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Medication review

Primary care network pharmacists to start delivering medication reviews earlier than planned in 'window of opportunity' before winter

A letter from NHS England lists the new structured medication reviews as a priority for primary care networks in August 2020.

Open access article

The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.

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The third phase of the NHS response to the COVID-19 pandemic includes structured medication reviews as a priority

NHS England has asked primary care networks (PCNs) to start delivering structured medication reviews in care homes earlier than planned as part of a national drive to return non-COVID-19 health services “to near-normal levels”.

But there is concern that a shortage of PCN pharmacists could limit the ability to provide the new-look medication reviews.

In a letter to PCNs dated 31 July 2020, Simon Stevens, NHS chief executive, and Amanda Pritchard, NHS chief operating officer, said the NHS would be entering the third phase of its response to the COVID-19 pandemic on 1 August 2020 and among the priorities it lists for August are for PCNs to “build on the enhanced support they are providing to care homes, and begin a programme of structured medication reviews (SMRs)”.

NHS England said the interim service will transition to the PCN care homes service, set out in the PCN contract directed enhanced service, from 1 October 2020.

According to the PCN contract directed enhanced service, published on 31 March 2020, SMRs were not expected to be a requirement until 1 October 2020, which was announced in a letter to GPs on 19 March 2020, outlining general practice’s response to COVID-19.

However, the NHS letter asks PCNs and other NHS organisations to “accelerat[e] the return of non-Covid health services, making full use of the capacity available in the window of opportunity between now and winter”.

Graham Stretch, president of the Primary Care Pharmacy Association, told The Pharmaceutical Journal that as clinical director of Brentworth PCN he “understood the impetus” to introduce SMRs, adding that his PCN was in a “lull period between what we had in May or June and what we’re anticipating, which is already starting to play out in Manchester, Bury [and] Leicester”.

But starting SMRs now was “almost putting the cart before the horse, because we don’t have the searches, the codes or the specification on actually how to do SMRs in a practical way,” he said, explaining that searches are needed to find the patients eligible for an SMR, while codes are needed to indicate where SMRs have occurred.

Stretch said PCNs will also face issues with delivering SMRs “because we don’t have sufficient numbers of people yet to do it”.

The Pharmaceutical Journal previously reported that almost a quarter of PCNs had either not hired or not claimed NHS funding for hiring a pharmacist by the end of March 2020.

However, the PCN contract notes that the volume of SMRs required is “determined and limited by the PCN’s clinical pharmacist capacity”.

Ravi Sharma, director for England at the Royal Pharmaceutical Society, said: “The revised contract recognises that meeting ambitions on SMRs will depend on pharmacist capacity. COVID-19 means that teams will need flexibility to deliver this safely as well as managing the backlog of work built up during the pandemic.

“Amid increased demand on the health service, we’ll need to see greater collaboration so that pharmacists across the whole of primary care can support medicines optimisation and keep patients healthy and out of hospital.”

Richard Vautrey, chair of the GP committee at the British Medical Association, said that practices will need “significant support” to cover the additional costs of the pandemic. “This is particularly important when PCNs begin structured medication reviews, as they can only do this activity when they have sufficient numbers of staff to do it,” he said.

A previous draft of the GP contract was criticised in January 2020 for creating an “unrealistic” workload for pharmacists working in PCNs by asking them to conduct millions of SMRs from April 2020.

Correction: This article was updated on 5 August 2020 to reflect clarification received from NHS England that the SMRs will only take place in care homes ahead of the original 1 October 2020 start date.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20208238

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