Community Pharmacy

From Social Prescribing and Self Care Wiki
Jump to: navigation, search

The following is taken from Arun Nadarasa book "Pharmacy Movement - How To Prescribe Social And Digital Medicines" (it is available on Amazon and Kindle):

The Time To Act Is Now

In the UK, the NHS has an allocated budget for community pharmacies. On the December 17th, 2015, it was announced that its budget will reduce by 6 percent by 2016 [1]. This led to a massive campaign by the NPA which gathered 2.2 million signatures [2]. Both the NPA and PSNC brought the government to court due to lack of communication and research with the sector, but the attempt was unsuccessful [3]. The NHS Five Year Forward View (5YFV) Document was released on October 22nd, 2014 [4] and was recently updated on March 31st, 2017 [5]. The document sets out recommendations to shift from a reactive approach to a pro-active approach in-order to reduce the severe challenges the NHS is facing. It emphasises the aim to bridge the health and wellbeing gap. There has been a shift to increase the number of Healthy Living Pharmacies (HLP) in the UK to help the sector meet that objective [6]. Currently, many newly qualified pharmacists are finding it difficult to find a full-time profession due to the lack of experience, and many locums are finding it harder to acquire regular shifts. Most notably, this is because there are 26 schools of pharmacy in England and the supply is far exceeding the demands of the market. With pharmacy cuts and the increasing number of candidates, the rate of pay for pharmacists has been drastically reduced, as well as being asked to do more services in return. As a result, many potential graduates feel discouraged to pursue this profession due to the direction it is heading in, which becomes apparent with the number of articles and comments made by current pharmacists and senior pharmacists online.

Social Prescribing For The Win

Social Prescribing has been referred as ‘signposting’ in the community pharmacy, with no remuneration in delivering this specific service. It has been used over the past 30 years by pioneers such as the Bromley-By-Bow Centre [7] and many others which led to the establishment of the Social Prescribing Network (SPN) on March 9th 2016 [8]. At the Social Prescribing Network Annual Conference – which was held at The King’s Fund on May 18th, 2017 – more than 400 delegates attended and the research results were very promising [9]. Additionally, Prince Charles was also present to show his support for social prescribing, however, he could not speak due to Purdah [10]. Up to 20 percent of GP appointments are for non-medical reasons [11] where Jeremy Hunt supports social prescribing. [12]. There are 1.8 million daily visits to 14,059 community pharmacies [13,14], with 44,000 pharmacists in this sector [15,16]. We are ideally placed to provide health and wellbeing services including Social & Digital Prescribing where MHRA has provided the CE marking for mobile apps meeting the correct standards [17,18]. The NHS also has a dedicated app store for those meeting the required criteria [19]. There are 44 STPs in UK [20] where 75 percent support SP, which works with the 207 CCGs [21]. Social prescribing pilots are usually done in collaboration with the H&B team and the Local Authority (LA). The first case which involved pharmacists with SP was Doncaster Social Prescribing [22]. This needs to become the norm across the UK but this requires a great deal of time investment and effort from pharmacists wishing to do a pilot in their locality, and several meetings with key stakeholders (CCG, HWB and LA) to allocate funding for SP. This is increasingly difficult for pharmacists working with chains of pharmacies due to the infrastructure of the organisation. The new GPhC standards were released on May 12th, 2017, stating that we must act professionally at all times, including hours outside of the workplace [23]. This caused confusion within the sector, creating the perfect opportunity to introduce new ways of working with Social and Digital Prescribing. This complies with the following GPhC statement:

“All pharmacy professionals contribute to delivering and improving the health, safety and wellbeing of patients and the public. Professionalism and safe and effective practice are central to that role.“

