Section 3: Potential medicines-related issues in social care settings in England, Scotland and Wales
In this section we set out the types of medicines-related issues that can arise.
People who receive social care are part of the general population and are entitled to NHS medical and pharmaceutical services regardless of whether they are in privately-owned homes or not. People who either live in care homes or who receive social care in their own homes may receive a very poor NHS service in comparison with those who live independently (reported in Handled with care? - managing medication for residents of care homes and children’s homes – a follow up study. CSCI February 2006.) Patients should always be encouraged and enabled to self-medicate if possible.
Patients, regardless of which setting they are in, should have a choice of general practitioner and pharmacist; staff or care home managers should not override patient choice.
Key areas requiring consideration include:
- The person’s direct access to a pharmacist for consultation when needed, for example, for advice in treating minor ailments. The NHS primary care provision is not set up to respond to people in social care. For example, in Scotland people who live in care homes (including children’s services) are excluded from the NHS Minor Ailments Service. Also, Medicines Use Reviews can only be carried out in care settings with permission from the PCO (England and Wales), thereby making it more difficult for patients in these settings to access this beneficial service. Often, the outcome is that care workers (or informal carers) take decisions about healthcare that should be referred to a healthcare professional. See information on Pharmacy helpline and Pharmacist prescribing.
- Provision for out-of-hours care. More often than not the visiting medical practitioner will not know the patient and may not have ready access to medical notes. In these circumstances the doctor may have to rely on information that is given by the patient or carer. See information on MAR charts.
- Between 20 and 25% of care homes are registered to provide nursing care, the remainder provide personal care alone. Most social care workers have little formal healthcare knowledge. They rely on NHS staff to support them to look after people in their care safely. In practice, care workers may not always have access to training appropriate for the level of work that they are doing. See information on Training.
- A care worker who accidentally makes an error may not understand what to do and whom to contact. It is important that the care worker is able to recognise the error and take appropriate action and that a system is in place to ensure that the care worker is not left unsupported. A local support system may be more effective in dealing with the immediate situation and preventing further errors. See information on medicines error reporting.
Case studies 1-5 illustrate some of the issues that can arise if pharmaceutical services or aspects of medicines management are not planned early in the process of service development.