National Assembly for
Wales
Health
and Social Care Committee
Follow-up inquiry on the contribution of community pharmacy to health services
Evidence from Cwm Taf University Health Board – CP 9
Follow-up inquiry on the contribution of community pharmacy to health services
Evidence submitted by Cwm Taf University Health Board May 2014
To assist with its follow up inquiry into the contribution of community pharmacy to health services in Wales, the committee sought any evidence of progress in relation to the recommendations made in the 2012 Report, and where progress is still required. There are addressed below.
CTUHB is committed to the development of the role of community pharmacy to improve patient outcomes within Primary Care. The 3 year CTUHB Community Pharmacy Strategy underpins this commitment and is attached as an appended document (Appendix 1).
Recommendations of the 2012 Inquiry
1. We recommend that the Welsh Government makes it an obligation for all community pharmacies to place a prominent notice in their premises identifying the range of services available in that pharmacy.
The requirement to publicise NHS services was introduced as part of the 2012 changes to Clinical Governance requirements for NHS Wales community pharmacy contractors. To support this requirement CTUHB undertakes an annual verification of the data held by the All Wales Pharmacy Database (AWPD) to ensure accuracy of information relating to NHS services provided by Cwm Taf contractors. The Contract monitoring procedure in place enables Health Board staff to confirm that contractors comply with the requirement to have a prominent notice identifying the range of services available.
2. The Committee recommends that the Welsh Government provides a clear national lead for the future development of community pharmacy services to ensure that the necessary policies and structures are in place to secure its delivery. This should include nationally agreed priorities for the service and a centrally driven direction for its development.
CTUHB strongly supports the recommendation for a national lead for the development of community pharmacy services. CTUHB has commissioned and implemented all Directed and National Enhanced community pharmacy services – Emergency Contraception, Needle Exchange, Supervised Administration, Just In Case Box and Smoking Cessation Services. All national and directed enhanced service training and accreditation has been aligned with the WCPPE All Wales Procedure for accreditation for Enhanced Services.
In addition, the Health Board has commissioned a number of local enhanced services to address local need, these include a Domiciliary MUR service, MAR Chart Administration Service (in partnership with RCT Local Authority Social Services department), Access to Palliative Care Drugs Service. The Health Board has also developed and commissioned a Supervised Administration Service for Tuberculosis Medication in response to local need. The CTUHB Medicines Management Practice Unit is responsible for overseeing the Community Pharmacy NHS Contractual requirements and regularly reviews service provision, in partnership with the local Public Health Team to ensure that services are provided across localities particularly in those areas with high deprivation/need.
Examples include
· The expansion of the Emergency Contraception Service within areas of high teenage pregnancy rates and development of specific information packs for young people accessing Emergency Contraception in these areas. These packs are currently being trialled and if successful will be implemented across Cwm Taf.
· The expansion of the Community Pharmacy Smoking Cessation Service to ensure that there is service provision across the Health Board, particularly in the more deprived communities.
In 2012, CTUHB included Enhanced Service Commissioning rates within its response, updated figures can be found in the table below:
The Health Board will continue to review service provision of all enhanced services and is currently undertaking a review of the provision of Needle Exchange Services by community pharmacies within CTUHB.
Long term funding of enhanced community pharmacy services remains a challenge at operation level within the Health Board in the absence of ring-fenced funding for community pharmacy services.
3. The Committee recommends that the Welsh Government should take the opportunity afforded by the recently announced national minor ailments scheme to consider changes to the way in which community pharmacies are remunerated, including a transition to capitation-based payments, underpinned by a patient registration system.
CTUHB supports the recommendation that changes to the way pharmacist contractors are remunerated are considered. CTUHB is one of two pathfinder sites for the NHS Wales Community Pharmacy Common Ailments Service - Choose Pharmacy. The service was implemented in October 2013 and is currently the only Community Pharmacy Enhanced Service commissioned that requires patient registration. Patient registration is integral to the delivery of the service and should be a concept considered in the development of future services.
The service is underpinned by a capitation based payments structure negotiated with the Community pharmacy contractual body – Community Pharmacy Wales (CPW).
4. The Committee recommends that the Welsh Government promotes further enhanced services with a national specification for community pharmacy, including a national Chronic Conditions Service, and follows the incremental model proposed for the introduction of the National Minor Ailments Scheme to ensure robust monitoring, evaluation and improvement of services. The Committee recommends that where there are clearly national health conditions, the service should be nationally specified, but that some continuing scope should be allowed for the volume and location of such services to be determined locally.