Community Pharmacy 2.0

On April 1st, 2005, the New Pharmacy Contract introduced MURs which was then followed by NMS on the October 1st, 2011 [24]. Both these advanced services better-enabled the pharmacists to increase their footprints within the community. This was further reinforced by the national flu vaccination which was started on September 16th 2015 [25]. For income stream, locally commissioned services can be contracted in collaboration with local stakeholders (CCGs, LAs & NHSE Teams). However, for pharmacists not involved with the Local Pharmaceutical Committee (LPC), it can be challenging to do a pilot with an associated budget. Therefore, the solution I propose is a social and digital prescription. As a Medical NLP practitioner [26], I was able to do over ten consultations to improve the wellbeing of patients on antidepressants, with immediate success as I was empowering them in less than 5 minutes with the techniques I learned from the practitioner course. Equally, as I learnt more about nutrition, I was able to advise patients better on healthy eating and, as a result, patients felt more encouraged to go through dietary changes. For those who do the SCOPE course, it can provide a quality mark in your knowledge [27]. Furthermore, as I was explaining to patients about neuroplasticity regarding behavioural changes, they were more prepared to attempt lifestyle changes. I have also been recommending the use of BrainHQ to patients to maintain a healthier brain [28]. After attending the Nidotherapy conference, also being the first pharmacist to do so [29], the skillset developed then is one transferable to a community setting which would help patients gain empowerment. Those additional services will lead to an increased SROI (social return on investment). Another term to be introduced is the Patient Activation Measure (PAM) [30]. If all 44,000 community pharmacists provided similar services, this would greatly increase the self-efficacy of the UK population and solve the problems of the NHS.

References

[1] DoH, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/486941/letterpsnc.pdf

[2] Chris Ford, https://www.npa.co.uk/2017/05/25/a-watershed-moment/

[3] PSNC, https://psnc.org.uk/our-news/high-court-rules-pharmacyfunding-cut-was-not-unlawful/

[4] NHS, https://www.england.nhs.uk/publication/nhs-five-year-forwardview/

[5] NHS, https://www.england.nhs.uk/publication/next-steps-on-the-nhsfive-year-forward-view/

[6] PSNC, https://psnc.org.uk/services-commissioning/locallycommissioned-services/healthy-living-pharmacies/

[7] BBBC, https://www.bbbc.org.uk/the-early-days-of-the-bromley-by-bowcentre

[8] SPN, https://www.westminster.ac.uk/news-and-events/news/2016/newnational-social-prescribingnetwork-addresses-nhs-healthcareaccessibility-issues

[9] SPN, https://www.kingsfund.org.uk/events/social-prescribing

[10] Isobel White, https://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN05262

[11] CAB, https://www.citizensadvice.org.uk/about-us/how-citizens-adviceworks/media/pressreleases/almost-400million-a-year-spent-ongps-doing-non-health-work/

[12] Neil Roberts, https://www.gponline.com/health-secretary-backs-gpsocial-prescribing/article/1326032

[13] PV, https://pharmacyvoice.com/community-pharmacy/facts-andfigures/

[14] FOI, https://www.whatdotheyknow.com/request/how_many_registered_community_ph

[15] Statista, https://www.statista.com/statistics/318874/numbers-ofpharmacists-in-the-uk/

[16] RPS, https://www.ilovemypharmacist.co.uk/what-do-pharmacists-do/community-pharmacists/

[17] MHRA, https://www.gov.uk/government/news/is-your-app-a-medicaldevice-its-healthy-to-knowregulator-issues-updated-guidance

[18] RAENG, https://www.raeng.org.uk/publications/reports/health-appsregulation-and-quality-control

[19] NHS, https://apps.beta.nhs.uk/

[20] NHS, https://www.england.nhs.uk/stps/

[21] NHS, https://www.nhscc.org/ccgs/

[22] SYHA, https://www.syha.co.uk/doncastersocialprescribing

[23] GPhC, https://www.pharmacyregulation.org/news/new-standardspharmacy-professionals-come-effect

[24] BMA, https://www.bma.org.uk/advice/employment/gp-practices/serviceprovision/prescribing/the-community-pharmacy/nhscommunity-pharmacy-contractual-framework

[25] PSNC, https://psnc.org.uk/services-commissioning/advanced-services/flu-vaccination-service/

[26] Medical NLP, https://www.medicalnlp.com/

[27] WO, https://www.worldobesity.org/scope/

[28] Posit Science, https://www.brainhq.com/

[29] NIDUS-UK, https://nidotherapy.com

[30] King’s Fund, https://www.kingsfund.org.uk/publications/supportingpeople-manage-their-health