Pharmaceutical Care Awards
Pharmacy chains join forces to deliver respiratory and polypharmacy services
The NHS could save £470m a year if all community pharmacies adopted the services piloted by one of the Pharmaceutical Care Awards finalist teams.
Source: Nadia Attura
In 2011 the four largest multiples — Boots, The Co-operative Pharmacy, Lloydspharmacy and Rowlands Pharmacy — met with health ministers. They asked a simple question: what do you want us to do? It was a meeting that led to the Community Pharmacy Future (CPF) project, which was one of six finalists at the Pharmaceutical Care Awards 2014.
“The multiples came together because everyone agrees there is a need to move beyond volume-based models of care,” said Liz Stafford, national primary care liaison manager for Rowlands Pharmacy, in a Q&A session at the event. “What’s been really good is the collaboration, working to everyone’s strengths. It takes a while to get to know people and share resources; it’s looking at everyone’s skills and using them in a valuable way.”
The aim of CPF was simple: demonstrate the value and outcomes of pharmacy services. The project launched in September 2012, with pharmacies in two pilot sites focusing on two key areas: Chronic Obstructive Pulmonary Disease (COPD) and polypharmacy in patients aged 65 years and older. In the Wirral, 21 pharmacies delivered a COPD case finding service, identifying undiagnosed patients at high risk of COPD through a questionnaire and spirometry. A total of 34 pharmacies in the area provided a COPD support service, where patients with established COPD received tailored counselling and “rescue packs” (corticosteroids and antibiotics) to self-manage exacerbations.
One of the challenges we had was making sure the support materials helped our pharmacy teams in an appropriate way and that we listened to them as we went through the process
Meanwhile, 25 pharmacies in Wigan offered a “four or more medicines” support service for patients aged 65 years and older. This aimed to optimise medicines use, reduce falls and improve pain management. It used two screening tools — “Screening tool for older people’s potentially inappropriate prescriptions” (STOPP) and “Screening tool to alert doctor to right (appropriate, indicated) treatments” (START) — to assess prescribing and, where appropriate, refer patients to their GPs.
The scale of the pilots meant the four multiples had to work closely to ensure the pharmacy teams were able to deliver the programme, according to Clare Kerr, head of external affairs for Lloydspharmacy’s parent company Celesio UK. “From an operational view, one of the challenges we had was making sure the support materials helped our pharmacy teams in an appropriate way and that we listened to them as we went through the process,” she told the audience.
Another key problem was recruitment. “When you go to community pharmacy with a research project, recruitment can be a challenge and collection is a challenge,” Kerr explained. ”So we spent a lot of time explaining the service to teams.”
These problems were overcome by unprecedented collaboration between the four companies. Pharmacy teams delivering the services were encouraged to support each other directly and came together for joint training and celebration events. As the service gathered momentum and expanded to pharmacies outside the initial four companies, the CPF team helped support local pharmacy committees (LPCs) deliver the service.
The service ended its data collection phase in June 2013, with results evaluated for all three pilots. The COPD case finding scheme had screened 238 patients, identifying 135 patients at high risk of COPD, of whom 88 were smokers. The service estimated that help to stop smoking would (assuming a successful quit rate of 33%) gain 38.62 life-years and save the NHS £93,500.
A total of 306 patients received COPD support, with statistically significant improvements in medicines adherence, the use of rescue packs and quality-adjusted life years. In addition, 97.5% of patients using the service received a flu vaccination, compared with a 75.4% average uptake rate locally. The service was estimated to save the NHS £168 per patient.
A total of 620 patients had been recruited to the polypharmacy pilot, which had seen improvements in medicines adherence and quality of life, in addition to a 46% reduction in falls.
“We were extremely pleased with the outcomes,” Kerr remarked. “We’ve shown improvement in [patient] adherence and quality of life, and we have shown that pharmacists are able to intervene at a clinical level, and develop relationships with GPs and talking peer-to-peer. It’s also great to hear that patients felt supported, that the relationships with their pharmacy teams had grown.”
The project evaluation, from the School of Pharmacy at the University of East Anglia, estimates that the NHS could save more than £470m if the service were to be rolled out nationally to 11,000 pharmacies in England.
Yet the project team was keen to highlight that this collaboration is only the beginning. “We’ve established a platform to work with LPCs and collect the data,” Stafford explained. “That was our goal; to establish that platform to roll out other services in the future.”
“Services like this demonstrate what can be done,” Kerr added. “We want to see the future of pharmacy in this role. We want to see the ongoing development of pharmacy teams — not just the pharmacists. [Each company] will each take a different approach to it but we absolutely want community pharmacy to move into that role.”
About the awards
The Pharmaceutical Care Awards 2014 were held on 19 June at the Royal Institution in London. The awards are run by The Pharmaceutical Journal and the Royal Pharmaceutical Society (RPS) and are supported by GlaxoSmithKline (GSK).
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065881
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