Thisis a village pharmacy in a rural area. It delivers the usual range of NHSservices, including Pharmacy First Plus. Pharmacy First Plus is an NHS Scotlandservice which includes prescribing for common clinical conditions by PharmacistIndependent Prescribers. The pharmacist in this pharmacy has several years’experience as an independent prescriber.
- 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
The pharmacy is providing safe and effective treatment to people through the NHS Scotland Pharmacy First Plus service. The pharmacist providing the service uses a structured consultation and record keeping approach. And refers to resources and colleagues from other professions to help form a multi-disciplinary approach to care when required. And they fully involve the patient in decisions about their care.
How the pharmacy did this
The pharmacist independent prescriber (PIP) regularly consulted with people presenting at the pharmacy for care through the NHS Scotland Pharmacy First Plus service. One Friday afternoon during the coronavirus pandemic a person presented with symptoms the pharmacist had not physically seen before. The pharmacist suspected the patient was suffering from a rare acute skin condition that could potentially be a medical emergency if not treated in a timely manner. The nearest hospital was 50 miles away, and there were concerns the condition could compromise the person’s vision and ability to drive.
The PIP examined the person, taking infection control precautions and wearing personal protective equipment. She then researched the condition further which confirmed her initial suspicions on diagnosis. The PIP discussed her findings with the person and explained that she would like to discuss her diagnosis and treatment plan with a GP, as this wasn’t a common condition. The person consented to this and was happy for the pharmacist to send photographs of the condition to the GP to support this discussion. The GP reviewed the photographs shortly after and discussed the case by phone with the pharmacist. The GP agreed with the pharmacist’s diagnosis and proposed treatment plan. And as such the pharmacist was able to inform the person of the outcome of the joint review. The pharmacy then supplied medication in accordance with the Pharmacy First Plus service specification. And the pharmacist provided follow-up advice, and recommended the person see their own GP the following week. When the GP reviewed the person the following week the condition had greatly improved with no effect on the person’s vision.
As part of the pharmacy’s record keeping, the PIP recorded presenting symptoms, history, observations from examination, diagnosis/impression and treatment. She used the same format for all consultations and typed into the ‘Pharmacy First’ module on the computer which also populated the patient’s medication record in the pharmacy. The PIP then copied this onto an SBAR communication tool (situation, background, assessment, recommendation – a standard tool used to share information within the NHS), printed it and sent to the GP. This ensured the GP was able to scan and save the SBAR to the persons medical record.
What difference this made to patients
The person accessing the service is fully informed of their treatment plan, and the need to consult other healthcare professionals when required. This means that patients benefit from safe, effective and timely treatment. Delays in treatment and unnecessary lengthy journeys to hospital are avoided.
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: