Health Service Focus

Time to bite the bullet on utilising pharmacists

As NHE went to the printers, Health Education England was still evaluating the results of the national emergency pharmacy pilot. We spoke to Howard Duff, Royal Pharmaceutical Society director of England, who is an advocate of the programme.

There is a “growing interest” across the country in using pharmacists more widely in accident and emergency departments, but more must be done to utilise the profession effectively, NHE has been told.

Speaking to Howard Duff, Royal Pharmaceutical Society (RPS) director of England, about the Health Education England-led national emergency department pilot, we were told that he is “very much in favour of the role of pharmacists in urgent care”.

Although the national pilot’s results are still being evaluated, it aims to build upon research conducted in the West Midlands from April 2013 by Health Education West Midlands.

This research identified a potential role for the pharmacist in areas such as pre-discharge medicines optimisation in the emergency department and acute medicine units, as well as within clinical decision teams in the undertaking of medicines-related and minor illness-focused clinical duties. Such duties are currently undertaken by junior medical staff, who face significant demands on their time with emergency admissions.

Duff told us: “The evidence from the West Midlands would suggest that finding pharmacists who can become advanced practitioners would be the gold standard, which we would like to see.

“In the West Midlands they have had pharmacists undergoing advanced practitioner training. This is where you have a qualified pharmacist who, as a prescriber at the start, could manage around 8% of presentations to A&E. But with the advanced practitioner training that went up to approximately 48%. It is astonishing.”

Last year, RPS published a document entitled ‘Improving Urgent and Emergency care through better use of pharmacists’. It called on NHS England to nationally contract all community pharmacies to provide a common ailment service and recommended that all A&E departments should incorporate a pharmacist to manage medicines issues.

On top of this, it was stated that if there was a nationally commissioned common ailment service it would be easier for this to be included in the local Directory of Services (DoS) for NHS 111 – a service that is commissioned and delivered locally but in line with national service specification and standards – as it would be standardised and available from all community pharmacies.

Duff told us: “Our view is that we need a uniform service across the country, but we are in this dogma at the moment of localism where local CCGs or [NHS England] area teams have to commission services multiple times across the country.

“I understand the drive behind localism, but if we had the minor ailments service and an urgent medication service aligned and if we bit the bullet and made it a national service, then all of the DoSs could be uniform across all of the NHS 111 providers – people would get used to it easier and quicker. This would then mean people know that if they are on holiday in Bodmin they will get the same service as they have at home in Leicester.”

He added that a key issue with the current growth in waiting times for accident and emergency services is the number of people with conditions that could be treated elsewhere but who use A&E services as an alternative source of healthcare.

“It is probably worth pointing out that one of the things we’re finding is that there is a manpower provision with the shortage of GPs, nurses, emergency room doctors – but there is a plentiful supply of pharmacists,” said Duff.

“There are lots of needs that pharmacists can help with and we’ve been making the case on a positive basis that pharmacists have expertise that they can bring, and we can actually help with the skills gap shortfall.”

Duff also stated that all trusts should consider the potential of harnessing community pharmacy to keep people away from their emergency department doors.

Following our interview with Duff, NHS England announced a £15m scheme aimed at recruiting and employing clinical pharmacists to work in GP surgeries.

The three-year pilot project for England will see up to 300 pharmacists support around a million patients with self-limiting illnesses or long-term conditions, while easing the workload pressures on under-pressure GPs.