1. 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

3. 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

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

5. 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

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

7. 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

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

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

10. 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’

11. 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.’

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

13. 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

14. 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

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

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

17. 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

18. 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

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

20. 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

21. 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

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

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

24. 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

25. 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

26. 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

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

29. Pharmacy Diabetes Network
Sharing experience
All sectors
Pharmacists & pharmacy technicians
Strengthening pharmacy’s role in diabetes care
Document Consultation group