From the Makers of Medicines to the Makers of Better Health The Modern Community Pharmacy James Wood MRPharmS Superintendent Pharmacist, Wicker Pharmacy, Sheffield

Pharmacist education 26 Schools of Pharmacy 4 year MPharm degree Pharmaceutical Chemistry – origin and chemistry of drugs Pharmaceutics – preparation of medicines Pharmacology – actions and uses of drugs Clinical Pharmacy, Social Pharmacy, Public Health… Pre-registration year in practice GPhC Exams Registration & CPD Expert in medicines and their use in the health care system

A recent history Role changed radically 1948 – squirreled away years – manufacture of nostrums 1948 – NHS Free access to GPs – two institution pillars developed 1960s – Thalidomide 2000s – Supply of medicines + valued added services 2010s – Supply of medicines + valued added services + Support people having an active engagement with their own health Are we really using pharmacists to full effect?

Context Health – continued pressures on funding, living longer and greater expectations Providers – productivity GP fully engaged in ill health + administration around it Need to do things differently: Not only to help the NHS meet demands on its resources But also in addressing health inequalities We need people to take an active interest and role in keeping healthy

Context: Medicines Medicines are the most common healthcare intervention, but we are not making a good job of it: 30-50% not taken as intended 4-5% of hospital admissions due to preventable adverse effects of medicines 1bn prescription items dispensed each year – 2.7m items a day Annual cost = £15bn Mass medicating A different kind of prescription?

Pharmacy stats Over 11,500 pharmacies in England situated in high-street locations, in supermarkets and in residential neighbourhoods Independents (1-5 pharmacies) 38% Multiples (6+ pharmacies)62% Most pharmacies have at least one private consultation area

Use of Community Pharmacies 99% of the population – even those living in the most deprived areas – can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport An estimated 1.6 million visits take place daily, of which 1.2 million are for health-related reasons A community pharmacy is one of the core businesses which can make a difference between a viable high street and one that fails commercially – thereby sustaining communities and building social capital

84% of adults visit a pharmacy at least once a year, 78% for health-related reasons Adults in England visit on average 14 times a year Around 1 in 10 get health advice Majority (>75%) use same pharmacy all the time Those with LTCs or disabilities or living in rural areas are more likely to visit the same pharmacy Use of Community Pharmacies

Pharmacy staff Pharmacist Medicines Counter Assistants/Healthcare Assistants Dispensers Registered Pharmacy Technicians Delivery driver Health Champions

Essential services Dispensing Repeat Dispensing Support for self-care Signposting patients to other healthcare professionals Healthy Lifestyles service (Public health) Waste medication disposal Clinical governance

Advanced services 1.Medicines Use Review (MUR) and Prescription Intervention Service 2.Appliance Use Review 3.Stoma Appliance Customisation 4.New Medicine Service

Supporting people to self-care Self-care advice Self-limiting conditions Long-term conditions Sales of over the counter medicines Common ailment services

MUR service Face to face with patient, using structured questions An adherence centred review, which assesses patient’s issues with current medication and its use Patient’s knowledge of medication is developed, working with patients to develop Report of outomes and solutions to patient’s GP where necessary Simple solutions = big effect Frequent faller – night time meds in a morning + telephone wire

The story so far… 3m + MURs provided pa Evaluation of respiratory disease project: 40% of people with asthma showed better asthma control during the time studied 55% of COPD patients showed an improvement in symptom management Analysis of data on emergency asthma and COPD admissions showed a positive association between the introduction of the project and changes in emergency hospital admissions

It’s all about the patient getting the most from their newly prescribed medicine – information, understanding, engagement, choice Three stage process 1.Patient engagement (day 0) 2.Intervention (approx. day 14) 3.Follow up (approx. day 28) Follows the prescribing of a new medicine for: ₋Asthma or COPD ₋Diabetes (Type 2) ₋Antiplatelet / Anticoagulant therapy ₋Hypertension New Medicines Services

Locally Commissioned Services Minor ailments service Emergency Hormonal Contraception Care home service Stop smoking Needle & syringe exchange Monitored dosage systems

Locally Commissioned Services NHS Health Check Supervised consumption Contraception Chlamydia screening & treatment Other sexual health screening Palliative care

Locally Commissioned Services Vaccination (influenza etc.) Alcohol screening and brief interventions Weight management Falls reduction Independent and Supplementary prescribing

