1. Overview of Pharmacy Services Gail Caldwell Pharmacy Director June 2012

2. Where are pharmacy services? HOSPITAL SPECIALIST SERVICE E.G. SUBSTANCE MISUSE MEDICATION REVIEW IN GP PRACTICES COMMUNITY PHARMACY (CHEMIST

3. What do community pharmacists do? Known as chemists, like GPs part of NHS family 94% of the Scottish population visit a community pharmacy at least once a year Situated in heart of communities, open long hours therefore accessible health care professionals Traditional role, dispensing prescriptions written by doctors changing

4. Traditional Community Pharmacy

5. Modern Community Pharmacy

6. Community pharmacy contract Acute medication service (AMS), is the provision of pharmaceutical care by community pharmacists for acute episodes of care; Minor Ailment Service (MAS) allows patients exempt from prescription charges to access a range of medicines free of charge with supporting advice directly from their community pharmacy; Public Health Service (PHS) where pharmacists will provide information on public health issues, create public health window displays and participate in national and local public health campaigns and Chronic Medication Service (CMS) formalises the role of community pharmacist’s in the management of individual patients with Long Term Conditions in order to assist in improving patient’s understanding of their medicines & optimising the clinical benefits from their therapy. Locally negotiated services

7. The Brown Family

8. Grandfather (68 years old) Grandmother (66 years old) Father (42 years old) Mother (38 years old) Daughter (18 years old) Daughter (10 years old)

9. Mrs Brown Junior (aged 38) – Acute Medication Service (AMS) Regular medication of Lamictal AMS prescription for ciprofloxacin (antibiotic) to treat urinary tract infection Potential drug interaction – can lower seizure threshold Pharmacist contacts GP/discusses with patient, Lamictal for trigeminal neuralgia OK to dispense ciprofloxacin

10. Caroline Brown (aged 10) – Minor Ailment Service (MAS) Suffering from Head Lice Pharmacist consultation Recommends checking the rest of the family Pharmacist prescribes Hedrin Solution & Head Lice Comb Advice – no swimming, use solution as directed, comb hair daily

11. Samantha Brown (aged 18) – Public Health Service (PHS) Enquires about ‘morning after pill’ or emergency hormonal contraception (EHC) Consultation with pharmacist in private consultation room to assess suitability for EHC EHC prescribed Advice and information re Sexually Transmitted Infections-offered Chlamydia postal testing kits Signposting to other health care professionals for ongoing contraception Patient confidentiality

12. Mr Brown Junior (aged 42) – Public Health Service (PHS) Smoked since teenager – motivated to quit Pharmacy Smoking Cessation Service (part of Public Health Service) Pharmacist consultation – provides information, advice, monitoring, prescribes Nicotine Replacement Therapy (NRT) patches for 1 week Pharmacy team offer ongoing support and further supply of NRT

13. Mr Brown Senior (aged 68) – Chronic Medication Service (CMS) & Over- the-Counter (OTC) History of peptic ulcer Receives regular prescription for omeprazole 20mg daily Asks to buy ibuprofen 400mg for sore knee Pharmacist intervenes – recommends paracetamol instead Suitable for CMS registration

14. Where are pharmacy services? HOSPITAL SPECIALIST SERVICE E.G. SUBSTANCE MISUSE MEDICATION REVIEW IN GP PRACTICES COMMUNITY PHARMACY (CHEMIST

15. Mrs Brown Senior (aged 66) – Medication Review Clinic Attends the over 65 pharmacist medication review clinic Current repeat prescription: –Bendroflumethiazide 2.5mg one tablet in the morning –Fosamax 70mg one tablet each week on a Wednesday –Calcichew D3 one tablet twice a day –Co-codamol 30/500mg effervescent tablets – two tablets up to four times a day when needed for pain

16. Mrs Brown Senior (aged 66) – Medication Review Clinic Orders all her medicines regularly – remembers to take them as prescribed History of high blood pressure, osteoporosis in her spine (painful) and fell and broke her arm last year Concerned about her poorly controlled blood pressure Would prefer not to take any more medicines

17. Mrs Brown Senior (aged 66) – Medication Review Clinic Pharmacist discusses her individual medicines –Salt content of effervescent co- codamol tablets – recommends changing to non soluble preparation –Advice on correct administration of Fosamax – recommends changing to generic product –Recommends changing her calcium & vitamin D preparation to Adcal D3 which contains the recommended amount of vitamin D

18. Where are pharmacy services? HOSPITAL SPECIALIST SERVICE E.G. SUBSTANCE MISUSE MEDICATION REVIEW IN GP PRACTICES COMMUNITY PHARMACY (CHEMIST

19. Mr Brown Senior-admitted to hospital with chest pain Accurate medication history obtained by pharmacy team before seen by Consultant in admissions unit Regular medications prescribed Patient - using wife's co-codamol as paracetamol alone not effective - pharmacist advised medical staff to prescribe co-codamol instead of paracetamol Diagnosed with suspected heart attack

20. Mr Brown Senior-admitted to hospital with chest pain Patient commenced on –Blood thinning drug - clopidogrel –Cholesterol lowering agent - statin –ACE - Inhibitor –Beta blocker –GTN spray Clinical pharmacist advised of interaction between omeprazole and clopidogrel - potential to reduce effect of clopidogrel - lansoprazole given instead

21. Mr Brown Senior-admitted to hospital with chest pain Patient advised on changes to medication by pharmacist before discharge Counselled on use of GTN spray Advised that regular co-codamol could lead to constipation - prophylactic laxative prescribed Discharge prescription generated by pharmacist and sent electronically to pharmacy for dispensing by robot Discharge letter sent electronically to GP after 6 hours Pharmacy Care Plan report shared with community pharmacist on discharge to advise of changes to medications and outstanding issues

22. Where are pharmacy services? HOSPITAL SPECIALIST SERVICE E.G. SUBSTANCE MISUSE MEDICATION REVIEW IN GP PRACTICES COMMUNITY PHARMACY (CHEMIST

23. Samantha Brown’s boyfriend, Jimmy 22 yrs: substance misuse History of short opiate career, lost job and started injecting 6 months ago. Previously attended pharmacy for clean injecting equipment Pharmacist registered patient & provides advice on hygiene, safe injecting, safe sex, risks of Blood Borne Viruses (BBV) and disposal of equipment Pharmacist signposted to hepatology service for hep B vaccination and hep C testing Pharmacist referred to Signpost Recovery for overdose training and supplied naloxone Pharmacy team provide information on treatment services

24. Samantha Brown’s Boyfriend, Jimmy 22yrs:substance misuse New relationship and motivated to change injecting behaviour Recently engaged in treatment and prescribed methadone Pharmacist works in partnership with Addiction Recovery Service: discuss treatment agreement Daily supervision of methadone Offers advice and health pack as part of NHS Forth Valley oral hygiene initiative Pharmacist provides support during opiate substitution therapy

25. Conclusion Medicines can lead to significant health improvements but they need to be managed well so that patients get most benefit Pharmacy services key role Transformation from “product focused service” to clinical profession, caring for patients and the public

26. Medicines waste: NHS Forth Valley Estimate £2.2 million

27. Repeat prescriptions Only order the items you need Are there any items you no longer require? Speak to your GP or pharmacist Please don’t –order “just in case” –hoard –Ask for a new prescription until you have collected the full quantity from the pharmacy