Community Pharmacy TOM KALLIS DEVON LPC TOMKDEVONLPC ORG

Community Pharmacy TOM KALLIS, DEVON LPC TOMK@DEVONLPC. ORG

Agenda Introduction Community Pharmacy Overview Technology: e. RD and SCR Compliance aids e. PACT insights Formulary Q & As

Key Statistics GPs and A&E staff treat over 60 million patients annually for ailments such as a cold, blocked nose, back pain, insect bites Recent estimates suggest that 5% and 13% of consultations in emergency departments and general practice, respectively, are for minor ailments that could be managed in community pharmacies. Up to 18% of general practice workload is estimated to relate to minor ailments, at a cost of £ 2 billion annually. 89% of the population in England has access to a community pharmacy within a 20 minute walk

Essential Services These are services that all community pharmacies provide

Coughs and Colds Constipation Diarrhoea Self Care Pharmacies already provide a range of over the counter advice and treatment without patients having to go to their GP. It is thought that 18% of GP appointments could be managed by community pharmacy Dry Skin and Rashes Earwax Hayfever and Allergies Headaches Emergency Contraception Indigestion and Reflux Sore Throats Thrush And Much More….

MURS Medicines Use Reviews, an annual review of how patients use their medicines, addressing side effects and providing healthy lifestyle advice Advanced Services These are services that most community pharmacies provide in an approved consultation room/area NMS Supporting patients newly prescribed medicines for COPD, Asthma, High Blood pressure or Medicines for anticoagulation/platelet NUMSAS Providing patients with emergency supplies of medications they have run out of (usually out of hours) following a 111 referral Flu Vaccinations Vaccinating at risk groups and patients over 65 against influenza as part of the wider NHS flu programme

Emergency Hormonal Contraception Locally Commissioned Services These services are commissioned locally according to population need and may differ from one geography to another. The services listed [R] are available for pharmacies to provide in North Devon. Chlamydia Screening Supervised Consumption Needle Exchange Smoking Cessation Electronic Transfer of Care from Hospital

Pharmacy First Services Allows specially trained pharmacists to provide Prescription Only Medication via an NHS service in Devon for a range of conditions Urinary Tract Infections Bacterial Conjunctivitis (1 year olds) Nappy Rash Impetigo

DMIRS ‘Digital Minor Illness Referral Service’ Allows patients to be directly referred digitally from NHS 111 into pilot pharmacy sites throughout Devon.

Improving Access in North Devon Two community pharmacies in Barnstaple are also involved in offering appointments out of normal surgery hours to support the improving access to GP surgeries… with more to possibly follow!

Primary Care Skills Pharmacists involved in the Improving Access scheme in North Devon have undergone additional training in taking basic vital signs, respiratory examinations, ENT examinations and back/leg examinations to help identify red flags which may need further referral.

Technology Community Pharmacies have shared NHS Mailboxes, which pharmacists and staff with NHS emails can access to receive referrals for services and communicate securely with other healthcare professionals. Pharmacists and Pharmacy Technicians can also view ‘Summary Care Records’ with patients’ consent, allowing them to view repeat medications and acutes issued in the last 12 months.

Electronic Repeat Dispensing (e. RD) Two thirds of prescriptions issued in primary care repeat prescriptions (80% of NHS primary care meds spend) 330 million prescriptions (80% of all repeat medication issues) could eventually be replaced by e. RD is a batch of electronic prescriptions issued by a prescriber for up to 12 months at a time Pharmacy responsible for carrying out checks and regularly reviewing

e. RD Contractual Questions Have you seen a HC professional since your last script was dispensed? Have you started any new medicines (Rx or OTC) since you last collected? Do you have any problems with your medication or any new side effects? Are there any items you don’t need this month?

e. RD Case Study

Compliance aids Large Print Labels ‘Talking’ Labels Braille Labels ‘Blister’ Packs (Non-Reusable) Apps Tick Sheets (Alarmed) Reusable Pill Boxes Mechanical Aids

The Evidence OP (Original Pack) dispensing preferred to MCA where there is no established need under the Equality Act 2010 OP dispensing as a mechanism to support independence and re-enablement Patients who have medicines adherence issues should have a robust individual assessment (Which setting? ) Acknowledgement that there is no national multidisciplinary tool for assessing Need for further evidence on use of MCAs on patient outcomes

Practical Considerations NHS Terms of Service do not require dispensing into compliance aids or to dispense in instalments No obligation under To. S or Equality Act 2010 to amend what has already dispensed midway through treatment Ideally, dispensing into compliance aids should be because of an established need under the Equality Act 2010 28 day v 7 day prescribing – what does this mean?

