VOLUNTARY HEALTH SCOTLAND BPC Conference September 2005 Pharmacists Prescribing – What patients want Helen Tyrrell – Voluntary Health Scotland

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Consumer principles support equity in public services: 1 Information2 Access 3 Choice4 Safety 5 Effectiveness6 Redress What patients want of public services

1. Supplementary Prescribing Information on SP unclear to the public – not repeat, further, emergency prescriptions. Understood by: asthma, arthritis groups Access to medicines – SP seen as promoting better access Choice of service welcomed Safety – pharmacists seen as more knowledgeable in medicines management of long-term conditions

2. Health Information in community pharmacies Access to range and coverage increasing; quality of information good Information helpful in relation to: analgesia, homeopathic cold remedies, constipation, sun protection, infant feeding, smoking cessation, travel medicine BUT – privacy an issue Recommendation: Arthritis Care is currently providing information on arthritis to Boots the Chemist for dissemination through their stores. This is something we would like to see expanded throughout the network of community pharmacies.

3. Treating minor and common ailments Range of conditions prescribed for: oral thrush, vaginal thrush, chronic sore throat, smoking cessation, eczema, GORD Information unclear – people unsure which conditions qualify for pharmacy prescribing – expectations sometimes not met eg. eczema care Privacy an issue Access appreciated – It allows people eligible for free prescriptions to access the most appropriate medicines locally without having to pay for them…

4. Emergency supplies of POMs Information lacking as to which POMs qualify for “emergency supplies” Definition of “emergency” unclear Emergency supplies ensure safety of individual at risk Examples quoted of: patient with chronic condition ran out of essential anti-inflammatory and was supplied; intermittent catheters were supplied on holiday; but anti-depressant refused; PEP for those occupationally exposed to HIV seen as important

5. Pharmacy-led hospital prescribing Few with any experience of this, but: Respondents enthusiastic about (OP) Pain Management Clinics, “Warfarin clinics” (Arthritis Care and individuals) People who were HIV-positive valued monitoring role of hospital pharmacist in their care – many different drugs taken Perceived advantages included: les potential for medical mistakes! Less wastage. One person with overview

6. Limits to pharmacy prescribing Pharmacy prescribing- increases access for certain groups: people with asthma, diabetes, chronic pain Pharmacy prescribing – addresses problems with out- of-hours service, NHS24 BUT Issues of perceived safety - I would not want them to replace the doctor’s role - Prescribing any drug that is toxic/potentially harmful should surely still remain within the remit of the doctor? - Drugs above Schedule 4 should remain with doctors

7. The changing classification of medicines People aware of increased expectations of self-care – (Kerr Review, Expert Patient initiative) Improved access - time, convenience, sometimes cost – seen as an advantage More developed relationship with pharmacist BUT: Safety – people delay seeing doctor? People “shopping around”. Accessing large quantities Risk of “over-medicated consumerist society”

8. Out-of-hours care and prescriptions Some people with long-term conditions increasingly self- manage out-of-hours care (asthma, arthritis) NHS24 seen as inadequate to manage out-of-hours care at present – access problem People choose alternative routes to prescriptions – A & E, accessing within community, letter to GP Opportunity identified for pharmacists

Pharmacists Prescribing – What patients want Conclusions Information – pharmacy policy moving fast – patients/the public need information on service changes, definitions Access – patients/the public welcome increased access – convenience, time saving, developing relationship with pharmacy – provided this is consistent with safety. BUT – privacy a major issue Choice – patients/the public welcome increased choice, especially as out-of-hours service reduced. But? Inequalities? Safety- Patients/the public remain concerned about professional limits, public behaviours

Individuals and organisations responding Home Start – 2 staff and 7 mothers (9) Arthritis Care 2 individuals HIV-positive Alzheimer’s Scotland Counselling Services; Manic Depression Support 2 anonymous respondents In Contact Clan Cancer Support – personal response by individual with asthma

VOLUNTARY HEALTH SCOTLAND BPC Conference September 2005 Pharmacists Prescribing – What patients want Helen Tyrrell – Voluntary Health Scotland