pharmacy first re-launch slides

19
Pharmacy First Patient Group Directions Update October 2020 Paul Humphriss, Medicines Optimisation Pharmacist, Devon CGG

Upload: others

Post on 05-Apr-2022

5 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Pharmacy First Re-Launch Slides

Pharmacy First Patient Group Directions

Update October 2020

Paul Humphriss, Medicines Optimisation Pharmacist, Devon CGG

Page 2: Pharmacy First Re-Launch Slides

Devon Pharmacy First Services

Due for relaunch on

Monday 2nd November 2020

Page 3: Pharmacy First Re-Launch Slides

Background and review of Pharmacy First PGDs

▪ Service Level Agreement – 2-year cycle: Review due by April 2020

▪ PGD Review – 2-year cycle: due by April 2021(Nitrofurantoin, Chloramphenicol,

Sodium Fusidate, Timodine). Timetabled to start late 2020 to ensure could be

completed by April 2021

▪ COVID-19 stalled SLA review in March 2020

▪ Pharmacy First Services suspended in March 2020

▪ Need to review PGDs prior to reintroduction to ‘future proof’ services

▪ Agreed to prioritise review of Nitrofurantoin PGD based on:

• PGD usage data across Devon and support relaunch

• Feedback from LPC and Community Pharmacists

• Requirement to align with PHE guidelines

• Eliminate urinalysis, reduce infection control concerns

• Consider remote PGD use (‘future proof’)

Page 4: Pharmacy First Re-Launch Slides

Process of review of Nitrofurantoin PGD review

▪ Review of existing PGD e.g. PHE evidence, PGD legislation,

Special Pharmacy Services website, other similar services

▪ Rewrite using resources and expert opinion

▪ Consultation of PGD draft – Devon wide Antimicrobial Steering

Group, LPC

▪ Consultation feedback review, PGD revision and agreement

▪ PGD panel presentation and approval

▪ PharmOutcome updating

▪ Sharing information / training

Page 5: Pharmacy First Re-Launch Slides

Nitrofurantoin PGD – what’s changed?

▪ Inclusion – principle change in the PGD

▪ Women aged 16 years and over and under 65 presenting with two or more of the

following symptoms:

• Dysuria

• New Nocturia

• Urine which is cloudy to the naked eye

▪ PHE referencehttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/

829721/Diagnosis_of_urinary_tract_infections_UTI_diagnostic_flowchart.pdf

▪ Eliminates urinalysis and allows remote use

▪ Where remote consultation is considered clinically appropriate, the Pharmacist must ensure that

an adequate clinical assessment can be conducted to positively identify the condition

▪ Remote SPS PGD reference https://www.sps.nhs.uk/articles/can-a-medicine-be-supplied-under-a-

pgd-in-the-absence-of-the-patient/

Page 6: Pharmacy First Re-Launch Slides

Nitrofurantoin PGD – what’s changed?

▪ Exclusion changes includes

• Women who have had 2 or more urinary tract infections within the past 6 months or more

than 3 during the previous 12 months (PHE)

• Expansion of definition of pyelonephritis and sepsis (PHE)

▪ Supply section:

• Supply and receipt of the medication to the patient must be made on the day of the PGD

consultation

▪ Advice section includes:

• Updated risks / symptoms associated with bladder cancer and menopause

• Provide PIL from the TARGET toolkit https://www.rcgp.org.uk/clinical-and-

research/resources/toolkits/amr/target-antibiotics-toolkit/uti-resource-suite.aspx

Page 7: Pharmacy First Re-Launch Slides

Relaunch and the future

▪ Pharmacy First planned to restart Monday 2nd November 2020

▪ PGDs for Chloramphenicol eye drops, Sodium fusidate cream and Timodine cream

are unchanged - not yet been considered for remote use

▪ GPs will be informed of relaunch

▪ Community Pharmacists invited to advise to GP colleagues when they are able to

reoffer the service

▪ PGD review for the remaining 3 Pharmacy First PGDs to commence in November

2020

• Consider inclusion of new CPPE Remote Consultations package as an educational

requirement https://www.cppe.ac.uk/programmes/l/consultrem-e-01

• Consider NICE guideline NG153 Impetigo: antimicrobial prescribing

• Consider implications of extending remote use of PGDs

Page 8: Pharmacy First Re-Launch Slides

Pharmacy First: Working with Primary Care PartnersTOM KALLIS

PROJECT PHARMACIST, DEVON LPC

TK DEVON LPC 2020

Page 9: Pharmacy First Re-Launch Slides

Patient Pathways

Pharmacy First builds capacity in the management of acute conditions in the health system

How do patients access Pharmacy First currently?

Push/Pull aspects of the service

Could you consider a referral pathway from your local practices?

