1. Tom Kallis, devon lpc tomk@devonlpc.org
Community Pharmacy
Tom Kallis, devon lpc

2. Agenda Introduction Community Pharmacy Overview
Technology: eRD and SCR
Compliance aids
ePACT insights
Formulary
Q & As

3. Key Statistics
GPs and A&E staff treat over 60 million patients annually for ailments such as a cold, blocked nose, back pain, insect bites
Recent estimates suggest that 5% and 13% of consultations in emergency departments and general practice, respectively, are for minor ailments that could be managed in community pharmacies.
Up to 18% of general practice workload is estimated to relate to minor ailments, at a cost of £2 billion annually.
89% of the population in England has access to a community pharmacy within a 20 minute walk
Putting the accessibility and capacity that pharmacy has into context in the national picture.

4. Essential Services
These are services that all community pharmacies provide
Core pillars of community pharmacy contract – every pharmacy with an NHS contract must offer these.
Focus on Promotion of Healthy Lifestyles, Self Care, Clinical Governance – these are lesser known elements of our NHS contract which other h/c professionals may not know about.

5. Self Care Coughs and Colds Constipation Diarrhoea Dry Skin and Rashes
Earwax
Hayfever and Allergies
Headaches
Emergency Contraception
Indigestion and Reflux
Sore Throats
Thrush
And Much More….
Pharmacies already provide a range of over the counter advice and treatment without patients having to go to their GP. It is thought that 18% of GP appointments could be managed by community pharmacy
Portfolio exhibiting what kinds of OTC queries we already deal with on a day to day basis over the counter – all of these could potentially represent an improved access appointment booked into a community pharmacy

6. MURS Medicines Use Reviews, an annual review of how patients use their medicines, addressing side effects and providing healthy lifestyle advice
NMS Supporting patients newly prescribed medicines for COPD, Asthma, High Blood pressure or Medicines for anticoagulation/platelet
NUMSAS Providing patients with emergency supplies of medications they have run out of (usually out of hours) following a 111 referral
Flu Vaccinations Vaccinating at risk groups and patients over 65 against influenza as part of the wider NHS flu programme
Advanced Services
These are services that most community pharmacies provide in an approved consultation room/area
NMS is commissioned specifically to support patients develop a good relationship with their new medicine and use it correctly. A large number of hospital admissions are patients with chronic illnesses with poor medicines adherence; MURs and NMS are commissioned to tackle this head on.
NUMSAS highlights the furthering integration of community pharmacy into the national agenda on urgent care.

7. Locally Commissioned Services
Emergency Hormonal Contraception
Chlamydia Screening
Supervised Consumption
Needle Exchange
Smoking Cessation
Electronic Transfer of Care from Hospital
Locally Commissioned Services
These services are commissioned locally according to population need and may differ from one geography to another. The services listed [R] are available for pharmacies to provide in North Devon.

8. Pharmacy First Services
Allows specially trained pharmacists to provide Prescription Only Medication via an NHS service in Devon for a range of conditions
Urinary Tract Infections
Bacterial Conjunctivitis (1 year olds)
Nappy Rash
Impetigo
These four conditions are key to be referred or booked in to a community pharmacy as part of the improved access appointments. Reception/Admin staff may not be aware we can give certain POMs/antibiotics out on PGD via pharmacy first, so good to highlight this. Even if practices only start with their uncomplicated UTIs, this can help with their overall capacity.

11. Highlighting what HLPs are, how they support the local public health agenda and fits in with the health needs of the community.

12. DMIRS
‘Digital Minor Illness Referral Service’ Allows patients to be directly referred digitally from NHS 111 into pilot pharmacy sites throughout Devon.
DMIRS – basically, IA referrals from 111 as opposed to GP practice. Demonstrates what community pharmacy can offer with regard to the wider urgent care agenda in assisting primary care capacity.
•Formal referral from NHS111 to Community Pharmacy
•DMIRS covers non-urgent, low acuity conditions (the types of conditions that pharmacies currently deal with regularly)
•The primary aim of the DMIRS is to increase capacity in the system and relieve pressure on existing urgent care services; delivering care closer to home in the community and promoting self care

13. Improving Access in North Devon
Two community pharmacies in Barnstaple are also involved in offering appointments out of normal surgery hours to support the improving access to GP surgeries… with more to possibly follow!

