This was a rural village pharmacy close to a city, dispensing around 6500 NHS items per month and a small quantity of private dispensing.The NHS items included supply to patients in MDS trays, a number of whom were patients with autism with support from a national charity. Pharmaceutical services were provided for a local 33 bed care home with s. Other NHS services provided were the standard Scottish pharmacy contract services – the Chronic Medication Service (CMS), the Minor Ailment Service, (eMAS), smoking cessation and the gluten free food prescribing service. Services provided under Patient Group Directions (PGDs) were unscheduled care, smoking cessation, emergency hormonal contraception, chloramphenicol ophthalmic products and post immunisation paracetamol supplies. A substance misuse service was also provided.
- 4.1 - The pharmacy services provided are accessible to patients and the public
- 4.2 - Pharmacy services are managed and delivered safely and effectively
Why this is notable practice
Close working with other healthcare professionals to provide an integrated and holistic service results in benefits for patients.
How the pharmacy did this
The pharmacy had an excellent relationship with other healthcare professionals and services in the local area. The pharmacist worked with a local school promoting eMAS, Emergency Hormonal Contraception provision, smoking cessation and general pharmacy services and the school matron referred pupils to the pharmacy. A local councillor had been contacted to enable the pharamcy to tap into local community groups including a lunch club. The pharmacist had attended a multi-disciplinary social prescribing day involving vulnerable and homeless patients and links had been built with the Samaritans. The use of the pharmacy premises was offered for events. There was close working with the local GP on high risk and new medicines reviews resulting in positive outcomes for patients, including Unscheduled Care (CPUS) prescriptions being written to synchronise prescriptions, or to address wrong quantities or misalignments.
The CMS was an integral part of the pharmacy's operation and was leading to more positive patient outcomes than serial prescribing. The pharmacy identified patients at surgeries that were currently not engaged with CMS to ensure that all patients had access to the benefits and the GP had acknowledged the pivotal role of the pharmacists in the success of CMS. Patients on repeat prescriptions had been reviewed to synchronise their prescriptions to ensure that all medicines were running at the same time. This had been prompted following a high-risk medication review when the pharmacist realised that a patient regularly ended up being one tablet short of a weekly dose of methotrexate due to the number prescribed. As this became very time onerous for both pharmacist and GP for the number of patients involved, following discussion it was agreed that the pharmacist could have autonomy to synchronise these himself by the use of CPUS prescriptions and this had a very positive outcome for all concerned. One patient having difficulty managing her medication, frequently running out or losing it, was switched to serial prescriptions dispensed every two weeks following medication review. This resulted in a dramatic reduction in the number of patient contacts with the surgery, freeing up GP and pharmacy time and the patient was very happy with the service. The GP presented the results in a national newsletter for GPs and discussed it at a GP locality event. It had also been included in a community pharmacy newsletter. Successes with CMS as demonstrated by this patient had resulted in queries from other pharmacists and the pharmacist was invited to attend a working group regarding promotion of this throughout the health board area to share his experiences and encourage other pharmacists.
What difference this made to patients
Collaboration with other primary care providers has ensured that vulnerable patients are identified and provided with more appropriate care and treatment.
We have identified the standards most likely and least likely to be met in inspections, and highlighted examples of notable practice for each of these standards; to help everyone learn from others and to support continuous improvement: