The Pharmacist’s role In the delivery of Diabetes care And the NSF Irene Gummerson Pharmacist with a Special Interest in Diabetes Member of the Diabetes UK Advisory Council

Drivers for Change Government: Wants better value ‘Pharmacists under-used’ ‘Choice, access, responsiveness & equity’ NHS Pharmacy Plan Choosing Health through Pharmacy Vision for Pharmacy New Contract Other national & local policy documents

Drivers for Change (Contd) Profession bodies RPSGB, PSNC, NPA Other Professions Diabetes UK Pharmacy Diabetes Network Pharmacists Hospital, Community, PCT, GP practice PhwSIs

National Service Framework (NSF for Diabetes) Standards for Diabetes Services (2001) Std.1 Prevention of Type 2 diabetes Std.2 Early Identification (Screening) Std.3 Empowerment Std.4/5/6 Clinical care of adults/ children Std.7 Management of diabetes emergencies Std.8 Care during admission to hospital Std.9 Pregnancy Stds. 10/11/12 Detection/management of L.T. complications

NSF Delivery Strategy (2003) To achieve the Standards by 2013: Clinical diabetes networks Workforce planning & development PCTs to assess training needs

NSF - Standard 1 Reducing Risk Of Type 2 Health Promotion raising awareness of benefits Primary and secondary care Posters/ Leaflets Verbally Opportunistic/ Reactive Medicines review, MUR

NSF - Std 1 Reducing Risk Of Type 2 Health Promotion Healthy eating Increasing physical activity Stopping smoking Be organised Have the ‘tools’ ready

New Contract & Std.1 Reducing Risk Of Type 2 Essential Services Public Health: health promotion 6 campaigns Signposting Enhanced Services Weight management clinic

NSF - Standard 2 Early Identification ‘When community pharmacists….. see people with symptoms suggestive of diabetes, they should advise them to see their GP for diagnostic testing’

NSF - Standard 2 Early Identification ‘..there is currently uncertainty as to what is the best way to identify people with undiagnosed asymptomatic Type 2 diabetes..’ ‘..targeted..’ ‘..combined with CVD.’

NSF - Standard 2 Early Identification RPSGB guidance Essential Practice Monitoring OTC sales – support staff New Contract Enhanced service Diabetes screening

NSF - Standard 3 Empowering Education, motivation & advice All pharmacists in contact with patients National resources Hand held cards Medicines Partnership Ask about Medicines Week RPSGB guidance check understanding extended/ reinforce information Diabetes care, medication

NSF - Standards 4,5,6 Clinical care of adults/ children RPSGB - first script Essential Practice Check they have diabetes Dosage regime, DIs, CIs etc Diabetes UK membership Desirable Practice Pro-actively - answer questions & concerns

NSF: Standards 4,5,6 Clinical Care of adults/ children RPSGB - repeat script Essential Practice Anomalies, side effects, concordance Desirable practice Remind, clarify, educate

NSF: Standards 4,5,6 Clinical Care (contd) LPS New Contract Advanced Services Medicines Use Reviews (MURs) Interventions

NSF: Standards 4,5,6 Clinical Care (contd) New Contract Enhanced Services Medicines reviews - medical records/ or not Pharmacy, care homes, domiciliary settings Not just target diabetes Supplementary prescribing BP, tests bloods by pharmacist, nurse, phlebotomist

NSF for Diabetes ‘Delivery Strategy’ ‘pharmacists are a regular point of contact for people with diabetes and can play a central role in improved medicines management’. recognition of the pharmacist’s role

Medicines Management Monitoring BP, BMI, U & Es, lipids, HbA1c Diabetes/CVD medicines optimised Guardian medicines eg aspirin Other medicines? Side effects, concordance

NSF - Standard 7 Management of diabetes emergencies Sick day rules Carrying identification Early recognition Hypo-, hyper-glycaemia Patients, carers, pharmacists, pharmacy staff Know what to do E.g. hypo- Lucozade/ Dextrosol followed by a sandwich

NSF - Standard 8 Hospital Care Be alert to diabetes cases on non-diabetic wards Inexperienced staff Pharmacist-led clinics Pharmacist input into protocols/ guidelines DKA, hypoglycaemia, ward insulin policies, care plans Research/ audit work

NSF - Standard 9 Pregnancy Planning Pregnancy medication review folic Acid; stop smoking; tight BG control During Pregnancy checking for problems/ referring ketone testing strips

NSF - Standards 10,11,12 Reducing the Complications Early detection, investigation & treatment Good clinical care & concordance Glycaemia & Blood Pressure Encouraging attendance at clinic appointments

NSF - Standards 10,11,12 (contd) Retinopathy Large labels (Essential Service) Lower Limb Foot care advice OTC sales Nephropathy Check for renal impairment Drugs to avoid or reduce dose

Smoking Cessation Relevant to: Management of L.T complications (Standards 10,11,12) Many government documents RPSGB - Desirable Practice New Contract – Enhanced Service Smoking Cessation Clinic

NSF – Standard 11 Reducing Complications - CVD RPSGB New Contract Guidance on testing (MEP) New Contract Enhanced Service Questionnaire risk assessment, Blood pressure, lipid monitoring, BMI, waist measurement Referral MURs, Medicines reviews – identify cases

Pharmacist’s role in the delivery of Diabetes Care? Expanding Increasing opportunities Challenging The New Contract & RPSGB guidance Guide implementing Diabetes NSF

Pharmacy Diabetes Network Sharing experience All sectors Pharmacists & pharmacy technicians Strengthening pharmacy’s role in diabetes care Document Consultation group pharmacydiabetesnetwork-subscribe @smartgroups.com