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Framework for Scotland’s chronic medication service launched

Management of patients with long-term conditions is firmly on the pharmacy agenda in Scotland following the launch of the framework that will underpin community pharmacists’ contribution through the chronic medication service (CMS) earlier this week

Management of patients with long-term conditions is firmly on the pharmacy agenda in Scotland following the launch of the framework that will underpin community pharmacists’ contribution through the chronic medication service (CMS) earlier this week (9 December 2009).

Scotland’s Deputy First Minister and Cabinet Secretary for Health and Wellbeing Nicola Sturgeon announced the launch at a Scottish Pharmacy Board Parliamentary reception and confirmed that the service will be rolled out across Scotland in spring 2010.

The framework outlines the three stages of the CMS — registration of patients, pharmaceutical care planning and a shared care stage involving the patient, pharmacist and the patient’s GP (see Panel).

The report highlights 13 long-term conditions that should be a priority under the CMS and for which disease-specific protocols should be developed first.

Evidence from the UK and US suggests that these 13 conditions are those that are most commonly associated with drug therapy: hypertension, hyperlipidaemia, asthma, diabetes, angina, heart failure, chronic obstructive pulmonary disease, epilepsy, rheumatoid arthritis, Parkinson’s disease, osteoporosis, chronic pain and hypothyroidism.

The report provides a generic framework to guide pharmacists in delivering CMS across Scotland. Chairman of the CMS advisory group and report author Lewis Ritchie said: “It will be crucial that the guiding principles in this report are translated as effective operational plans, sufficiently resourced and adequately piloted/tested, as an essential precursor to national roll-out.”

Such preparation is already under way. Detailed work on the pharmaceutical care review plan is taking place along with work to ensure that IT systems underpinning the service are fully functional ahead of national roll-out, according to Community Pharmacy Scotland.

CPS is also working with the Scottish Government to finalise remuneration for pharmacists. However, the head of corporate affairs at CPS, Alex MacKinnon, was unable to say when these details would be announced.

Panel: How patients will be managed


Under the CMS, a patient with a long-term condition will register with a community pharmacy. The pharmacy patient medication record (PMR) system generates an electronic CMS registration notification visible on the GP’s IT system. This acts as a trigger to the GP who has the option to enter into a shared care arrangement. Part of this arrangement includes the option to generate serial prescriptions of up to 48 weeks.

Pharmaceutical care planning requires the pharmacist to document and identify the patient’s pharmaceutical care needs, issues, desired outcomes and actions needed to achieve those outcomes. Ongoing monitoring and reviewing of the patient’s progress against the plan will also be undertaken. Pharmacists are encouraged to counsel and advise patients on their medicines both during the initial assessment and on an ongoing basis.

If the patient’s GP chooses to enter into a shared care arrangement, the pharmaceutical care plan remains as the basis of ongoing care for the patient. At this stage, the GP can generate a serial prescription for the patient based on national CMS disease specific protocols. The protocols will outline common potential pharmaceutical care issues, referral criteria and reporting requirements to help the pharmacist identify instances where referral or reporting is necessary.

Citation: The Pharmaceutical Journal URI: 10989180

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