This was a community pharmacy close to a GP practice in a town with a population of 50,000 of which the pharmacy served around 10,000. It had recently had a complete refit and was dispensing around 12,000 NHS items each month. The NHS items included supply to around 350 patients in monitored dose devices. Dispensing was highly automated using 2 robots. Other NHS services provided were the standard Scottish pharmacy contract services – CMS, eMAS, smoking cessation and the gluten free food prescribing service. A substance misuse service was provided An extensive range of other services were delivered including independent prescribing for respiratory conditions, pain management common clinical conditions.
- 4.1 - The pharmacy services provided are accessible to patients and the public
- 4.2 - Pharmacy services are managed and delivered safely and effectively
- 4.3 - Medicines and medical devices are: obtained from a reputable source; safe and fit for purpose; stored securely; safeguarded from unauthorized access; supplied to the patient safely; and disposed of safely and securely
Why this is notable practice
Service delivery is targeting the needs of the local community and relieving pressure on other services. A large part of the pharmacy workload is dispensing in its various forms, which is highly automated increasing capacity and efficiency. Measures are in place with thorough records kept ensuring the safety of this process. A triaging and treating 'common clinical conditions' service is always available with a competent nurse or pharmacist delivering this. This service demonstrates good quality outcomes for patients in a timely manner while working closely with other healthcare professionals. All aspects of medicines management are well addressed with very thorough audit trails in place to ensure medicines are appropriately stored and supplied.
How the pharmacy did this
Much use was made of the consultation rooms by different staff members to give privacy to patients. Services provided were displayed within the pharmacy and externally. Services delivered reflected the needs of the local community with an emphasis on triaging and treating common clinical conditions, including respiratory conditions.
The Minor Ailment Service (eMAS) formed a large part of the pharmacy business with many patients eligible for the service. Over time the approach to the service had changed and this was reflected in the design and layout of the pharmacy following the refit. The premises and equipment/resources, and pharmacist expertise were used to maximise the benefits of this service. Patients with any warning symptoms or symptoms lasting more than a few days were referred to the pharmacist to be triaged. She responded by prescribing within the EMAS specification, or had the ability to prescribe within her competence as an independent prescriber. This now formed a large part of the pharmacy business.A more recent innovation had been the inclusion of prescribing for common clinical conditions for which she had undertaken additional training both at university and by shadowing medical and nursing staff at the local out of hours’ service. The service that had developed was effectively an enhanced minor ailments type of service enabling effective treatment to be given to patients presenting at the pharmacy with symptoms on an ad-hoc basis. PGDs, SOPs, guidelines and the local NHS formulary were readily available in each consultation room, to be referred to as necessary. When prescriptions were written, patients were at liberty to take these to any pharmacy although they were usually dispensed on site. The prescribing pharmacist ensured that she was not involved in any aspect of the dispensing of these prescriptions and the checking pharmacists always carried out clinical checks as they would with any other prescription, and were empowered to challenge or question her prescribing as well as that of GPs and highlight any issues.
What difference this made to patients
Services delivered reflect the needs of the local community with an emphasis on triaging and treating common clinical conditions.
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: