Section 4: Pharmaceutical needs in social care settings

The objective of pharmacy services in social care settings is to support the people in social care to ensure that they are able to make the most effective use of their medicines. This contributes to improving health outcomes for individuals. 

This section describes the elements of a pharmaceutical support plan. A person will need different elements according to his needs and circumstances. The starting point will always be the person’s needs.

Some of the medicines-related needs of people in social care settings can be met by direct person-centred services, for example, medication reviews or signposting to patient support groups. Other needs can best be met indirectly by services designed to support care settings or GP practices, for example, care worker training, helping care managers to comply with medicines legislation or repeat dispensing schemes. Figure 2 below shows how pharmaceutical support services, both those that are available now (as ‘essential services’ in England and Wales or ‘core services’ in Scotland) and those that might be commissioned in future, contribute to the overall support for medicines-related needs for people in social care settings. 

The next section gives a short description of each of the services shown on the figure and explains how the service can help to meet specific medicines-related needs and improve outcomes for people. We have also included some examples of established services to illustrate how services can work in practice.

Some of the services listed on the figure form part of the current community pharmacy contract. However, a care home service, which includes the provision of advice and support to the residents and staff within the care home, over and above the Dispensing service, falls into the category of enhanced services which are planned and funded locally to meet local needs. It is unlikely that all community pharmacies would be able to provide all the services listed and commissioners should also consider the possibility of provision of some services from other sources such as pharmacists working in secondary care or other healthcare professionals.

One important aspect of medicines management in connection with people in social care settings is equitable provision of routine services. Someone who visits a pharmacy is able to access pharmaceutical advice, for example about the use of dispensed medicines or healthy living, but this may not be available to people in some social care settings. In these situations some form of locally funded outreach service may be considered (see case study 7).

figure2-pharmaceutical-services-social

Pharmaceutical support for health outcomes

The section below contains tables with the elements of pharmaceutical support grouped according to the needs that they are intended to meet.

Additional guidance can be found at the websites of the Pharmaceutical Services Negotiating Committee and the National Prescribing Centre.

Commissioners have a duty to ensure that when they contract for services, the provider complies with current legislation.

Pharmacy advice and support services for people

Commissioned pharmacy helplines may be considered as a means of providing pharmaceutical advice.

Service       Description        Pharmacy contract category (diagram code)
Promotion of Healthy Lifestyles  

The provision of healthy lifestyle advice and public health advice to patients receiving prescriptions who appear to:

• have diabetes; or

• be at risk of coronary heart disease, especially those with high blood pressure; or

• who smoke; or

• are overweight,

and participation in national/local campaigns to promote public health messages to general pharmacy visitors during specific targeted campaign periods.
  Essential (E)
Signposting  

Provision of information (including contact details) about patient support groups and other health and social care bodies that could help people with aspects of self-care.

  Essential (E)
Minor ailments   Information about the treatment of minor ailments for which over-the-counter remedies can be purchased. This could also include information about treatments that can be supplied as part of formal (locally commissioned) minor ailments schemes.  

Essential (E) (signposting)

Enhanced (formal minor ailments service)
Self-care support  

Help with self-administration of medicines e.g. information about medicines and how to take them.

  Essential (E)

Medicines use review (MUR)

 

Review of medication with the person to check that it is being taken correctly, that person knows what to expect, is getting the expected effects, is not getting troublesome side effects and to answer questions.

  Advanced (A)
Outreach services  

The provision of any of the above services on an outreach basis – ‘taking the service to the person’ rather than waiting for the person to come to the pharmacy. (see case study 7 below)

  Enhanced (LC)
Supervised administration  

Supervision of the consumption of prescribed medicines at the point of dispensing in the pharmacy, ensuring that the dose has been administered to the patient.

  Enhanced (LC)

Pharmacy helpline

Commissioned pharmacy helplines may be considered as a means of providing pharmaceutical advice.

Service       Description        Pharmacy contract category (diagram code)
Promotion of Healthy Lifestyles   A telephone help-line service where a pharmacist will answer people’s questions about medicines and medicine-related issues.    Enhanced (LC)

Pharmacy helpline for care workers

 

A telephone help-line service where a pharmacist will answer care workers’ questions about medicines and medicine-related issues.

  Enhanced (LC)

Pharmaceutical support (for GP services and surgeries)

These elements of pharmaceutical support are intended to help to ensure that people have access to medicines when they need them and that they are able to use them safely and effectively.

Service       Description        Pharmacy contract category (diagram code)
Repeat dispensing  

An arrangement that allows people to obtain their regular prescribed medicines and appliances directly from a community pharmacy for a period agreed by the prescriber thereby increasing patient choice and convenience. (Note: this arrangement can only be implemented for those patients on long term medicines; it cannot be used for Controlled Drugs)

  Essential (E)
Disposal of unwanted medicines  

Collection and disposal of unwanted medicines from households and individuals via pharmacies.

Note: Waste regulations (in England and Wales) require care homes that provide nursing services to make their own arrangements for disposal of waste medicines.

  Essential (E)

Prescribing

 

Suitably trained and accredited pharmacists can undertake prescribing. The pharmacist may be an independent prescriber or working with a GP as a supplementary prescriber. This can support the GP service by working in partnership to manage medicines for some patients with long-term conditions.

  Enhanced (LC)
Clinical medicines review  

A structured, critical examination of a patient’s medicines with the objective of reaching an agreement with the patient about the continued appropriateness and effectiveness of the treatment, optimising the impact of medicines, minimising the number of medication related problems and reducing waste. Includes provision of advice and support and, where appropriate, referral to another health care professional.   

   

Monitored dosage systems

 

Provision of monitored dosage systems (MDSs) - devices designed to hold medicines so that individual doses are in separate compartments or blisters.  They can be used by care workers to administer medicines or by patients as compliance aids.

  Enhanced (LC)
Compliance aids  

Provision of and/or filling of compliance aids (devices designed to help people to remember to take their medicines.  MDS can be used to help with compliance but there is a range of devices that can be used to help people, for example, timed pill wheels, reminder charts, electronic medication containers) 

  Enhanced (LC)
Prescription synchronisation  

Organisation of quantities on prescriptions so that regular prescriptions all run out on the same date instead of being staggered.  This makes it easier for the person and/or carers when requesting repeat prescriptions and is likely to reduce waste.

  Enhanced (LC)

Care Service Support

These elements of pharmaceutical support are intended to help care services to manage medicines effectively and to comply with the principles set out in ‘The handling of medicines in social care’ and regulatory requirements.

Service       Description        Pharmacy contract category (diagram code)

Meeting regulatory requirements for medicines

 

Provision of advice on complying with regulations for legal aspects of handling of medicines.

  Enhanced (LC)
Safety aspects – storage  

Provision of advice complying with regulations for safe storage of medicines.

  Enhanced (LC)

Care worker training

 

Training of care workers on aspects of medicines’ use e.g. safe administration of medicines, safe storage, what to do if a mistake occurs, missed doses, ensuring supplies do not run out etc (See Appendix 1)

  Enhanced (LC)
Medication error reporting  

Support in setting up and helping to run a reporting system for errors or incidents with medicines in the social care setting. (All settings should have systems in place for reporting and learning from incidents and near misses) 

  Enhanced (LC)
(Note: Incident reporting in the pharmacy practice is an essential service)

Medicines administration record charts

 

Printing of medicines administration record (MAR) charts. Review of the items listed on the MAR chart to check that doses, dose intervals and durations of treatment are rational and that records are appropriate.

  Enhanced (LC)

 

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