On my patch 4: Devon
Devon LPC explains how it has secured funding for new services by spotting gaps in healthcare
In the fourth of our series on local service commissioning, Devon LPC explains how it has secured funding for new services by spotting gaps in healthcare
If there's one thing Devon LPC has achieved over the past year, it's spotting a gap in the market.
Its newly developed services have sought to target vulnerable patients in need of a pharmacist's input – tackling conditions from diabetes to psoriasis and depression. Not only has this made a difference to patients, but the benefits are backed up with hard evidence.
It's this approach that has won local pharmacies sought-after funding and praise from public health chiefs, MPs and commissioners. Against a backdrop of tight funding, heavy workloads and the roll-out of the healthy living pharmacy initiative locally, it's certainly been an achievement. So how did Devon LPC manage to secure new services despite the tough environment?
Dealing with diabetesWhen it came to developing new services, diabetes was perhaps an obvious area for Devon LPC to start. The condition is becoming ever-more prevalent and the cost of prescribing diabetes drugs jumped 5 per cent to £803.1 million between 2012-13 and 2013-14, NHS data shows. This prompted charity Diabetes UK to back the "vital" role of community pharmacies in reducing the enormous cost of diabetes treatment.
Devon LPC has sought to do just that. It recognised that, with around 124,000 items being dispensed for diabetes each day, pharmacists are well-placed to intervene. Last year, the LPC organised for 12 local pharmacies to pilot a type 2 diabetes support service. The pilot involved a face-to-face consultation in the style of an MUR, followed by a phone call from the pharmacist a few weeks later.
The evidence shows pharmacists made some difference. In the first consultation, almost three quarters of the 111 patients taking part agreed to follow an action plan to improve their adherence. By the second consultation, 56 per cent were still adhering to all of the pharmacists' recommendations. A follow-up survey on 34 patients found patients were more knowledgeable about their condition; however, their average adherence score had only increased by 1 per cent as a result of the service.
Devon LPC project leader Mark Stone says the evidence still demonstrates a "significant change in behaviour" and he is keen to see the project rolled out to nationally. He admits this may prove unlikely, but at least part of his wish has come to fruition.
Swindon and Wiltshire LPC was granted £5,000 in funding from Wiltshire Council to replicate the pilot there last summer. Fiona Castle, the LPC's chief executive officer, believes Devon's success was key to getting the service commissioned. "The secret to getting money like this is having something you can just deliver without having long consultations about it," she says.
Mr Stone is delighted with the result. "This was one of our aims when we did the work – to get it used and tested elsewhere – as we need evidence for community pharmacy," he tells C+D. He is now looking to secure funding to take the project further. Devon LPC is applying for a National Institute for Health Research grant and is joining up with Sunderland University as an academic partner to provide the "health economist side of things", Mr Stone reveals.
This success has spurred on Devon LPC to try out more new services. It is keen to use the network of healthy living pharmacies (HLPs) in its area to deliver these. There are currently nine HLPs in Devon and 22 more pharmacies are looking to get accredited.
The Boots branch in Chard Road, Plymouth, was one of the first HLPs in the region and took part in the diabetes pilot. Pharmacist Yvonne Andrews says this service-led approach has been beneficial for the business, as well as customers. "People liked [the diabetes service], so even though it was a bit of extra work it was worth it, and straightforward for us to carry out because we do MURs anyway," she says.
Ms Andrews is also positive about taking part in Devon's depression new medicine service (NMS) pilot, conducted in May and June. She describes the service, which involved seven HLPs in the area offering patients consultations on how their medicine worked and how to minimise side effects, as a "success".
The evidence backs up her view. There was a clear need for the service – of the 30 patients who took part in the pilot, a third initially experienced side effects from their medication. One in six was uncertain whether their medicine was working before talking to the pharmacist.
Given the direction that Devon LPC is taking, Ms Andrews says she's "certainly optimistic" about the future of local pharmacies. "Services are taking off and we are doing a few PGDs for minor ailments, which have continued to put us on the map and bond us with our customers, as well as helping local GPs get to know us better," she tells C+D.
"Pharmacy always has a heavy workload but we seem to be progressing down the services route and, with more ACTs and dispensers taking the pressure off in terms of prescriptions, I think we have a lot to be positive about in the future."
A far-reaching effect
Devon LPC's ambitions don't stop in its area, though. It is keen to share its experiences with other parts of the country to help them develop similar services. For this reason, the LPC has published a range of toolkits that are free to download from its website, devonlpc.org. "We want to develop a suite of advice for pharmacists on long-term conditions," says Mr Stone.
"For example, psoriasis can be well-managed in primary care if patients understand how the treatment regime works so, with the help of experts from the Royal Devon & Exeter Hospital, and the Psoriasis Association, we've drawn up a printable PDF that contains a knowledge update, a consultation brief and a patient record form that pharmacists can use with their patients living with psoriasis." The LPC is now planning to produce similar resources on COPD and acne.
This forward-thinking approach has managed to influence high profile figures, which could also reap wide-reaching benefits. Local MPs took the merits of Devon's diabetes service to Westminster. Charities have also backed their work. And Kevin Elliston, consultant in public health for health improvement at Public Health England's Devon, Cornwall and Somerset centre, is now a vocal advocate for the role of community pharmacy.
"Pharmacists' skill sets and expertise are still the best-kept secret in public health," says Professor Elliston, who is also chair of the Peninsula Public Health Network – the multidisciplinary network for Devon and Cornwall, Isles of Scilly and Somerset. "But they're not always able to be out there cheerleading for the services they have to offer. We need more Mark Stones showing what the profession can do."
Professor Elliston stresses that this enthusiasm for pharmacy is felt across Public Health England and that it must now work with the Department of Health and national pharmacy groups to maximise the sector's potential.
In the meantime, though, Devon LPC is determined to keep its work going within the current funding and organisational constraints. Its enthusiasm for developing new services shows no sign of stopping.
In fact, as C+D went to press, Devon LPC revealed it had secured £130,000 in funding for a winter minor ailments service and training of pharmacy staff to offer healthy living advice. It can only be hoped that this success, backed up by evidence, can help pharmacies – in and outside Devon – convince commissioners of their worth.
Heart disease
Coronary heart disease is the largest cause of death among people aged 75 and under in Devon – accounting for more than 12 per cent of all mortalities in this age group.
Ageing population
Devon has an older population profile than nationally because of significant in-migration. Elderly residents are more likely to have complex health needs.
Dementia
Nearly 5,000 people in Devon were on a GP register for dementia in 2011-12, but actual numbers are expected to be much higher at more than 13,000.
Smoking
For Devon the most recent estimated smoking rate is 20.2 per cent in the overall population, which is slightly higher than the England average of 20 per cent.
Eye conditions
The older age profile in Devon means there is a higher than average prevalence of eye health problems. The most common condition is cataracts, which affect around 22,400 people in Devon or just under 3 per cent of the total population.
Rurality
Devon is one of the most sparsely populated counties in the country, which can make it difficult to access health services – particularly for those people who rely on public transport. Source: Joint Strategic Needs Assessment Devon Overview 2013
