Implementing Supplementary Prescribing for Pharmacists

1
Implementing Supplementary Prescribing for
Pharmacists

• Beth Taylor
• Principal Pharmacist, Community Care, London
  Specialist Pharmacy Services
• beth.taylor_at_southwarkpct.nhs.uk

2
Implementing supplementary prescribing for
pharmacists

• The context
• The London support teams activity
• Identifying candidates
• Training preparation
• Putting prescribing in practice
• Issues for practitioners
• Issues for organisations
• Things that we still need to work on..
• Next steps

London Specialist Pharmacy Services
3
The context for supplementary prescribing by
pharmacists

• Experience to date with nurse prescribing
• Wider context for developments in prescribing
  patient group directions, medicines management
• Political context access to medicines,
  developing the workforce
• New PCTs lack of infrastructure and other
  priorities

London Specialist Pharmacy Services
4
London Supplementary Prescribing Support team

• Successful bid to Lead WDC for London
• Initially 1 year, probably extended for 3
• Aim to support implementation of SPP in London
  for all sectors (secondary, primary and community
  pharmacy)
• Led by and integrated with London Specialist
  Pharmacy services (Community Care, Clinical
  Pharmacy, Education and Training)
• Parallels sector nurse or NMP leads
  (but no London-wide nurse lead)

London Specialist Pharmacy Services
5
London Supplementary Prescribing Support Team

• Strategic lead Jane. Nicholls_at_nwlh.nhs.uk
• Tel [phone]
• Secondary care lead Jatinder.Harchowal_at_bartsandt
  helondon.nhs.uk
• Tel [phone] pager number 857440
• Primary care lead Nuttan.Tanna_at_harrowpct.nhs.uk
• Tel [phone]
• Appointing in 2004 Community pharmacy lead
• Briefings on www.druginfozone.nhs.uk under
  extending prescribing
• Plus London Specialists David Webb, Beth
  Taylor, Susan Sanders

London Specialist Pharmacy Services
6
Tasks we identified

• Communication generally
• Infrastructure and systems for SPP
• Identifying candidates
• Working with HEIs and WDCs
• Application process
• Medical support
• Clinical models for SPP and CMPs
• Ongoing support and CPD for prescribers

London Specialist Pharmacy Services
7
Identifying candidates

• Awareness of what SPP is, and other options
• Networking with specialist groups (clinical
  pharmacy, mental health, paediatrics, HIV etc)
• Working with Trust and PCT pharmacy leads
• The application process

London Specialist Pharmacy Services
8
Training preparation

• Supporting HEI staff
• Contributing to curriculum development
• Disseminating information on available options-
• Course length 3 or 6 months
• Course structure
• Uni- or multidisciplinary learning
• Face to face teaching vs CAL and distance
  learning
• Location
• Additional skills courses eg physical examination
• Supporting candidates before and during training
• Support for referred candidates?

London Specialist Pharmacy Services
9
Putting SPP into practice- issues for
practitioners

• Practicalities of CMPs
• Drafts on www.druginfozone.nhs.uk
• Can be worked up by peer support groups
• Working arrangements
• Referrals
• With doctors/nurses also in team
• Ordering tests etc
• Relationship with patients
• Shift to more holistic role in care
• Relationship with other pharmacists

London Specialist Pharmacy Services
10
Putting SPP into practice Issues for
organisations

• Infrastructure needs to be put in place NOW!
• Includes clinical governance issues, policies,
  amendments to job descriptions
• See chart for PCTs http//www.druginfozone.nhs.uk/
  Record20Viewing/viewRecord.aspx?id524078
• See guide for secondary care at
  www.druginfozone.nhs.uk

London Specialist Pharmacy Services
11
Results so far in London

• 33 pharmacists started training Sept 03
• 23 pharmacists expected to start in Feb 04
• HEIs offering SPP courses in 2004
• Kings College
• London Metropolitan
• South Bank (subject to accreditation)
• In South Brighton, Canterbury,
  Southampton/Portsmouth (subject to accreditation)
• Support project extended for 2 years

London Specialist Pharmacy Services
12
Clinical areas for first wave SPP candidates

• Cardiology
• heart failure
• Transplantation
• Hypertension
• Cancer
• chemotherapy
• supportive therapy
• Practice support
• osteoporosis
• diabetes
• CHD
• Dyspepsia
• Older people
• Adult ICU
• Prison service

• Mental health
• Lithium clinics
• Renal
• Anaemia
• Hypertension
• Bone disease
• Nutrition
• TPN
• Anticoagulation
• Warfarin
• HIV
• antiretrovirals
• supportive therapy

London Specialist Pharmacy Services
13
Things that we still need to work on..

• Practitioners generally
• Understanding what SPP really is and how it will
  benefit their patients
• There are people on courses who may not be able
  to prescribe because this, and PGDs, are still
  not widely understood
• Doctors
• SP should be promoted to doctors at national as
  well as local level
• Practical models for SPP, especially for
  community pharmacists
• Illustrating early examples eg using videos
• How to incorporate SPP into medication review
  activity

London Specialist Pharmacy Services
14
What do we still need to work on?

• What is prescribing?
• Unsuitable areas anticoagulation, discharge
  prescriptions, surgery
• A Specialist role?
• Unlicensed products / CDs
• Success of designated medical practitioners
• IP SP partnership?
• Supporting community pharmacists to develop
  models
• How does the CMP work?
• Ensuring the SPs prescribe - if not, why not?
• Provision of training where how
• Views from patients, medical, nursing, other
  health care professionals

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Next steps

• 2004 workplan
• Focus on practical implementation
• Infrastructure
• Practitioner support
• More work to support community pharmacists and
  their PCTs
• Work with doctors
• Awareness and understanding of options for
  prescribing and supplying medicines

London Specialist Pharmacy Services