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Way still to go on effective prescribing


Way still to go on effective prescribing

The chief pharmaceutical officer in England’s recommendations for tackling overprescribing put medicines optimisation front and centre for pharmacists working in primary care

23 August

Service praised by public

People have generally felt satisfied with pharmacies during the pandemic, according to public interest body Healthwatch. People particularly praised time slots for prescription collection, medication deliveries, pharmacies being open while other services were difficult to access, and being able to collect or order repeat prescriptions in person.

In a comment which will resonate with many, Healthwatch concluded: “The main reason people use pharmacies is to get their medication. But not everyone understands the full range of services and support pharmacies offer, such as preventative advice and treatment for minor ailments.” 

Further insight from Healthwatch, which was established under the Health and Social Care Act 2012 to understand the needs and concerns of health and social care service users here.

1 September

PQS guidance for 2021/22 published

Guidance to support the 2021/22 Pharmacy Quality Scheme is published. Participating contractors will need to declare their performance against the quality domains between 31 January and 25 February 2022. The points-based system is retained; for each contractor, the maximum number of points for each domain will be dependent on a banding system based on total prescription item volume in 2020/21 “to better reflect the workload of meeting the requirements for different contractors”. The 2021/22 scheme retains a cashflow boosting aspiration payment, which needs to be claimed by 29 October 2021. 

2 September

ICS leadership shapes up

More guidance on ICSs is published by NHS England. Of interest to community pharmacy is implementation guidance which says that ICSs should “ensure leaders from all clinical and care professions are involved and invested in the vision, purpose and work of their ICS as it matures”. Published alongside, the NHS Confederation’s engagement work, which informs the guidance, can be found here. Encouragingly, the Confed found that the professionals at its engagement events, of whom 15 per cent described themselves as pharmacists, were more interested in ICSs being informed by effective clinical representatives, rather than sectional interests. One said: “I don’t mind whether it is a doctor, nurse, pharmacist or anybody that represents me to do my job to help patients get the care they need. The more we talk about whether it’s a doctor, a nurse, an AHP, the more we divide ourselves and miss the point about going into an ICS.”

6 September

Sector lauded by Welsh first minister

Community pharmacy has support across the political spectrum in Wales, says first minister Mark Drakeford. Praising the sector’s pandemic response at a Cardiff Castle dinner to celebrate the centenary of the National Pharmacy Association, Mr Drakeford said: “Without you, we wouldn’t have got through this together. As well as being an essential clinical resource, community pharmacy is an economic driver. As we rebuild after the pandemic, you will be one of the anchors that help maintain the vitality of local high streets.

7 September

Act now to help patients breathe better

FIP, the International Pharmaceutical Federation, has issued an urgent call to action to address pharmacy’s role in minimising the impact of air pollution on respiratory health. The result of an expert roundtable held in collaboration with GlaxoSmithKline’s scientific initiative The Clean Breathing Institute (TCBI), the Call to Action advocates ‘strong and effective integration of community pharmacists in improving respiratory healthcare’, including increased recognition of their role in primary healthcare and expanded authority to manage respiratory conditions and vaccinate to prevent respiratory diseases. 

TCBI and FIP are encouraging pharmacists to take the ‘Breathe Better’ pledge as a commitment to raise awareness of air pollution, identify risk factors and provide supportive services. The organisations will co-create professional pharmacy services, education and training. Take the pledge

Prescriber competency framework updated by RPS

The Royal Pharmaceutical Society updates its Competency Framework for all Prescribers, setting out what good prescribing looks like across all health professions. The scope of the framework has been expanded, 12 new supporting statements have been included and new information sections have been added. An online version of the framework is available here along with a Welsh version, examples in practice, a presentation, help on how to evidence competency and further supporting resources. The framework can be used by any prescriber at any point in their career – it is already used as the competency framework for nurse prescribers. It can be used as a self-assessment tool, says the RPS, to inform standards and education of healthcare professionals, and by prescribing trainees to evidence they are delivering the competencies required of their role.

10 September

New inquiry into the sector’s future

The All Party Pharmacy Group (APPG) opens an inquiry into the future of community pharmacy following the Covid pandemic. It says it wants input on topics such as how pharmacy can be best employed to deliver primary care services, how it can support people with long-term conditions and how pharmacies can be better integrated into NHS pathways. The inquiry will also examine how the community pharmacist consultation and discharge medicines services can be maximised and independent prescribers used to improve outcomes for patients. The APPG is accepting written evidence submissions until 1 November and will hold oral evidence sessions in due course. 

13 September

Animation on right sepsis response 

For World Sepsis Day (13 September), Health Education England (HEE) releases a new animation, showcasing learning resources designed to educate health professionals on sepsis and boost their confidence in responding to cases. The animation includes HEE’s Think Sepsis e-learning programme, and a range of learning materials for primary care as well as the public.

16 September

Covid costs reimbursement in October in England

The PSNC confirms that all contractors who lodged claims for their Covid costs will receive some money at the start of October and reveals the total amount is more than twice that first offered by the Government. The negotiator said the Department of Health and Social Care and NHS Business Services Authority had processed the claims in line with the Drug Tariff, with 95 per cent of contractors set to receive the full amount claimed once it has been verified.

20 September

Hope for medicines supplies into NI as industry raises withdrawal concerns

The Government hopes the extension of the grace period that prevents further checks on goods provides some breathing space for medicines supplies into Northern Ireland (NI), but accepts the current situation is not ideal. 

