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
Joint working with local GPs to ensure more effective treatment of patients with chronic conditions.
How the pharmacy did this
There were CMS serial prescriptions in place for some patients for standard dispensing, and many of the compliance aid patients. Over 1000 patients were registered for CMS and the assessment carried out prior to registration had been a useful tool to identify and resolve pharmaceutical care issues. Examples included inhaler overuse, prescriptions for different items being supplied at different times – the pharmacy liaised with the GP practice to synchronise medicines and obtained prescriptions for varying amounts to do this. This was also done when there were dose changes but prescribed quantities did not reflect this – the pharmacy was able to request and obtain new prescriptions.
Opportunities were taken whenever possible to optimise medicines for patients to ensure that the lowest effective dose was used and unnecessary medicines stopped. At the point of supply patients were always asked if they required all the medicines and this was an opportunity for counselling by the pharmacist. If some items were not required each time, there was an ability to suspend these and reinstate them later. Items no longer required by patients could also be terminated in the pharmacy and a message sent to the GP. Benefits of this were twofold – patients were only receiving medicines that they required minimising confusion for them, and reducing waste medicines.
There was a focus on encouraging registered patients to be changed onto serial prescriptions as it had been demonstrated that patients’ medicines were better managed by this method of dispensing. These patients were highlighted when their prescriptions were labelled, and the pharmacist had a discussion with them and amended their records accordingly. A variety of pharmaceutical care issues were identified, including difficulty managing devices or not complying with medicines. These were addressed by switching to different devices or medicines depending on the situation and the GPs worked closely with the pharmacist, trusting and accepting her judgement and making the necessary changes. There was an excellent relationship with the local practice, with one doctor as a named point of contact for the pharmacist. One urgent referral made to the GP involved a patient who had presented at the pharmacy requesting a cough bottle; the pharmacist carried out an assessment and examination, discovering severe symptoms. The patient was seen by a GP within half an hour and admitted to hospital with pleurisy. Another example was an elderly patient, new to the pharmacy, invited for a COPD review following changes to his inhalers. Several issues were highlighted – he was taking high-dose painkillers, so often his cognitive function was poor resulting in poor compliance and difficulty using inhalers. He also had burns to his skin from the use of hot water bottles. On examination, he had a wheeze and low oxygen saturation levels, so he was urgently referred to the GP and hospitalised.
What difference this made to patients
Close working relations with GPs ensures that patients receive the urgent care they need following review of their condition by the pharmacy.
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: