Putting pharmacy into the NHS team
By Primary Care Journal-
The coronavirus pandemic has reminded us all that primary care, broader health care, and indeed social care, is a team effort. All parts of the NHS, including community pharmacy, have needed to pull in the same direction in the face of a deadly common enemy: Covid-19.
Health and Care Secretary Matt Hancock has adopted the mantra that pharmacies are part of the “NHS family”. That’s not a new notion, but the idea is certainly being repeated more than ever by senior people in government and health service management.
It is estimated that community pharmacies nationwide have 300,000 one-to-one interactions a week with other parts of the health system (such as NHS111, GPs and community nurses). Approximately 26 interactions for every pharmacy in England. This data is extrapolated from a small sample of pharmacies operating over a bank holiday, so we must treat these numbers with caution – in fact they seem to be an underestimate going by my own experience of operating five pharmacies in the West Midlands.
The best patient care is usually based on partnerships between healthcare professionals, who may work in different settings and have different skills, but who come together to provide seamless support. The below account from one of NPA’s members in London shows what this can mean in practice.
Jignesh Patel's account:
“The fact that at our pharmacy we have read/write EMIS web access to local GP practices has been crucial during the pandemic. This has allowed me to see the clinical history of patients, which includes medication, allergies, diagnosis, GP consultation summaries, investigations and blood tests.
“I have found that having access to integrated IT with GP surgeries has been crucial to ensuring we provide a safe service and has helped us deal with a massively increased workload. It means we spend less time phoning GPs and most issues can be dealt with by having full access.
“With practices that don't share their records with us, patients and my pharmacy team can end up waiting 40-plus minutes to resolve prescription and clinical queries when calling the practice. This adds a lot of pressure on our existing workload.
“The system is also brilliant for my private and NHS immunisation and PGD services where I can quickly check past vaccination histories, allergies and contraindications.
“Having up to date information when patients have their flu and pneumonia vaccines prevents duplication. When I input information on what vaccines I provided, this helps the practice know which patients have been vaccinated by us.
“This winter everyone is going to be swamped with workload - GPs, pharmacists and hospitals. How do we all work together to ensure we don’t duplicate, to make sure patients have wider access?
“We need to think innovatively in terms of how we utilise the NHS Community Pharmacy Consultation Service better. I would like to see GPs able to directly refer patients to pharmacies, so if a receptionist feels there is something that a pharmacist can deal with first, then they should come to us. We can support GPs by giving patients access, and a choice in terms of prevention and treatment of minor ailments.
“With this year’s demand for flu vaccinations likely to be high, this is the time to start fostering better partnership working across primary care. Collaboration is going to be key to delivering services this year.
“In Newham, we have Newham Flu Group, which has representatives of primary care including community pharmacy. The group works together to plan the flu service locally, share information and support practices in increasing the vaccine uptake and with issues like vaccine ordering. ”
Redesigning the model
So, how will all the pieces fit together in the ‘new normal’, post-Covid-19? Which elements of the remote working that GPs have adopted to cope with the crisis will continue? Will electronic repeat dispensing become more commonplace, bringing efficiency benefits for all concerned?
For my part as a community pharmacist, I want to develop as an essential component of the urgent care pathway, as well as a health and wellbeing hub and mainstay of support for people with long-term medical conditions, integrated with the wider primary healthcare team.
GPs and pharmacists will have to work together more closely to meet growing demand, the need for efficiency and in line with NHS Long Term Plan. As PCNs get up and running, trusted relationships are going to be key.
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