Speaking at an Ethical Medicines Industry Group (EMIG) compliance special interest group online meeting hosted by law firm VWV, Antonia Jeans, who leads on NI regulation at the Department of Health and Social Care, accepted that the operation of the Northern Ireland Protocol is causing significant disruption for businesses and patients. “Everyone is trying to get to a solution as quickly as possible. We believe it’s crucial people in Northern Ireland have access to a full range of medicines, equal to other parts of the UK,” Ms Jeans said. The EU has recently published proposals designed to tackle some of the technical issues “but we do have some serious concerns about the practicalities”, she added.

The Government has proposed that medicines should be removed from the Protocol altogether to avoid two regulatory regimes across one territory. In the meantime, discontinuations were concerning, hence the announcement of a non-time limited ‘standstill’ on 6 September, which should allow meaningful negotiations with the EU Commission to take place. The EU has stated that no legal action to enforce the Protocol will be taken in the interim. 

Representatives for the UK’s generic drug companies had earlier reacted to the EU’s proposals for easing the flow of medicines by suggesting they are inadequate, telling the BBC on 15 September that over 3,000 drugs were at risk of being withdrawn. Some Britain-based companies have already declared their intention to stop distributing some products in Northern Ireland, with health minister Robin Swann recently saying he had been notified of 910 medicines that were due to be withdrawn and a further 2,400 at risk.

The terms of the Protocol state that Northern Ireland-bound medicines that have been batch tested by authorities in Great Britain will also need to be tested in NI or the EU, creating additional supply chain complexity and costs. The BGMA said: “In an environment where margins are razor-thin, extra complexity isn’t feasible. The alternatives – a UK-wide licence for medicines – would service Northern Irish patients best.”

22 September

Pharmacists to be at the forefront of tackling overprescribing

System-wide culture change is needed to address the problem of overprescribing in England. This is the headline conclusion of a landmark review, led by outgoing chief pharmaceutical officer Dr Keith Ridge. The review found that a tenth of all prescription items dispensed in primary care are inappropriate for patients’ needs.

It also found that 6.5 per cent of all hospital admissions are still caused by the adverse effects of medicines, rising to 20 per cent of admissions among people aged 65 and over – this is not the first time admissions data has revealed the impact of medicines-related harm. The review also revealed that overprescribing may be contributing to health inequalities by disproportionately affecting black, Asian and minority ethnic communities and those who are more vulnerable, such as the elderly and those with disabilities. Overprescribing may occur in a range of circumstances, such as when a patient no longer needs a particular medicine but continues to be prescribed it, or when a different treatment may be more effective but is not prescribed.

To address the issues, the review sets out a number of recommendations, including recruiting a national clinical director for overprescribing, improving data collection and communication between primary and secondary care and making medicines information more accessible to patients. It also recommends a shift from over-reliance on medication to a culture that supports shared decision-making between clinicians and patients and increases the use of social prescribing. 

The review notes the expansion of pharmacy professional roles in primary care networks, and suggests that by 2024, each of England’s 1,200-plus PCNs could have seven clinical pharmacists or pharmacy technicians to support improvements to prescribing and medicines safety, leading to a further expansion of clinical pharmacist-led structured medication reviews. 

Dr Ridge said: “Tackling overprescribing depends on continuing to develop a culture of openness to challenge within healthcare… some clinicians react negatively if a pharmacist or another clinician queries a prescription.” 

Welcoming the review’s recommendations, Royal Pharmaceutical Society England board chair Thorrun Govind said: “For too long, the healthcare system has focused on the positive effects of adding medicines to a prescription, rather than acknowledging that this can also increase the risk of side effects and interactions between medicines.”

Nick Kaye, vice-chair at the National Pharmacy Association, said: “Community pharmacists could play an increasingly important role in ensuring effective prescribing – for example, through structured medication reviews and as independent prescribers. The clinical skills of all pharmacists – not just those working in GP practices – need to be brought to bear further on this important agenda.

“On the flip side of overprescribing is the matter of helping patients get the most from their medicines once dispensed, which is the bread and butter of community pharmacy. New services like the Discharge Medicines Service and the extended New Medicine Service build on this role significantly.”

25 September

ACTNow campaign 2021 starts on World Pharmacists’ Day

The Pharmacist Support charity kicks off its 2021 wellbeing campaign ‘ACTNow’ with five themes – Be Active, Give, Take Notice, Keep Learning and Connect – running across five weeks. “The campaign aspires to provide tools and inspiration to enable and support the pharmacy family to prioritise mental health and wellbeing in the workplace,” says the charity’s chief executive Danielle Hunt. Pharmacist Support is also launching a wellbeing learning platform to enable people to take control of their own wellbeing, and is seeking to recruit Listening Friends volunteers, the peer support service that marks its 25th anniversary this year. To pledge support and for more information. ACTNow is supported by the Pharmacists Defence Association and Day Lewis Pharmacy. 

27 September

NPA/Confed set out ICS engagement plan

A report co-authored by the NHS Confederation, the National Pharmacy Association and the Primary Care Pharmacy Association suggests seven requirements to bring the best out of community pharmacy working as part of ICSs. Dr Graham Jackson, GP and senior clinical advisor at the NHS Confederation, says: “It is critical that all available clinical capacity is used effectively. Our report examines the opportunities of collaboration with community pharmacy and identifies key enablers available to local systems, as well as addressing barriers.”

The key requirements include:  

  • Giving community pharmacists the time and space to get involved 
  • Community pharmacy and general practice needing to work through historical perceptions of their relationship, to move from competition to collaboration as providers, with benefit for patients, contractors and primary care a whole 
  • National contract specifications for local adoption
  • Nationally specified services properly resourced
  • Mechanisms and resources to involve community pharmacy in decision-making at all levels, with resources to enable this. 

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