Changes to prescribing – new people and new ways to access medicines Alaster Rutherford Head of Medicines Management Bristol North PCT

Old drugs in new clothing POM to P changes –Statins –Triptans –PPIs –Beta-blockers for anxiety –Orlistat –Oral contraceptives –Moderate/potent topical corticosteroids

Old drugs in new clothing Issues for PCTs –Impact on other services e.g.demand for GP consultations –Training and agreement of local protocols –Pharmacy-based minor ailments services – SLAs not PGDs? –Risk management Admissions clerking, patients own drugs in community hospitals –Core skills training for pharmacists – BP?

Minor ailments schemes Building on the best – Choice, Responsiveness and equity in the NHS 28 PCTs have commissioned pharmacist- led minor ailment schemes Patients exempt from Rx charges have their minor ailments managed by a community pharmacist and can have their medicines on the NHS. Enable patients to go to CP rather than their GP Improves access to NHS services overall..

Minor ailments schemes Patients welcome convenience Better use of pharmacists professional skills. Increase options through use of PGDs, e..g chloramphenicol for conjunctivitis. We would expect all primary care trusts to consider carefully targeted schemes to meet the needs of patients who would otherwise go to their doctor for a prescription.

Repeat dispensing New national scheme –not a pilot –Patients will be able to obtain repeat dispensing from a pharmacy without having to visit the GP each time to obtain a new prescription National target for all PCTs by end of 2004 Explicit milestone in Choice agenda Formalises pilot activities, such as Exminster project Formal separation of Medicine Act and NSH reimbursement system

Repeat dispensing -How does it work? GP issues a single 'Authorising' FP10 prescription form and the required number of 'Repeat' FP10 prescription forms. Patient presents ALL forms at an approved pharmacy. 'Repeat' form submitted to PPA for reimbursement. When all 'Repeat' forms dispensed, 'Authorising' form sent to the PPA for storage

Repeat dispensing -How does it work? Pharmacist will monitor the effectiveness of the course of treatment and regulate frequency of supply –Holidays –Drug changes –Side effects –Research base

Repeat dispensing Works on EMIS, Exeter, Synergy Premiere Software and hardware issues Practices need laser printers Start with easy patients – thyroid, hay fever, eczema Need for PCTs to making it happen

N3 and ETP by December 2007, the new national IT programme will mean patients using this new service will be able to pick up their medicines from any pharmacy in England

New prescribers Mode 1 and 2 prescribing –Original legislation to allow health visitors and district nurses to prescribe from limited list Extended prescribing for nurses –Allows independent prescribing from wider range of products, but still doesnt include all products –10 new categories –30 extra POMs –More to follow Supplementary prescribing

What is Supplementary prescribing? A voluntary prescribing partnership between the independent prescriber and a supplementary prescriber, to implement an agreed patient- specific Clinical Management Plan with the patients agreement.

Supplementary Prescribing - Who can do it? Nurses, midwives and pharmacists From 2005 –optometrists –some AHPs e.g. physios

Using Supplementary Prescribing in Practice Ongoing management of long-term conditions Asthma, diabetes, hypertension, mental health, obesity Management of out-patients HRT clinic, renal patients, Rheumatology, Parkinsons In-patient settings with predictable pathways Post-op pain, nausea in oncology, TPN

Supplementary Prescribing - Boundaries It is not proposed to restrict SRx to specific clinical conditions – the decision to introduce SRx arrangements for a specific patient will depend on agreement between independent and supplementary prescribers, and the patient, to implement an agreed clinical management plan for that patients condition. BNF – not CDs(at present) Unlicensed drugs (e.g. TPN -soon)

Benefits of Supplementary Prescribing Improved patient choice & access Key tool in service redesign –Supports changes needed following Working Time Directive, Junior Hospital Doctor hours, etc.. Greater flexibility for patient management Re-distribution of prescribing workload Improved job satisfaction for supplementary prescriber Formalises some vicarious prescribing that currently goes on

nGMS – can we do it differently? Medicines related targets –Influenza vaccination –Smoking cessation –BP, Cholesterol, Antiplatelets, ACE1, ß-blockers –HbA1c, Epilepsy –Medicines management specific targets

New Technologies Home INR monitoring –Can pharmacists train patients? Telephone monitoring of BP –Nuneaton pilot Mobile phone technology –Digital photos –Telephone reminders

NHS Digital TV will provide information, supported by useful images and video clips on: –NHS services (such as directories of GPs, dentists, pharmacies etc); –encyclopaedia of illnesses and conditions, tests, treatments and operations; –self-care advice on treating common health problems; –advice on healthy living; –hot topics on current health issues. will develop to offer other services such as ordering repeat prescriptions. on air during the summer of 2004 –will it change behaviour?

Challenges Communicating the agenda –Count pharmacy in Remodelling the workforce –Role of pharmacy technicians Pace of change –Seizing the initiative Practice pharmacists –Potential impact PCT support –CPD for new prescribers Incentives to practices –Development catalysts