Changes to prescribing – new people and new ways to access medicines

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

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

3. 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?

4. 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..

5. 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 targetedschemes to meet the needs of patients who would otherwise go to their doctor for a prescription.

6. 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

7. Repeat dispensing -How does it work? • GP issues a single 'Authorising' FP10 prescription form and the required number of 'Repeat' FP10 prescription forms. • Patient presentsALL 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

8. 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

9. 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”

10. 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

11. 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 doesn’t include all products • 10 new categories • 30 extra POMs • More to follow • Supplementary prescribing

12. 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 patient’s agreement”.

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

14. Using Supplementary Prescribing in Practice • Ongoing management of long-term conditionsAsthma, diabetes , hypertension, mental health, obesity • Management of out-patientsHRT clinic, renal patients, Rheumatology, Parkinson’s • In-patient settings with predictable pathways Post-op pain, nausea in oncology, TPN

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

16. 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

17. 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

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

19. 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?

20. 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