At your service

LPC chairman and NPA board member Dilip Joshi seeks clarification over EHC provision and is inspired by pharmacy practice north of the border.

Monday January 15

I am in discussions about a suggested modification of the Patient Group Direction (PGD) for emergency contraception (EHC). The new PGD states that a woman’s BMI must be taken into consideration before making a supply. The commissioners interpret this in ‘practical terms’ as having a conversation. I state that pharmacists cannot make a subjective judgement and BMI needs to be measured.

The issue is that although the fee for the service has not been revised for over 8 years, commissioners are unwilling to recognise the cost of additional equipment and time required to deliver the new PDG requirement. Clinical commissioning group (CCG) pharmacists explain that best practise needs to be reflected in PGDs and are generally sympathetic, but suggest this needs to be taken up with commissioners – in this case, the Local Authority.

Funding constraints mean the Local Authority is continuing to look at decommissioning options where it can
but in Lambeth & Southwark, teenage pregnancy and sexual health are such major issues that this would be difficult to defend. Instead, I am told of plans to commission a ‘holistic and comprehensive’ sexual health service with a key role for pharmacy in the new financial year and to bear with the situation in the meantime – words I have heard on many previous occasions!

Wednesday January 17

I attend a diabetes medicines optimisation meeting for Lambeth & Southwark contractors this evening and listen to a CCG pharmacist with a special interest in diabetes who delivers the talk together with a local CPPE tutor. The talk is informative and well-received and ends with a suggestion of commissioning a service to optimise medicines-taking in diabetic patients.

I am aware this project is based on a successful charity funding bid from the CCG pharmacist that the LPC supported, and look forward to how contractors will be involved. Often well-meaning first steps such as this training are delivered, but a successful project that is properly evaluated is more challenging. The service rarely rolls out beyond the pilot stage.

Monday, Tuesday - January 22 and 23

The highlight of the NPA Board meeting this month is a visit by Rose Marie Parr, chief pharmaceutical officer at the Scottish Government. Rose Marie outlines a Scottish Government vision for community pharmacy that leaves many south of the border, distinctly envious. The biggest difference in approach is that many Scottish services are nationally commissioned, unlike the more fragmented services commissioned by CCGs and Local Authorities in England. 

Adaptable services responsive to local needs is a laudable aim, however funding challenges often lead to reduced access to effective pharmacy services.

In Scotland, minor ailments, smoking cessation, EHC and gluten-free food are services available in every pharmacy. Rose Marie is convinced of the part community pharmacy can play in delivering a strong healthcare proposition to Scottish citizens. Of course, England is bigger with many more pharmacies and different political dynamics but focusing on inequalities and universal access to services might be a good starting point for a fundamental review. 

Wednesday - January 24

At a Lambeth Borough Prescribing Committee meeting today, GP prescribing targets are reviewed but all on the basis of cost. More pharma company rebate schemes are emerging with one potentially saving £200 per patient per annum.This is resulting in prescribing conflicts between GPs and secondary care specialists. For example, GPs are penalised for continuing to prescribe tadalafil and ‘items of low value’ such as Omacor initiated by hospital specialists. The local medical committee rep is exasperated by this, stating that Omacor is often initiated by lipidologists to reduce triglycerides where fibrates are not tolerated, and it is not right for GPs to have to contradict specialists.

Another GP target calls for a reduction of at least 9% for OTC items in the coming year. A case is reported when a patient referred to pharmacy with a recommendation for a product by his GP was supplied with another product. I explain why this could have happened and highlight the risk of patients going to supermarkets where professional advice is unavailable and the possible increase in A&E visits.

Monday - January 29

I attend an NPA Insurance board meeting today and we discuss increased risks members face in provision of new services. In these challenging times, many are considering providing other services. These range from independent prescribing and online doctor services to phlebotomy and the more exotic botox services. Additional premiums need to reflect increased risk and to ensure members are well-protected, we agree to get a better understanding of numbers of community pharmacies involved and the range of services being provided.


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