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Pharmacist-led care of people with long term conditions
The RPS believes that utilising pharmacist led care of people with long term conditions will deliver cost-effective services that will bring significant results to patients and the NHS
Treatment and support for people with LTCs is placing significant demands on the NHS and other public services. With £15 billion being spent on medicines in 2015/16 they are the most common intervention in the management of LTCs. Medicines can be life-prolonging and life-saving but they can also cause harm if used incorrectly. As the experts in medicines and their use, pharmacists can ensure people get the best outcomes from their medicines, reduce adverse events, minimise avoidable harm and un-planned admissions to hospital, while ensuring resources are used more efficiently to deliver the standard and level of care that people with LTCs deserve.
Call to action
The RPS has made four key calls to action:
1. Pharmacists providing direct patient care should have the opportunity to train to become a prescriber
2. The patient journey will be made easier by enabling pharmacists to directly refer to appropriate health and social care professionals, improving patient access to care and reducing the number of unnecessary appointments
3. Patients will benefit from further integration of pharmacists into their multidisciplinary team, ensuring support at every stage of their journey
4. All pharmacists directly involved in patient care should have full read and write access to the patient health record, with patient consent, in the interest of high quality, safe and effective patient care.
Who's supporting our campaign?
David Mowat MP, Parliamentary Under Secretary of State for Community Health and Care
"I welcome the recommendations of this report and the direction of travel which the RPS has outlined. "Community pharmacists are skilled, registered health professionals who are the experts in medicines use and optimisation. I want their clinical skills to be much more available to patients to help them manage not just their medicines but also their overall health through the provision of healthy lifestyle advice. "This is particularly true for patients with long term conditions who may be taking many medicines and where there is evidence that outcomes are not always as good as they could be."The RPS's report is timely because the Independent Review of Community Pharmacy Clinical Services will report later this year and it will recommend how the NHS should develop and improve clinical pharmacy services for patients."
The Patients Association: Chief Executive Katherine Murphy said:
“It is so important that patients have quick and easy access to care. Being able to speak to a local pharmacist could mean that patients are able to access the right care closer to home or their workplace; completely removing the challenges of booking an appointment with a GP, cutting out waiting times and taking out the worry for many patients who get anxious visiting a surgery.
“The Patients Association warmly welcome pharmacists becoming trained prescribers, not just because it will take pressure off GP surgeries meaning a better service for patients who need to see their GP, but also because it is a better for patients who don’t need to see their GP. It is a win-win situation for patients.”
National Voices: Don Redding, Director of Policy:
“National Voices congratulates the Royal Pharmaceutical Society for its consistent efforts to shape future roles for pharmacists that help create better lives and outcomes for people with long term conditions. In dialogue with our member charities who work with hundreds of thousands of people, RPS has shown genuine commitment to mutual learning and to pursuing effective person centred care, as reflected in this new policy position.”
Alzheimer’s Society England: Jeremy Hughes, CEO Alzheimer’s Society:
An enhanced and more integrated role for pharmacists in the NHS has the potential to bring significant benefits for people with dementia. A diagnosis of dementia is crucial to get the right information, treatment and support, yet a third of people living with the condition still don't have one. Pharmacists’ routine contact with patients make them ideally placed to spot the early signs of dementia and make referrals to the GP for a diagnosis.
Diabetes UK: Simon O’Neill, Diabetes UK’s Director of Health Intelligence said:
“Diabetes UK fully supports the recommendations of this report. Pharmacists are working with patients in their communities every day. Integrating them into the multidisciplinary team could really support people living with diabetes and other long-term health conditions.
“People with diabetes get just three hours support from traditional diabetes team members each year on average. Extending the role of pharmacists into areas such as prescribing and specialist referral could mean people with diabetes have more support when they most need it.”
Arrhythmia Alliance: Trudie Lobban, Chief Executive said:
“We support this report from the Royal Pharmaceutical Society about improving patient care for people with long term conditions. Making sure patients with atrial fibrillation (AF) are quickly diagnosed and appropriately anticoagulated is vital as AF is a major cause of strokes.
“Pharmacists have such an important role to play in supporting these patients, whether that’s raising awareness of AF symptoms in people at high risk, screening for AF by taking their pulse; using a handheld ECG app on a smartphone, or prescribing and monitoring their anticoagulant therapies. We would like to see pharmacists across the country involved in this kind of activity and fully integrated into the multidisciplinary team. Arrhythmia Alliance and its’ sister organisation, AF Association, is working closely with pharmacists across the country to bring about this change.”
The Stroke Association: Alexis Wieroniey, Deputy Director, Policy and Influencing:
“The Stroke Association welcomes these proposals on long term conditions from the Royal Pharmaceutical Society. People at risk of stroke can really benefit from the kind of risk reduction activity that pharmacists can provide, such as advice on healthy eating and exercise, and weight and blood pressure checks. They also play a very important role in ensuring people with conditions such as atrial fibrillation and hypertension understand and take their medicine to reduce their risk of a stroke.
