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The innovation game

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The innovation game

The future of independent pharmacy doesn’t rest solely with our GP relationships  

Chairman of the LIPCO federated group Mukesh Lad explains how innovative services can cement pharmacy’s position at the heart of the healthcare team

There’s been much talk in recent weeks of radical proposals calling for pharmacists to work in GP surgeries. Waiting times for GP appointments have become a national talking point and cause for concern. The Royal College of General Practitioners and the Royal Pharmaceutical Society have come up with the plans in a bid to ease current pressures in general practice but it’s not a situation that can be turned around overnight.

With so much talk of a ‘hidden army’ of highly-trained pharmacists capable of providing a solution to relieve pressure, there are many ways in which the NHS could make full use of our clinical skills. This would provide benefit for patients and at the same time take the role of the pharmacist to the next level.

However, there is another issue that’s particularly important to the development of community pharmacy services and their integration within the wider NHS – the promotion of seamless transitional care. It’s generally accepted that the interface between organisations and professional groups such as secondary and primary care is the point at which communication is most likely to break down. This is particularly true of the transit of patients into and out of hospital.

Many studies have shown how this has had a negative impact on patient care and it’s an issue that’s particularly important to the development of community pharmacy services. There’s an opportunity for community pharmacy to work efficiently and establish closer cooperation with secondary care in order to benefit patients and prevent unplanned or emergency admissions and readmissions into hospital.

Innovation in collaboration

 

Our Leicestershire pharmacy federation has recently started an innovative project in collaboration with secondary care to develop a medicines adherence programme for people with inflammatory bowel disease. Patients with long-term conditions such as IBD or who have specific or complex medicine needs could particularly benefit from having a pharmacist to support their self-management. Navigating the information they receive about their treatment as they move between hospital, GP and community care can be conflicting and confusing and often leads to unnecessary hospital consultation or even unplanned admission.

One of the greatest causes of expense in the treatment of this cohort of patients and those with Crohn’s disease or ulcerative colitis is the disease progression with ensuing flare-ups leading to the need for emergency interventions from a consultant. Emergency endoscopy procedures cost hundreds of pounds per patient and emergency surgery is five times more costly to the NHS.

Many flare-ups could be avoided if patients took their medication regularly and as prescribed. We use our MUR service as the framework to provide a patient adherence program. In the first instance, the pharmacist supports the patient in gaining a full understanding of their condition and how to optimise their medicine regimen. The patient is then enrolled onto a support program to provide them with online assistance and 24-hour careline access to specialist IBD and Crohn’s nurses for up to 12 months.

As pharmacists, we know medicines adherence is a major issue not only for people with IBD. It affects almost all people with long-term conditions and they could be better managed by community pharmacists. The SIMPLE respiratory programme, which has also been developed in Leicestershire, has recently been recognised nationally as an excellent community pharmacy service to improve patient outcomes and integrate our profession into a multidisciplinary approach to good clinical practice.

Ambitions and flexibility

 

One of the key ambitions of the Leicestershire federated pharmacy model is to prove that early pharmacy intervention bringing primary care into the heart of local communities can reduce the need for urgent and unplanned admissions to hospital, drastically cutting the number and cost of expensive interventions by secondary care consultants. The health needs of the population are changing. Pharmacy, and especially independent community pharmacy, is flexible enough to adapt to the changing healthcare landscape. What we now need to concentrate on is creating new models of care that are innovative, collaborative in terms of multi-disciplinary delivery. Above all, they need to be realistic solutions that are workable from the point of view of our daily pharmacy business routine.

We have unique strengths and the ability to support patient education as well as advise other professionals about medicines, resolve problems with prescriptions and reduce prescribing errors. And, of course, we can visit patients in their own home when needed.

As part of the healthcare team, we can make a huge difference to all clinical colleagues in both primary and secondary care. But above all, we can provide patients with easier access to high quality care and services that can improve their quality of life considerably by keeping them out of hospital.

The future of independent pharmacy doesn’t rest solely with our GP relationships. Of course we need to work well with them to ensure the efficient and timely supply of medicines. It’s our core contract and we rely on our supply function for the survival of our businesses. However, we need to create other value-added reasons for our existence in the community. Whilst continuing to work with colleagues in primary care is vital, we also need to develop key collaborations with secondary care and the third sector organisations and charities in order to provide the added value that will clearly determine our invaluable position in the healthcare landscape and support NHS provision.

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