Conversation at both a practice and a PCN level

TK DEVON LPC 2020

Page 10: Pharmacy First Re-Launch Slides

GP CPCSExample of established referral pathway

Pilot service in Devon across a handful of GP/Pharmacy sites across Devon

Direct referral from GP practice into a pharmacy consultation ‘CPCS style’

Via PharmRefer

For minor ailments, can encompass conditions not to be routinely prescribed for

TK DEVON LPC 2020

Page 11: Pharmacy First Re-Launch Slides

GP CPCS Patient Journey

TK DEVON LPC 2020

Patient contacts GP

Patient is assessed and low acuity condition (see following page for

list) identified for potential referral

Patient advised that a referral to the local community pharmacist

who will contact them today about their condition

With patient consent, pharmacy is selected and referral sent via

PharmRefer

The patient is advised that the pharmacist will contact them by phone in the first instance. They

may need to attend the pharmacy for a further consultation if

necessary

Patient has consultation with Pharmacist & is given appropriate

advice around self-care and prevention. Patient possibly

directed to medicines which will help their condition, or have

referral escalated

Page 12: Pharmacy First Re-Launch Slides

GP to Pharmacy Referral sheetE X C L U S I O N C R I T E R I A : P R E G N A N T W O M E N , C H I L D R E N < 1 Y E A R

CONDITIONS What conditions are SUITABLE for referral to pharmacists? Do Not refer in these circumstances

BITES / STINGS • Cold Sores

Coughs• Flu-like symptoms • Sore throat • Drowsy/fever

Fast heart rate• Swelling or cramps

Red, inflamed or hot to touch

COLDS • Cold Sores

Coughs• Flu-like symptoms • Sore throat • Lasted +3 weeks • Unable to swallow

CONGESTION • Blocked or runny nose • Constant need to clear

their throat• Excess mucus • Lasted +3 weeks • 1 side obstruction or facial swelling

EYE • Conjunctivitis

Eye,red or irritable• Eye, sticky

Eyelid problems• Watery / runny eyes • Severe pain

Reduced vision• Light sensitivity

GENERAL • Constipation

Diarrhoea• Sleep difficulties

Tiredness• Vomiting or nausea • Severe / on going • Blood loss

Weight loss

FAILED

CONTRACEPTION• Morning after pill • Known or suspected

pregnancy• Under 13

PAIN • Acute pain

Ankle or foot pain

Haemorrhoids/Piles

Headache

Heatburn or indigestion

Hip pain or swelling

Infant colic

• Knee or lower leg pain

Lower back pain

Lower limb pain

Mouth ulcers

Rectal pain

Shoulder pain

Sore throat

• Sprains and strains

Teething

Thigh or buttock pain

Toothache

Wrist, hand or finger pain

• Condition described as

severe or urgent

Conditions have been on going

for +3 weeks

• Pharmacy treatment not worked

SKIN • Acne, spots and pimples

Athlete’s Foot

Blisters on foot

Cold sores

Dermatitis

• Dry skin

Hair loss

Hayfever

Mouth ulcers

Nappy rash

Oral thrush

• Rash – allergic

reaction

Scabies

Skin dressings

Skin rash

Wound problems

• Condition described as

severe or urgent

Conditions have been on going

for +3 weeks

• Pharmacy treatment not worked

Bites

Nappy rash over 3 years old or children already

using a prescribed nappy rash cream

SORE THROAT • Adults and children over

12 months• Flu-like symptoms • Hoarseness • Lasted +3 weeks

Voice change• Unable to swallow

SWELLING • Ankle or foot swelling

Lower limb swelling• Thigh or buttock swelling

Toe pain or swelling• Wrist, hand or finger

swelling• Condition described as

severe or urgent• Pharmacy treatment not worked

GYNAE THRUSH • Vaginal discharge• Vaginal itch or soreness • Diabetic/Pregnant

Under 16/over 60• Pharmacy treatment not worked

TK DEVON LPC 2020

Page 13: Pharmacy First Re-Launch Slides

But what does this mean for me and my pharmacy?

TK DEVON LPC 2020

Page 14: Pharmacy First Re-Launch Slides

Consider…

What next steps might you take for your pharmacy and these PGDs linking in with local practices?

-Local conversations on a practice by practice basis

-Linking in with pharmacy PCN lead

-What capacity might you have?

-Ad hoc referrals?

-When does your business have best capacity?

TK DEVON LPC 2020

Page 15: Pharmacy First Re-Launch Slides

TK DEVON LPC 2020

Page 16: Pharmacy First Re-Launch Slides

TK DEVON LPC 2020

Page 17: Pharmacy First Re-Launch Slides

PCN Mandate to collaborate with Community Pharmacies

5.7.1. A PCN must agree with local community services providers, mental health providers and community pharmacy providers how they will work together

5.7.4. A PCN must detail its arrangements with community mental health providers, and community pharmacy (via the community pharmacy nominated Pharmacy PCN Lead) in Schedule 7 of the Network Agreement by 31 March 2021.

Also a role for community pharmacy in the SMR DES spec…

TK DEVON LPC 2020

Page 18: Pharmacy First Re-Launch Slides

SMR Service Requirements

Identification of Patients

Prioritisation and Capacity

Invitations

Qualifications and Training

Recording of SMRs on GP IT Systems

Collaboration on Meds Optimisation

New Medicines Service

TK DEVON LPC 2020

Page 19: Pharmacy First Re-Launch Slides

Summary of Key Points

Opportunity for Push and Pull pathways into Pharmacy First

Local conversations at Practice Level

PCN lead conversations

Resources available with exclusion criteria

Several areas of collaboration, including in PCN specification

Support available via Devon LPC