programme where the cycle just starts again.”

 

“…A third of criminals who are released from prison are in addiction or have had addiction problems since they went into prison,” she added. “What hope do they have if they are just released?”

 

Elsewhere in the session witnesses told MPs their time in prison had been introduced them to more harmful substances such as heroin.

 

Also giving evidence was 45-year old Scott Ferguson, who called for possession of drugs for personal use to be decriminalised along the same lines of Portugal and Canada, and the money released from the justice system diverted into treatment and recovery programmes.

 

He went on to suggest a compassionate response was key, telling the panel of MPs the “first bit of empathy” he received from a support worker had given him hope he could recover:

 

“My “[criminal justice worker] was doing a lot of linked casework with my community alcohol and drug services worker, so they were singing off the same hymn sheet and knew what stage I was at.

 

“That was the first bit of compassion and empathy…I felt worthless because that was where my direction had taken me.

 

“I was in and out of homeless accommodation and I just couldn’t get it until I got shown that compassion and empathy, and I got that sense of belief in myself for the first time that I could maybe change.”

 

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