14. Primary Care Skills
Pharmacists involved in the Improving Access scheme in North Devon have undergone additional training in taking basic vital signs, respiratory examinations, ENT examinations and back/leg examinations to help identify red flags which may need further referral.

15. Technology
Community Pharmacies have shared NHS Mailboxes, which pharmacists and staff with NHS s can access to receive referrals for services and communicate securely with other healthcare professionals.
Pharmacists and Pharmacy Technicians can also view ‘Summary Care Records’ with patients’ consent, allowing them to view repeat medications and acutes issued in the last 12 months.
Secure communication via with community pharmacy is now a real option with NHSMail.
SCR access gives a top line view of a patients meds and conditions, which helps in OTC consulations

16. Electronic Repeat Dispensing (eRD)
Two thirds of prescriptions issued in primary care are repeat prescriptions (80% of NHS primary care meds spend)
330 million prescriptions (80% of all repeat medication issues) could eventually be replaced by eRD
eRD is a batch of electronic prescriptions issued by a prescriber for up to 12 months at a time
Pharmacy responsible for carrying out checks and regularly reviewing

18. eRD Contractual Questions
Have you seen a HC professional since your last script was dispensed?
Have you started any new medicines (Rx or OTC) since you last collected?
Do you have any problems with your medication or any new side effects?
Are there any items you don’t need this month?

22. eRD Case Study

24. Compliance aids Large Print Labels ‘Talking’ Labels Braille Labels
‘Blister’ Packs (Non-Reusable)
Apps
Tick Sheets
(Alarmed) Reusable Pill Boxes
Mechanical Aids

25. The Evidence
OP (Original Pack) dispensing preferred to MCA where there is no established need under the Equality Act 2010
OP dispensing as a mechanism to support independence and re-enablement
Patients who have medicines adherence issues should have a robust individual assessment (Which setting?)
Acknowledgement that there is no national multidisciplinary tool for assessing
Need for further evidence on use of MCAs on patient outcomes

26. Practical Considerations
NHS Terms of Service do not require dispensing into compliance aids or to dispense in instalments
No obligation under ToS or Equality Act 2010 to amend what has already dispensed midway through treatment
Ideally, dispensing into compliance aids should be because of an established need under the Equality Act 2010
28 day v 7 day prescribing – what does this mean?

28. Devon Formulary

30. Chapter 6 Reconnoitre Sulphonylureas Gliclazide Glimepiride Glipizide
Biguanides
Metformin
Metformin Modified Release (MR)(Sukkarto)
Alpha glucosidase inhibitors
Acarbose
Dipeptidylpeptidase-4 (DPP-4) inhibitors (Gliptins)
Alogliptin
Sitagliptin
Linagliptin
Sodium-glucose co-transporter 2 (SGLT2) Inhibitor
Canagliflozin
Dapagliflozin
Empagliflozin

31. Chapter 6 Reconnoitre
Glucagon-like peptide-1 receptor agonists (GLP-1 mimetics)
Lixisenatide
Dulaglutide
Exenatide
Liraglutide
Thiazolidinediones
Pioglitazone
Meglitinides
Repaglinide
 Guidelines for the management of hypoglycaemia for adults
Glucagon
GlucoGel®
Chronic hypoglycaemia
Diazoxide
Other equipment
Needle Clipping (Chopping) Device
Sharpsguard
Sharpsafe

32. Chapter 6 Reconnoitre Soluble insulin Actrapid® Humulin S®
Insuman® Rapid
Rapid-acting human insulin analogues
NovoRapid® (Pumpcart)
Humalog®
Apidra®
Fiasp®
Isophane insulin
Insuman® Basal
Insulatard®
Humulin I®
Biphasic insulins
Humulin® M3
Insuman Comb 25®
NovoMix30®
Humalog® Mix25
Humalog® Mix50

33. Chapter 6 Reconnoitre Long-acting analogues Insulin glargine
Abasaglar®
Lantus®
Toujeo®
Insulin detemir
Levemir®
Insulin degludec
Tresiba®
Hypurin® Porcine Isophane
Hypurin® Bovine Protamine Zinc
Hypurin® Porcine 30/70 Mix
Hypodermic equipment
Pen needles
BD Viva®
GlucoRx® Finepoint
Microdot Droplet®
Omnican Fine®

34. FreeStyle Libre

35. Any Questions?