(Same style as before) December 2013, interview from the future
Has community pharmacy changed much from last year?
This time last year pharmacy had a difficult time. Corporation tax, personal tax all hit at a time when income was reduced, but the changes in the NHS have given us a new set of opportunities.
What has been the most important change?
There is not just one, but a collection. For me it was the NHSCB transformation fund that supported me in changing the working structure of the pharmacy. We were able to work through a new portfolio of clinical services and set a target for clinical activity. Once these targets were set the NHSCB would guarantee income for up to six months.
So what did this actually mean?
Well I restructured the way that I run the pharmacy to engage two additional part time pharmacists to help us deliver services. It just covered our costs while we built things up. But at a tough financial time it just meant that they took some of the risk away.
So did this support NMS and MUR?
Well yes and no. Obviously these are separate things, but the flexibility allowed us to deliver these services better. These have been much more rewarding linking NMS to medicines reconciliation and MUR to medication reviews. It standardised the language and supported communication. It has simply added value and built bridges between hospitals, general practice and community pharmacy.
So what were the additional clinical services?
There were a range of opportunities. We have taken on a number of very interesting new services. They are based on common chronic conditions that can be adequately managed in community pharmacy. We don’t need access to medical notes and patients don’t need to visit their GP. For example we offer services for patients with IBS and GORD.
So how does this work?
Well the CCG realise that a lot of patients with IBS come to us and buy OTC products. They are dissatisfied with treatment and take up a lot of GP time. There are loads of referrals with lots of investigations and some emergency admissions. We offer patients a short consultation and link them up to a charity who supports self care. We have the opportunity to continue with OTC medicines or ask the GP to prescribe from a limited list of medicines. One of our pharmacists is an independent prescriber so she has taken on this role herself. Many of the patients are saying that their quality of life has improved significantly and the number of referrals has gone down significantly.
Similar thinking as IBS. We have been working to reduce long term PPI use and we have been very successful so far.
And how are other services developing?
It is interesting that there was some confusion as to where existing LES services were going to go to. Some actually stopped, but some went to the local authority and we found a new invigoration and a new focus on driving potential clients into our service. Our counter staff have received additional training from the local authority and they are now better identifying new clients. They have a hub program that is in its early stages that is interesting and it seems to join everything together.
A hub program – what do you mean by that?
The theory is simple. There are 68 community pharmacies in this area and we are forming the hubs for chronic illness and public health services. This is a concept that brings the local authority, the CCG and the community pharmacists together and is supported by the Health and Well-being board. The aim is that we become the triage point for health promotion and chronic illnesses.
So what do you actually do for people?
In effect we look at people as individuals. We are able to refer them for weight management and activity promotion services and offer stop smoking. For certain long term conditions we will manage them ourselves like IBS and GORD and others we refer to a GP. On top of this we have some shared care arrangements in place, particularly asthma and COPD where we manage reviews on a regular basis.
Are there any problems with this?
The great thing is that we can provide the equivalent of 30 hours of planned clinical services a week, but our consultation room is virtually full all the time and we have a waiting list – who would have ever thought this a year ago. There are other services that I can take on, but I now need to think about reorganisation again.
And the future?
We are in the middle of our dermatology training program which is another obvious condition that we are already heavily involved in. And we are also talking about mental health related services.
We have to stop there, but I would like to thank you for our chat.