Last week I was chatting to a District Nurse. Under pressure now that district or community based nurses are at a record low. Half the number with twice the workload – running around likes the proverbial blue XXXXX fly. Loved the Care in local communities vision for district nursing, but hardly the time to say hello my name is…. At the bottom of this there is a recruitment issue – just not enough nurses to fill the posts. It is OK to use healthcare assistants, but sometimes that is not the same.
It’s obvious, it is not the vision that is broke – far from it – it is the ability to deliver.
We talked a little about geography. She lived 8 miles away from here and the base was four miles further away. It’s outer London – so four miles doesn’t sound much, but could take 20minutes.
The first discussion was about why she uses the base. It would seem ‘not a lot’ since all of the appointments were scheduled electronically, but it was probably necessary to visit the base to pick up equipment for the day – catheters, dressings and other equipment that was required. Thinking about this list, there was very little that wasn’t stockable or orderable from the community pharmacy. You could easily use a community pharmacy an outpost of the unit – then at least you could be on patch quicker.
We chatted about the things that she and her team do on a regular basis for people who live in the streets around the community pharmacy.
Ok – I am not going to get involved in catheterisation or wound management, but I can at least ensure that the products required are available or close to the patient’s home – perhaps even delivered. LMW heparin injections, blood glucose testing, insulin injections, anticoagulant monitoring and immunisation for the housebound – well I could do all of those.
Falls assessment – tick – I do those for the elderly who can get to the pharmacy and basic health checks – BP etc – tick.
Visiting some frail elderly patients after discharge and liaison with social services. Well I bet we deliver to them weekly – why can’t our delivery driver check on them regularly then either ring me or you or their care worker when something is not right.
Setting up remote monitoring equipment – right up my street – I love gizmos.
And connect to voluntary support and help – excuse me – I work in this community – I know most people who live in those streets. My staff live in those streets.
Throughout the conversation there were many more things that were mentioned that a community pharmacist could deliver with a small amount of additional training and orienteering. At one point the nurse looked longingly at the consultation area – could we run some clinics in there?
When I mentioned that we were hoping for read/write connection to the GP clinical system of the nearby practice, she nearly fell of her chair – advanced communication between district nursing and General Practice through the Community Pharmacy – just let the thought of that sink in!
At the end of the day we must accept that district nurses are valuable commodities that need to be protected and supported, but they don’t grow on trees. There are numerous functions that a community pharmacist and their team could deliver through an integrated multispecialty community service.
And then we might think about introducing more advanced nurse practitioners and a few independent prescribing community pharmacists. Was this Simon Stevens vision?