RG Y ER EN TR C SU M HA RT NO RG Y E TR ER RG SU IC AL ED M RT N TO IN G SU DA OO W RR PO UT BO TO K AC BL E CE CT I L C EN IC A ED EN TR L P RA TA AS N M DO CH LIT E UP RO L G TH C AL H E C O BE M CO ON E TR EN TR L C IC A ED M RY GT IN RR TO IC A E TR EN L C EN IC A ED E E RE EN T AL C IC ED ED M M N TO NT OU C BY RU OL M NA M AN BR UT H SO C EN TR TH C RE NT Y EN TR C IC AL ED M S M EE N' N AL H E IC AL ED M ER RY Y ER GE RG H CE LT H EA ON TO IN G QU EM FR NT LY RD FO BI DE RG UR Y SU TH EN S S RD W OR AD RO OK LIN GB W AL BR E TR L C EN SU ND LA IC A ED RT GA E TL CA S HA N M CA E Percentage of Patients over 65 on Eight or More Medications 20 15 10 5 0

Devon Formulary

Spend per patient % Registered patients with Hb. A 1 c <59 mmol/mol RG Y ER E E TR L C EN SU M HA RT NO IC A ED Y ER RE E EN TR C IC AL ED N M DO CH LIT RG SU N TO NT C E AL IC E EN TR C IC AL ED IN G M ON GT IN EM FR RR TO K AC BL M N' S EE QU E TR Y TR EN L C IC A ED M RD FO BI DE ED ER EN AL C IC E RE NT RG SU DA ED M N M TO OL M H UT SO NA M AN BR OO W H CE LT RE IC L P RA CT TA ER Y EN T L C IC A H EA ON GT IN RR TO AS C O BE M CO RG UP RO L G E TR Y E TR ER C EN SU ND ED M RT PO UT BO LA RT HA IC A ED M Y TH EA L H OK RO Y SU RG TH E RY GE UR EN TR L C EN IC A ED OR W AD NT R OU C BY RU LIN GB W AL BR N M CA E EN S S RD TH C AL H E GA E TL CA S ON NT LY Spend per patient (Q 2 2018) on the diabetic register v Percentage of patients with Hb. A 1 c control below 59 mmol/mol 80 70 60 50 40 30 20 10 0

Chapter 6 Reconnoitre Sulphonylureas Gliclazide Glimepiride Glipizide Biguanides Dipeptidylpeptidase-4 (DPP-4) inhibitors (Gliptins) Alogliptin Sitagliptin Linagliptin Metformin Sodium-glucose co-transporter 2 (SGLT 2) Inhibitor Metformin Modified Release (MR)(Sukkarto) Canagliflozin Alpha glucosidase inhibitors Dapagliflozin Acarbose Empagliflozin

Chapter 6 Reconnoitre Glucagon-like peptide-1 receptor agonists (GLP Guidelines for the management of -1 mimetics) hypoglycaemia for adults Lixisenatide Glucagon Dulaglutide Gluco. Gel® Exenatide Chronic hypoglycaemia Liraglutide Diazoxide Thiazolidinediones Other equipment Pioglitazone Needle Clipping (Chopping) Device Meglitinides Sharpsguard Repaglinide Sharpsafe

Chapter 6 Reconnoitre Soluble insulin Isophane insulin Actrapid® Insuman® Basal Humulin S® Insulatard® Insuman® Rapid Humulin I® Rapid-acting human insulin analogues Biphasic insulins Novo. Rapid® (Pumpcart) Humulin® M 3 Humalog® Insuman Comb 25® Apidra® Novo. Mix 30® Fiasp® Humalog® Mix 25 Humalog® Mix 50

Chapter 6 Reconnoitre Long-acting analogues Hypurin® Porcine Isophane Insulin glargine Hypurin® Bovine Protamine Zinc Abasaglar® Hypurin® Porcine 30/70 Mix Lantus® Toujeo® Hypodermic equipment Insulin detemir Pen needles Levemir® BD Viva® Insulin degludec Gluco. Rx® Finepoint Tresiba® Microdot Droplet® Omnican Fine®

Free. Style Libre

Any Questions?