Supplementary Prescribing in Practice 26 September 2005

1. Supplementary Prescribingin Practice26 September 2005 Mr. Mahesh Sodha, M.Sc. F.R.Pharm.S. Community Pharmacist and Member of Professional Executive committee and Board Chelmsford PCT

2. Mahesh Sodha • Community Pharmacist with an extensive experience of both secondary and primary care. A generalist with a special interest in Oncology, Palliative Care, Urology and Diabetes. Worked as a Practice Research Pharmacist and as a Primary Care Cancer Lead for Harlow and Epping Forest PCTs • Member of the Executive Committee and Board of Chelmsford PCT and works as a GP Practice Pharmacist

3. Setting • 6 partner GP Practice – 2 branches in Chelmsford - 2 sessions per week • Qualified Summer 2004 • Started 1st surgery in September 04 and currently manage some 70 to 80 patients • One generic CMP agreed by all GPs • Electronic CMP on IT system – approval • IT link in Pharmacy with GP system

4. Supplementary Prescribing • In theory – Implementation of a Clinical Management Plan • In Practice – Doctors do not warm up to CMPs – Hence one generic CMP • My CMP: Conditions: BNF Class: Type ll diabetes 6.1 Hypertension 2.2,2.4,2.5,2.6, Dyslipidaemia 2.11 and 2.12

5. Case Study 1st Patient

6. Evaluation • Patient Satisfaction Questionnaire 28 out of 32 returned • PACT data to look at prescribing trends • Evaluation and feed back from a consultant diabetologist

7. What do the patients think? My overall satisfaction with this visit to the pharmacist

8. What did the patients think My confidence in the ability of this pharmacist

9. What did the patients think The recommendation I would give to my friends about this pharmacist would be… Excellent

10. What do the GPs think? My Mentor and other GP Comments: • Increased patient access and choice • Efficient use of skill mix in Primary care • Significant contribution to high QOF practice achievement • This successful model can be disseminated to other practices and other areas of clinical management.

11. Hurdles/Challenges • Selling the idea to the PCT and obtain some funding for training • Locum expenses to get protected time for study was not possible • Personal effort to study a course that is non-scientific (cf to Pharmacy) • The biggest obstacle even today is the funding to run the actual clinical sessions – who pays?

12. Worth It – WHY? • Patient benefits • Longer unrushed appointments • Thorough counselling • Full monitoring • Holistic treatment • Satisfaction survey • GP work load – can concentrate on tackling complex cases requiring high clinical skills and for which they are trained • Good use of skill mix

13. Some Minor Problems • Computer generated prescriptions and Signing repeats • Prescribing for minor ailments – independent prescribing? • Where should the funding for the pharmacists come from? They are independent contractors like GPs

14. Next Steps • Develop further skills and initiate type II diabetes patients on insulin and monitor them • Provision of services to other GPs • Development of CMPs in other areas of care e.g. Chronic Pain • Extend to independent prescribing particularly in the area of minor ailments.

21. Successful Prescriber • A clear focus on exactly how, when and where you want to practice. • Have good clinical practice skills. • Have the support of the key people in your local Primary Care Trust • Have the respect and support of clinicians whom you want to work with (independent prescribers) • Above all, enthusiasm and motivation to pursue this ambition to manage patients in a clinical practice. NEEDS: not only good therapeutic skills but also excellent consultation skills, which focus on psycho- social aspects of disease management. • NOT ROCKET SCIENCE

22. Thank You