Pharmacy in a New Age Mr Sultan ‘SID’ Dajani Royal Pharmaceutical Society

UK Pharmacists Where we were Where we are now Where we could be How we approached identifying extended roles for pharmacy

Pharmacy in the UK 45,000 Registered pharmacists 10,500 community pharmacies/Walk-in Healthcare Centres across the UK 800 Hospitals 6 million people visit pharmacies daily Dispense around 700 million prescriptions a year Have a pharmacy family In Community, hospital, industry, academia, army, GP surgeries, the government, agriculture, medicines information, prison.

Statistics 4-21% of patients achieve optimum benefit from their medication 1 Between a third and a half of prescribed medicines for long-term conditions are not used as intended or recommended 2 Errors found in 7.5% of Rxs written % of patients discharged have at least one discrepancy 4 Preventable waste costs £750 million in England alone 5 £100m medicines unused and returned to pharmacies annually 6

Potential for Progress UK ’s £9bn annual prescription medicine cost 786m Items % - Preventable ADR Hospitalisations 10% of prescriptions are never dispensed. 50% don’t take medicines correctly as prescribed 58% - Not told about Side-Effects The largest group of drug users is the over 65’s who account for 50% of all prescriptions issued Polypharmacy & Increasing Risks of ADRs

PDRM – drug related morbidity Unnecessary therapy Inappropriate Rxing Inadequate follow-ups Failure to recognise symptoms Over-Rxing Medication errors Over/under dosing ADR Contraindications Non-compliance !

What might have changed? Societal change –Ageing population living longer –Informed, knowledgeable patients Politics Patient expectations Professional aspirations Cost management

What will change? Information technology –Robotics, artificial intelligence, home health management systems –New diagnostic tests performed anywhere Science –Stem cell technologies, genomics, nanotechnology, etc. Medicines –New cures for new diseases

where does pharmacy fit in? See the walking wounded and the wounded well Availability of healthcare Products No appointments or referrals necessary Manage repeat medication See patients up to 5 times more than other HCPs Trained experts in medicines and symptoms

The management of prescribed medicines The management of long-term conditions The management of minor ailments The promotion & support of healthy lifestyles Advice and support for other health professionals Community Remove harm and add good

Barriers to Change Lack of Evidence Base practice GP bias Confidence of the patients and Public Belief by pharmacists Funding Professional settings Medicinal information and support Tools e.g. Software, paperwork, record keeping Could pharmacists really make a difference?

Vision Partnerships Remuneration Pharmacy Fit for the Future

Partnerships Other Pharmacy Organisations Other Medical Professional Bodies Consumer & Patient Groups Government/Politicians The Pharmaceutical Industry Academic/Research Institutions Our Members

Vision What is Pharmacy? What is our role/vision? How Have External Drivers Affected Us? How do we build a strategy?

Consultation Results More clinical role Regular practice guidance and support Better funding mechanisms Reduce stress and workload pressures Want devolved powers to address local not just national needs Become more multidisciplinary Must focus on down stream treatment and upscale upstream prevention Have an Evidence Base of Our Value Measureable patient orientated outcomes Many resisted/feared change!

Roles of the Professional Leadership Body Professional Support Professional Development & Education Leadership & Advocacy Professional Networking Science and Research

New Contract 2005 Essential Advanced Enhanced 600m GBP to 1.76bn GBP

Current Pharmacy Contract - £2.3 Billion p.a. Dispensing Signposting Support For Self Care Disposal Of Unwanted Medicines Clinical Governance Computerised patient records of dispensed meds Annual Patient Surveys Two annual Audits Promotion and support of healthy lifestyles – Five Public Health campaigns a year

Medicines Use Review (MUR) Patient interviewed & profile compiled Pharmaceutical care plan generated Pharmacist implemented agreed plan & Monitored Mean of 2.8 Changes per patient GP acceptance rates were between 87-95% Similar rates were seen for patient acceptance

The Message is Coming Through - Change is Inevitable!

MUR outcomes 1,265,278 carried out in Approx 30,000 forms monitored and assessed: 19% non GP changes 67% queried with GP 90% GP amendments (68% deemed serious) 42% resulted in medicines stopped 15% new therapy initiated 10% referred to specialistic care Huge savings to hospitals, reduced medicines wasted

Enhanced Services in Pharmacies Minor Ailments Services Smoking Cessation Services Supervised Administration Needle Exchange Anticoagulant Monitoring Blood Pressure Monitoring Diabetes Monitoring Care Home Support Full Clinical Medication Reviews (Level 3) Vascular Risk Assessments

Prescribing Screening Flu Vaccination Travel Vaccines Providing Devices Palliative Care Services Other Examples of Clinical Roles

The facts… Assess patients’ pharmaceutical care needs Plan a strategy for the individual Monitoring Achieving therapeutic goals Remove harm and add good

Medication Reviews 26,000 in Pharmacists with premises fitted out for private discussion will interview selected patients about their medication so as to identify any problems that might have arisen. The pharmacist will make a structured assessment of the patient’s prescribed medicines with a view to discussing the matter with the patient’s general practitioner.

The Pharmaceutical Care Cycle GP Recognise Patient Problem Assess Patient Problem Therapeutic Plan (Rx) Record / Interpret Patient Information Consider Therapeutic Objectives Assess Therapeutic Plan Design Monitoring Regime Dispense and Advise Implement Monitoring Plan Assess patient problem (if any) Respond to problem (if any) RESOLVED

Pharmaceutical Care for the Elderly 117 medication reviews Average age 79 Resulted in 49 recommendations 23 hospital admissions prevented Saving £49, recommendations accepted

Self Care & OTC Health Campaigns e.g. Obesity, smoking cessation Training Support for Pharmacists & Staff Professional Tools Screening equipment Information Sharing Audits Media/Publicity products & services – ‘Ask Your Pharmacist First’ Prescription Only Medicines to Over The Counter medicines

Diabetes Facts & Stats Increasing every year Million in the year th leading cause of death 9% NHS budget Over a million undiagnosed cases Chronic Disease Many Complications Health Promotion just as Important as Medicinal Care Early intervention - L/T complication

COPD Costs to the NHS £900 Million 3.4 Million sufferers 2000 Deaths a year 80% of the fatalities are estimated to be avoidable Asthma results in 85,000 hospital admissions 25% of Asthmatics suffer daily symptoms

Future Patient registration Minor Ailment Services Pharmacist with a Special Interest (PhwSI) Generic Substitution Repeat Dispensing Medication Reviews/Medicines Management/Pharmaceutical Care More use of IT & technology- EPS, patient care records Clinical Screening Healthy Living Centres GP appointments booked through pharmacists 1st Prescription Service Prescribers at undergrad level First Prescription Service

Consultation Questions What functions do you expect to do more of or less of in future & why? What are the 3 changes that need to happen in order to deliver the aspirations of the profession? What 3 things should the national pharmacy bodies do now to create the future for pharmacy? What 3 things should you do now to create the future for pharmacy?

Pharmacy Beware!

The Message is Coming Through - Change is Inevitable! Thank You