Wicker Pharmacy

Open late night every single day of the year since 1952 Was set up when independent owners in the city came together to fund a central late night pharmacy, to avoid having do unsocial hours themselves Now providing a wide range of pharmacy, medicines, health and wellbeing services - 15 on top of national contractual framework Excellent rating by the regulator, the GPhC Award wining Known for innovation and progressive services

Sheffield Sheffield is post industrial one of largest of cities in the North of England Sheffield is characterized by stark inequalities between different groups of people and between different geographical communities. People in the most deprived parts of the City still experience a greater burden of ill-health and early death than people in less deprived areas

Sheffield 8 mile road in Detroit 83 bus Location

Drug Treatment 450 patients 2000 needle exchange transactions and harm reduction advice per month Dedicated area for supervision of opiate substitution – more than just supply Monitoring of physical and mental health Multi-agency work – protect vulnerable adults, communities, drug workers Use of facilities – wound clinic, prescribing clinic User input – TV screen with presentation harm reduction. DVDs on recovery position overdose Codeine pilot – self help, referral in Pharmacist with a special interest Performance enhancing drugs clinic Recovery focus – engaging and retaining in treatment

Extended Hours Provided full pharmacy services everyday of the year – wrap around service Helping people to sort medicine related problems and self care calls per year from carers response to growing problem with need for medicines advice Emergency supplies -- partner with NHS111 urgent care helpline – rpt medication request acute issues, but helping to self manage First pharmacy to make proper use of Summary Care Record – testing the professional issues and IT connectivity. Wider proof of concept work by NHS England to inform national roll out

Supporting people to live independently Reablement services following discharge from hospital – quick to put packages of ‘care’ in place around medicines: rationalise medication Working with others for handover of pharmaceutical care Supply of daily living aids e.g Inhalers Identifying emerging problems with peoples’ health Signposting patients or their carers to additional support and resources related to their condition or situation In addition to support to optimise the use of medicines… Support with re-ordering repeat medicines / the NHS repeat dispensing service Home delivery of medicines to the housebound Solutions to help medicines adherence

Supporting people to live healthier lives Healthy Living Pharmacy concept Structured support team training for health and wellbeing advice Key services and advice delivered

Common Ailments Promotion Prevention Protection Early detection Diagnosis & Treatment Initial supply and support Ongoing adherence support PATIENT and PUBLIC Self care & Healthy lifestyle interventions Making Every Contact Count Medicines Optimisation

Supporting people to live healthier lives Stop Smoking support Alcohol screening and support NHS Health Checks Weight management services Emergency contraception / Contraception Chlamydia / Gonorrhoea / Hep B / HIV testing Immunisation – flu, travel health, HPV etc. Substance misuse – needle exchange and supervision of consumption of substitute medicines Early detection of cancer

Empowered Staff Majored on staff training and skill mix Comms – intranet, staff meetings, toilet doors Shared learning – e.g dispensing incidents Empowering staff to act in the best interests of patients A different way to do business - employee owned – 12% business owned by staff via an employee trust. Other staff own shares themeselves = over 60% business owned by employees – meaning those that work there take a real interest in the service that we provide Patients first. Safety first. SOPs last – overarching SOP Culture of continues review and learning Good old fashioned service – tea and coffee ?

Overaching principles Professional excellence – requisite for commercial success Dispensing of medicines at the very core of what we do – platform for sustainability to develop other services to add value Operating in a wider environment than pharmacy including health, social care, public health – or across all three! Look outside the door Using the whole team inside our building and out – maximize potential. Innovation is rarely driven by a solo genius - but collective genius

What should the future look like? Pharmacies must become a health place, which people use to keep healthy, avoid disease and risk factors, deal with minor episodes. They do so as part of a health system that is underpinned by communication and team-working, in which people are nudged towards using the right level of resource for their own needs. This cannot be a system rooted in traditional roles established long before developments in medical technology, communications, and treatments

Four domains of services Optimising the use of medicines Supporting people to self-care Supporting people to live independently Supporting people to live healthier lives/public health

The Third Pillar – supporting future NHS provision Community Pharmacy GP led primary care Hospitals Optimising the use of medicines Supporting people to self-care Supporting people to live healthier lives/public health Supporting people to live independently