1. Community Pharmacy Cheshire & Wirral (CPCW) Helen Murphy Chief Executive Officer Community Pharmacy Cheshire and Wirral

2. Community Pharmacy Cheshire & Wirral Medicines NHS England spends over £8 billion on medicines in primary care, and there is growing evidence that the use of medicines is not optimal. Medicines are the most common healthcare intervention, but: 30-50% are not taken as intended 4-5% of hospital admissions due to preventable adverse effects of medicines Every year around £300million of medicines are wasted of which £150million of this is avoidable.

3. Community Pharmacy Cheshire & Wirral The role of community Pharmacy in Managing Medicines Repeat Dispensing service. Medicines Use Review Service – (MUR) The New Medicines Service – (NMS) Disposal of unwanted medication Repeat ordering of medication. Pharmacies can provide medication in Monitored dosage systems

4. Community Pharmacy Cheshire & Wirral Repeat dispensing Service Different to regular repeat ordering from your Pharmacy or GP Service for patients who are on long term medication and have a stable condition. Patient will have a consultation with the GP and then be issued with prescriptions for a set period time. Usually 6 to 12 months The prescriptions are usually held by the pharmacist or can be electronic. Pharmacist must confirm if medication is required before issue.

5. Community Pharmacy Cheshire & Wirral MUR service An Accredited pharmacists will undertake a face to face review to find out how the patient is taking their medication using structure questions. It is designed to identify if patients understand what their medication is for and if they have any problems with current medication. Introduced 10 years ago, with over 3 million completed. Maximum of 400 per year per pharmacy

6. Community Pharmacy Cheshire & Wirral Any patient who is on two or more medicines and has visited the pharmacy for the last 3 months. 70% are provided to specific patients Patient taking medications classed as a higher risk for adverse events Patients with respiratory disease Patients at risk of or diagnosed with cardiovascular disease - on 4 or more medicines Patients recently discharged from hospital Who can have the Service

7. Community Pharmacy Cheshire & Wirral Patient has a discussion about all of their medication with the pharmacist in the consultation room. How do you take each medicine? Do you know what each medicine is for and why is has been prescribed ? How do you feel about the medication you are taking ? Do you have any difficulty taking the medication or are you experiencing any side effects ? When did you last forget to take one of your medicines? Is there one that you find difficult to remember to take ? Is there is anything that you would like to discuss in particular or ask about your medication? Advice regarding healthy lifestyle MUR Consultation

8. Community Pharmacy Cheshire & Wirral Patient not taking the medication at the optimum time A lady was taking metformin to treat her Type 2 diabetes. Her GP had been discussing adding an new medicine because her blood sugars were poorly controlled. The metformin tablet worked best if taken when she had her main meal. The lady thought she just had to take the tablet with food rather than her main meals and took her last tablet at night with a piece of toast. As a result she wouldn’t have been getting the benefit of the tablet helping to control her blood sugars after her main meal. Patient Experience 1

9. Community Pharmacy Cheshire & Wirral Patient unable to use medical device correctly A patient came in to the pharmacy and requested an emergency supply of a reliever inhaler. He had received an inhaler only a week earlier so the pharmacist completed a review of his medication. When the patient demonstrated how they were using the inhaler they were only putting the inhaler close to their mouth - not in it - so wasn’t getting much benefit. The pharmacist was able to show the patient how to use the inhaler so that it delivered the correct dose to their lungs and alleviated their symptoms. Patient Experience 2

10. Community Pharmacy Cheshire & Wirral Patients missing doses that impact on daily life A gentlemen regularly missed taking his diuretic ( water tablet ) on the days he went to play bowls in the morning. This is because it was difficult for him to access a toilet when he was out. The pharmacist advised that the tablet could be taken at lunch time when he returned home and he started to take his tablets on a regular basis. Patient Experience 3

11. Community Pharmacy Cheshire & Wirral MUR consultations in the patient’s home? Pharmacists currently have to ask for special permission from NHS England for each individual MUR that they wish to carry out in a patients home. As a result housebound patients, who are unable to come into the pharmacy to collect their medication, often miss out on this service. At the moment there is a pilot that has been carried out in the Warrington area with one GP practice. MUR Consultation

12. Community Pharmacy Cheshire & Wirral New Medicines Service (NMS) It’s all about helping patients to get the most from their newly prescribed medicine 10 days after starting a medicine, almost a third of patients aren’t taking it as prescribed of these 55% don’t realise they are not taking their medicines correctly 45% are intentionally non-adherent

13. Community Pharmacy Cheshire & Wirral Who can have the service ? Patient prescribed a new medicine that is used to treat certain long term conditions High blood pressure, Diabetes, Asthma, Chronic lung problems Or medicines that thin the blood How is the service delivered ? The service is split into three stages: Initial conversation and sign up to service 1st Intervention consultation – 7 days after medication prescribed Follow up consultation – 21 days after medication prescribed NMS

14. Community Pharmacy Cheshire & Wirral Consultations - face to face or over the phone Consultation is very similar to the Medicines use review Is the medicine being taken Is it taken at the correct time of day Any problems taking the medicine Any side effects What happens at the end of the service? The pharmacist will discuss recommendations with the patient. or they may with the patients consent send information regarding the consultation to their GP, they may refer the patient to their GP NMS Consultation

15. Community Pharmacy Cheshire & Wirral Advice about Minor ailments and over the counter medicines Pharmacy First campaigns Right Route Right Care Campaign Think Pharmacy Other Pharmacy Services

16. Community Pharmacy Cheshire & Wirral Disposal of unwanted medication Pharmacists can now vaccinate all patients who are eligible for a NHS flu vaccination, in addition to the patients GP surgery. Other Pharmacy Services

17. Community Pharmacy Cheshire & Wirral There are a number of services that community pharmacies provide to help people manage their medication more effectively. If your pharmacist offers you one of these services. Do please take up the offer. Summary