A comment from a community pharmacist after a recent and very disturbing disaster has stuck in my mind. She said ‘I was not part of their care’.
Of course we could all say – don’t be silly the community pharmacist is a very important part of that patient’s care – you dispense the medicines and see the patient more often than some of the clinical staff – but we all know that this is a really ‘thin’ answer. But what does the community pharmacist do when they suspect that a patient who visits their pharmacy is obviously unwell?
Community pharmacists come into regular contact with patients and are one of the most accessible healthcare professionals to the population. They regularly answer questions from neighbours, relatives and carers.
Mental health services have moved into the community, but I am not sure that this has included full integration within primary care and the relationship with general practice and community pharmacy is essential. There is an obvious link to be made between mental health and physical health, but community pharmacy has a role in both of these, linking them together and providing a ‘first port of call’ to the population.
I understand some of the barriers – competing work responsibilities, lack of knowledge about specific mental health conditions, the skills to engage patients with mental health problems and the need for advanced training and changed systems. But we must do something to prevent more tragedies.
I believe that there is a real case to fully engage the community pharmacist in the care of some higher risk patients and ensure that they are formally part of the patient’s support network. After all the community pharmacist will probably know these patients, their neighbours and relatives as regular customers.
Here are some suggestions:
- Patients should be encouraged to ‘register’ with a specific community pharmacy and be introduced formally to the community pharmacist in charge and the pharmacy team
- The pharmacy team should have additional training in working with patients with mental health issues and recognising specific symptoms and signs of deterioration.
- The community pharmacy should receive a payment to manage the dispensing process and to follow up the patient if they do not bring in a prescription or collect their medicines in time
- The community pharmacist should explore creative ways to help the patient to manage their medicines and identify potential issues early. There is an important role in joining up prescribing to dispensing to taking medicines.
- The community pharmacist should play a pivotal role in reinforcing the importance of continued treatment and the provision of information on prescribed and purchased medicines to avoid side effects and interactions
- The community pharmacy team should have the opportunity to feed comments in through the multi-disciplinary team as appropriate
- The community pharmacy should be aware of the care plan and the referral pathways
The ultimate goal is for people with mental health issues to have the support network that they need, the information that they want and a reliable system that identifies potential problems early and can mobilise additional care and support.
In my recent experience, the involvement of the community pharmacist in the wider team might well have saved two lives.