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Electronicjuice Vol 264 No 7094p651
April 29, 2000 The Society

Welsh Executive

Chairman backs medicines management

The case for pharmacists to offer a medicines management service was made by Mr Colin Ranshaw (chairman of the Welsh Executive of the Royal Electronicjuice) on April 18.
Speaking at the executive's annual dinner, Mr Ranshaw said that no-one currently had responsibility for managing the patient's medication and helping him or her to use it efficiently. No-one had the task of evaluating the patient's progress with a medicine, to decide whether it was the best treatment for a particular condition and to advise if the dose was correct. And there was no-one to talk to the patient on a regular basis about the problems he or she was having in taking their medicines.
Pharmacists operating a medicines management service were the right people to fill the gap, Mr Ranshaw told dinner guests, among whom were representatives of patients' self-help organisations such as the Parkinson's Disease Society and the British Diabetic Association.
Mr Ranshaw said that in hospitals, and increasingly in the community, pharmacists worked with doctors and nurses as part of the team providing patient care, their role being to provide the expertise on medicines. They also developed protocols, revised medicines formularies, ensured value for money from the drugs budget and tried to make sure that patients' medication was monitored and adjusted as patients were admitted and discharged from hospital. Patients received medical care from doctors, and nursing care on the wards and in the community. In the same way patients wanted complete pharmaceutical care from pharmacists.

Colin Ranshaw
Colin Ranshaw: no one responsible for managing patients' medicines

Best kept secret

Opening his address, Mr Ranshaw said that pharmacists were the best kept secret of the NHS. All too often, when new services were being discussed, or new ways of delivering existing services were proposed, no-one remembered the pharmacist. All the discussion seemed to focus on the doctors and nurses, and yet there were as many community pharmacists in Wales as there were GPs. Pharmacists were an underused resource. About £1 in every £8 spent on the NHS went on medicines. For many patients, medicines were the only treatment option. But individual medicines could be harmful if not properly prescribed, dispensed and used. Patients needed help and advice and their use of medicines monitored over time in relation to their symptoms. In many cases, pharmacists (working with GPs) were the best placed to do this.
Mr Ranshaw said that pharmacists managing patients' medicines would help reduce the waste generated by unnecessary repeats.
One of the great strengths of community pharmacy was that it offered choice. Each pharmacist sought to provide what the local population wanted but if he or she failed to do so people could take their custom elsewhere. So, arguably, community pharmacists were the most responsive of health care professionals to patients' preferences.
The current work of the Prescribing Task and Finish Group, which had been set up by the Welsh Assembly to report on prescribing and provision of pharmaceutical services and the supply of pharmaceuticals, was an opportunity to review services from the patient's perspective. Pharmacists helping patients manage their medicines would deliver quality pharmaceutical care which would meet the needs of each individual patient.
So far as patient self-help groups were concerned, they needed to identify with pharmacists how the latters' unique skills and attributes could be made to work harder for patients. There could, for example, be more services specifically for older people. Inappropriate medicines use in the elderly caused ill health. The pharmacist could help.
They could also have a role in palliative care. A pilot trial had started in Newport, Gwent. Five pharmacies were each taking it in turns to be on call for a week to supply medication in emergencies to terminally ill patients at home. The service was being funded for a year by the local health group's primary care development fund. If successful, the project might continue and be extended elsewhere.
And those with long-term, chronic conditions like coronary heart disease, mental health problems, or diabetes or asthma, could choose to have their medicines use or blood glucose levels assessed in pharmacies, if that was more convenient to them.
Mr Ranshaw declared: "With appropriate treatment and referral protocols, and sharing of relevant medical records, experience elsewhere has shown that everyone gains: the patient has a more convenient, equally high quality service; the NHS saves money and resources; and pharmacists gain job satisfaction."
Concluding, Mr Ranshaw said that pharmacy was ready and willing to contribute to improved patient care.

Unsung heroes

Responding, Mrs Vanessa Bourne (chairman of the Patients Association) congratulated the executive on its choice of guests. Each person present was representative of the unsung heroes and heroines of the NHS - the voluntary organisation without whom the NHS would collapse. If there was one thing that they needed to do, it was to make sure that carers got a much better deal than they did currently.
Ms Bourne said that working voluntarily was difficult to do. One problem was that it only seemed to be possible after the age of 50 or so. Steps should be taken to allow younger people to carry out voluntary work.
She was, she said, pleased that former NHS professionals were moving into the voluntary sector. They would not be intimidated by what other professionals still in the service told them.
Turning to the world of pharmaceuticals, Mrs Bourne noted that drugs did not always enjoy good publicity, being criticised for cost and other reasons. However, if patients were asked about advances in health care, most of them would say something to do with drugs, whether the field was mental health or reduction in time in hospital. She could not see why something that was essential and valued by patients should have such appalling public relations.
On pharmacies, she said that the pharmacy door was the only one that people went through in the NHS where they could be confident that something nasty would not happen to them. That could not be said of general practitioners or dentists. And she had never met an arrogant or pompous pharmacist. That was because the patient could always go elsewhere.
Mrs Bourne said that not enough use was made of the possibility of the pharmacy being used as a source of general health information. Pharmacists could, for instance, tell members of the public when their local health group was meeting and how they could get in touch with it.
On the Welsh Assembly, Mrs Bourne said that it seemed to be missing many opportunities. It did not seem to be doing what the organisations present at the dinner thought that it would. Like the Mars Polar Lander, everyone knew it was there but it did not seem to be sending any signals back.

Vanessa Bourne
Vanessa Bourne: pharmacies not used enough as information source

Citation: Electronicjuice URI: 20001362

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