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How pharmacy further integrated with NHS during 'gruelling' COVID-19

From left clockwise: Ade Williams, Andrew Lane and Ali Sparkes
From left clockwise: Ade Williams, Andrew Lane and Ali Sparkes

During COVID-19, many pharmacies have forged stronger links with their NHS colleagues to ensure patients have access to their medicines

Community pharmacy has proven its worth as a keystone of the NHS throughout the COVID-19 pandemic, keeping its doors open to desperate patients while other parts of primary care became less accessible. A crucial part of their work has involved teaming up with other primary care professionals to ensure patient care continues despite the overwhelming pressures of the pandemic.

To mark Ask Your Pharmacist week, running from November 2-9, C+D has collaborated with the National Pharmacy Association to showcase the pharmacy projects involving other NHS professionals ranging from nurses to opticians.

Ali Sparkes, owner of The Health Pharmacy in Neath, Port Talbot in Wales, says the pandemic was a gateway for forging links between pharmacy, GPs, hospitals and health boards.

“The onslaught of COVID-19 brought a need for a heightened sense of urgency, efficiency and more co-operation with GP surgeries,” says Ms Sparkes. We looked at ways to communicate more effectively and to provide better access to medicines. We’ve sent weekly email updates to surgeries on our capacity.”

“We’ve helped our community hospital’s acute medicines department get medicines quickly by providing a separate entrance to the pharmacy.”

“As an independent prescriber, I’ve had meetings on Zoom with the health board, which is safer and saves time [on] travelling.”

The efforts of her pharmacy team, which won the C+D Award for Independent Pharmacy of the Year in 2017, have not gone unnoticed. “The practice manager of a local GP surgery came in and told us we were doing a fantastic job,” she says. “Our relationships with surgeries are much closer now.”

“It’s been a really interesting time. I’ve been in pharmacy for over 30 years. This has been the most gruelling, hardest time but also really rewarding.”

PCN collaboration

Ade Williams, superintendent pharmacist of Bedminster Pharmacy in Bristol, has been tackling health inequality with nearby members of his primary care network (PCN).

He aims to provide cardiovascular care throughout the PCN, targeting patients at greater risk of suffering from health inequalities. “We are looking to facilitate community pharmacy commissioning so we can provide appropriate care such as cardiovascular and diabetic checks,” he says.

Working with GPs

Video calls with GPs have become a staple part of daily working life for many pharmacies since the COVID-19 outbreak. Andrew Lane owns the Alchem Pharmacy group, which has 14 pharmacies between Yorkshire and Devon. He has been speaking to GPs remotely since before the pandemic.

“With things like flu jabs, for example, we can work out a combined strategy, collaborate at a senior level and iron out issues,” he says.

“It is very useful to get intelligence on what is happening elsewhere in the healthcare system,” says Mr Lane, who is also NPA chair. “The doctors get to know what is happening in community pharmacy and we can share opportunities.”

Alison Webster, a dispenser at Blackburn Pharmacy in Aberdeen, says her pharmacy has been working with her GP surgery to ensure patients who are unable to leave the house still receive their medicine through free deliveries.

“We also work with community practitioner nurse prescribers with patients who have had addiction problems, checking their usage of methadone, buprenorphine, suboxone or naltrexone,” she says.

Anand Shah, superintendent pharmacist at Cotham Pharmacy in Bristol, has been receiving patient referrals from doctors via the pilot General Practice Community Pharmacist Consultation Service, which launched in April. The service became part of the Community Pharmacist Consultation Service, which directs patients to pharmacies via NHS 111, on October 31.

“All our local GP surgeries are now referring patients with minor ailments – we’ve had 45-50 referrals in the last month,” he says.

“Surgeries have a triage list and they ask patients who have called for a GP appointment for their symptoms. Patients with minor illnesses are advised they should see a pharmacist for a consultation and that, if they agree, personal data, including a short description of their presenting condition, will be transferred to the pharmacy.”

Despite the COVID-19 outbreak, Mr Shah’s team have been conducting some socially distanced consultations with patient referrals in person for conditions that require contact, he says.

“This pilot has taken the pressure off surgeries and for patients it has offered convenience. It’s an alternative source of income for the pharmacy.”

Hospital discharge

Pharmacies have reached beyond GP surgeries to hospitals. James Thorne, the director of Gravells Pharmacy in Llanelli, Dyfed in Wales, has been joining forces with a hospital as well as a GP surgery through the Discharge Medicine Review service.

Under the service, pharmacies help patients who have been discharged from hospital. They check that the medicine prescribed in hospital matches the one later prescribed by the GP, as well as discussing the patient’s medicine use.

“We then later contact the patient to see that everything is OK with how they are taking their medication and that there have been no problems,” Mr Thorne says.

Supporting the elderly with social workers

Some pharmacies have collaborated with social workers on community projects. Stephen Burns, a pharmacist at Ballee Pharmacy in Ballymena, County Antrim in Northern Ireland, has been working with a GP and social workers on a project connecting patients aged over 65 years to their community.

Staff at Ballee Pharmacy signpost patients to the ImpactAgeWell initiative. “A plan is put in place once the patient’s needs have been identified. This might be to address medication issues, mobility issues, social isolation, or frailty, the list goes on,” says Mr Burns.

“Each month I meet with a GP, a social worker and an officer from the project to discuss each patient’s action plan and see how we can each help.

“There are many examples, such as one patient who uses a scooter and had trouble getting into town.” Project participants spoke to the bus company, who introduced a service with scooter access.

The pharmacy has helped patients through the project by offering its medicine reviews and smoking cessation services.

“This project has broken down barriers between different parts of the health system and given us a greater appreciation of each other’s roles,” adds Mr Burns.

Dentists and opticians

Even dentists and opticians have joined up with pharmacies. Raj Aggarwal, the superintendent pharmacist of Central Pharmacy in Cardiff, says dentists and opticians rallied with the pharmacy to answer patient medicine demands.

Mr Aggarwal also works with his GP surgeries and health board. “There was complete 24/7 support in one way or another. Everyone felt for each other and had trust in each other.”

The COVID-19 pandemic has placed record pressure on the NHS, but it has also helped NHS professionals to bond with pharmacy over the shared goal of protecting patient care.

How does your pharmacy collaborate with other NHS professionals?

A.S. Singh, Community pharmacist

I'm sick and tired of hearing how we are constantly ignored even though articles like this prove time and again how we can be utilised as a profession.

There is obvious hatred of us by Keith Ridge. Since he has come in pharmacy has plummeted as a profession and is going to hit rock bottom soon. We need to come together and oust this monster from his position or we have no hope.

Kevin Western, Community pharmacist

...and to answer the question above, I have tried phoning, not a chance of a GP response, I have tried Emailing...ignored... collaboration implies two way communication, and its rather difficult when its only one way.

Kevin Western, Community pharmacist

These are all laudable and heartwarming examples of what can be done when both sides are willing to co-operate, and on a purely local level are great.... But it is a misnomer to say "How pharmacy further integrated with NHS  during 'gruelling' COVID-19" because the NHS, as a whole, studiously ignored Pharmacy and Pharmacists (note the capitals, C&D) whenever it could get away with it, and still is - GPS given system for ordering flu vaccines and no one thought about Pharmacy until it was pointed out, Covid vaccination, GPs have had letters telling them how it will work... we are still negotiating, etc etc.the list is impressive.

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