“After a stroke, pharmacists need to be fully integrated into the discharge pathway so transfer of care around medicines from hospital to home runs smoothly. They may well be the healthcare professional that patients see most often as they collect their medicines on a regular basis, and can help people understand their medicines better and manage any side-effects.”
Richmond Group: Dr Charlotte Augst, Richmond Group of Charities Partnership Director said:
"Seven in ten people with dementia live with one or more other health conditions. With different doctors working in different parts of the health service prescribing medicines to treat each condition, people with dementia often end up with complex, outdated treatment packages. Pharmacist-led medicine reviews ensure holistic oversight of a person's treatment, ensuring the medicines are working effectively, complement each other and that a person is able to adhere to them. People living with one or more long term conditions need holistic and well co-ordinated support to live as well as possible for as long as possible. Pharmacists can play a significant role in prevention, early detection, supported self-care and ongoing management of long term conditions. We all know that pharmacists need to be deployed much more effectively to enhance the accessible, person centred contribution they can make to health and wellbeing. It is now time to make this ambition a reality not just for small minorities of patients who benefit from pilots and innovation, but for everyone who lives with a long term condition."
RCN: Wendy Preston, Head of Nursing Practice said:
High quality care for people living with long term conditions depends on substantial multidisciplinary working, involving specialist and community nurses, pharmacists, allied health professionals, social care workers, health care assistants, and others.
Nurses are often closely involved in the care and assessment of people who are receiving long term care. Particularly in community and primary care settings, a specialist nurse will often assist other healthcare professionals as much as patients: a specialist nurse will support GPs and practice nurses as well as providing advice and support to patients. They often give advice and support which may prevent the need for secondary interventions. Nurses will also work closely with pharmacists regarding medicines management. In this way, their expertise is central in supporting an integrated system of care, from acute and specialist services to self-management.
Self-management is also important, and community nurses and community pharmacists can play a crucial role in helping individuals to manage their own conditions. It is vital that people living with long term conditions are given the information and training to make choices about where and how they want to live, and are supported by appropriate, competent staff.
Royal College of GPs, Dr Maureen Baker, Chair of the RCGP, said: “Pharmacists already offer an excellent service to patients and provide really valuable support to hard pressed GPs, so any recommendations to increase their involvement within general practice and to train them to become prescribers is welcome.
“Patient demand in general practice continues to grow significantly and our ageing population means that we are now seeing many more patients presenting with at least one long term condition.
“As well as benefitting our patients, a more prominent role for pharmacists within general practice will also cut unnecessary appointments and free up GP time for those patients who need the knowledge and skills of an expert medical generalist.
“The RCGP is keen to work with pharmacists as part of the wider multi-disciplinary practice team and have already championed a successful pilot scheme with NHS England deploying pharmacists in GP surgeries to help with a number of tasks, including medicines management.”
Royal College of Physicians: Registrar Dr Andrew Goddard said:
‘Through its Future Hospital Programme, the RCP has long recognised the importance of bringing care closer to the patient by integrating care across the primary, secondary and community care sectors. As healthcare professionals on the high street, pharmacists are there for patients and families every day. Enhancing their role as part of the multidisciplinary team will open up new opportunities to identify and manage patients with long-term conditions, help patients better manage their own health and avoid hospital admissions.’
Royal College of Psychiatry: Dr Amanda Thompsell FRCPsych, Chair of the RCPsych’s Faculty of Old Age Psychiatry
The Faculty of Old Age Psychiatry welcomes this report “Improving care for people with Long Term Conditions”. It highlights the increasing number of people living with long term physical or mental conditions with older individuals in particular often having multiple comorbidities .It stresses the importance of health professionals including the pharmacist working collaboratively and in an integrated manner across all systems to ensure the person with the long term condition (LTC) gets the best possible advice and support. Older people with mental health issues benefit from early recognition of their symptoms and prompt signposting for support/treatment. Pharmacist are in a unique position to see people with LTCs on a regular basis and so are well placed to recognise any signs and symptoms of mental health issues such as depression or dementia.
Rob Darracott, Chief Executive, Pharmacy Voice ‘This report from the Royal Pharmaceutical Society highlights the important, indeed vital, role pharmacists are playing in supporting people with long term conditions. Its case studies and examples highlight the growing evidence that the greater use of pharmacists within a multidisciplinary approach to care can improve outcomes, with the accessibility and convenience of the community pharmacy setting providing an ideal place for expanding the opportunities for prevention and screening as well as using the skills of community pharmacists to support those living with a long term condition. The report is a timely call to action, and the recently announced Pharmacy Integration Fund should be used to develop these new pharmacy-based models of care, and explore how we they should be commissioned and delivered at scale. With increasing numbers of people living longer while managing one or more long term conditions, it’s time for a change of pace in developing the pharmacist’s contribution through patient-centred approaches that help people use medicines to achieve the right result for them, while maximising the efficient use of vital NHS resources.”
Chief Pharmaceutical Officer Dr Keith Ridge said:
“NHS England welcomes this report which further underlines the case for community pharmacists to spend more time delivering services for all patients including those with long term conditions. We are working with the profession to increase the number of pharmacist prescribers, which will deliver better and faster care for patients, relieve pressure in general practice and increase integration across the NHS .”