CTUHB is committed to the monitoring, improvement and evaluation of the Common Ailment Service in partnership with WG and other stakeholders. CTUHB would support Welsh Government in the development of further Enhanced Services that based on the model implemented for the Common Ailments Service following full evaluation of the service in 2015.
5. The Committee recommends that the consistent participation of community pharmacies across Wales is secured for the next round of public health campaigns, whether national or local. Close monitoring of community pharmacy’s participation is required by Local Health Boards to ensure that those failing to deliver on their contractual obligations are called to account for their non-compliance.
The Health Board has contract monitoring procedures in place to address non-participation or compliance with any aspect of the NHS community pharmacy contract. CTUHB would welcome advice/guidance from Welsh Government on the management of contractual non-compliance to help ensure a consistent approach across Wales.
Participation in national Health Promotion campaigns is monitored via national reports and local contract monitoring visits. In addition to the national Health Promotion campaigns, CTUHB develops local Health Promotion campaigns to support delivery of local public health objectives, these may be planned (e.g. No Smoking Day) or in response to a local need (e.g. measles outbreak). The Medicines Management Practice Unit works closely with the local PHW team to ensure campaigns deliver against key priorities; participation is monitored via contract monitoring procedures.
The Health Board has recently implemented a campaign to improve medicines adherence – Your Medicines Your Health (YMYH), community pharmacists are a key stakeholder in delivering campaign messages, planned activities include
· Encouraging patients to access the MUR service to understand more about their medicines
· Using the YMYH message to encourage seasonal flu vaccination uptake in at risk patient groups
6. The Committee recommends that the Welsh Government and Local Health Boards prioritise taking proactive action to address issues of cooperation and joint working between community pharmacists and GPs, both in rural and urban areas. We believe that better leadership from within the professions in this context is vital to securing the stronger relationships between key health professionals which are needed for the successful integration of community pharmacy services and the delivery of the Government’s ambitions for primary care in Wales.
Since the publication of the 2012 Inquiry, the Health Board has been proactive in identifying opportunities to develop services that require collaboration between community pharmacists and other Healthcare professionals. Examples of such developments include the Repeat Dispensing Service, Seasonal Influenza Vaccination Service and the Common Ailments Service. These developments are supported by joint statements from the professional bodies for GPs and pharmacists, the RCGP and RPS.
There remain a number of challenges in securing close working relationships and successful integration of community pharmacy services within primary care in Wales
· Belief that services are duplication of GP services. This is particularly relevant to the Seasonal Influenza Service, where despite developing a model which encouraged a collaborative approach to vaccination, whereby community pharmacists specifically targeted patients who had not previously received vaccination, GP engagement in this collaborative approach was lower than anticipated.
· Communication – collaborative working requires good communication between healthcare professionals. Currently reliance on verbal or paper communication hinders close working and the lack of direct channels can have a detrimental effect on relationships and patient care. This has been observed in practice whist developing the RDS and CAS services, where communication delivered by third parties (often patients, support staff) causes interprofessional tensions.
· Realignment of contractual funding and may reduce interprofessional barriers and encourage the integration of services delivered by primary care healthcare professionals..
The Health Board will continue to encourage a collaborative approach to patient care and plans to incorporate the principles of Prudent Healthcare when developing and reviewing community pharmacy services.
7. The Committee recommends access by community pharmacists to summary patient records where patients are registered with a community pharmacy.
CTUHB strongly supports community pharmacy access to summary patient records. This is an important patient safety issue and supports the principles of Prudent Health Care.
The need to obtain patient consent prior to sharing of information between primary care healthcare professionals is a barrier to closer working. The process and current requirements for obtaining patient consent for sharing information between health care professionals may need to be reviewed as part of this process e.g. timely access to information on hospital discharge medication.
Concluding Remarks
The 2012 Inquiry required NHS commissioners both locally and nationally to invest in the development of the role of community pharmacy. Considerable progress has been made in relation to the development of a pathfinder Common Ailments Service and development of national Public Health Campaigns and the standardisation of national enhanced service specifications. Locally, CTUHB has increased commissioning of Enhanced Community Pharmacy Services
Further work is needed to integrate community pharmacy into the Primary Care network, and to develop IT solutions to enable access to appropriate patient records and better communication channels between Health care professionals.
Further work is required to review current community pharmacy contractor funding streams. This will enable LHB’s to identify core service funding and to identify sustainable funding for the development of new services.
Dr Brian Hawkins – Chief Pharmacist, Medicines Management Practice Unit, CTUHB
Emma Hinks – Lead Pharmacist for Community Pharmacy, CTUHB