The Pharmacist’s role
In the delivery of Diabetes care
And the NSF
Irene Gummerson
Pharmacist with a Special Interest in Diabetes
Member of the Diabetes UK Advisory Council
Drivers for Change
Government:
– Wants better value
‘Pharmacists under-used’
– ‘Choice, access, responsiveness & equity’
NHS Pharmacy Plan
Choosing Health through Pharmacy
Vision for Pharmacy
New Contract
Other national & local policy documents
Drivers for Change
(Contd)
Profession bodies
RPSGB, PSNC, NPA
Other Professions
Diabetes UK
Pharmacy Diabetes Network
Pharmacists
Hospital, Community, PCT, GP practice
PhwSIs
National Service Framework
(NSF for Diabetes)
Standards for Diabetes Services (2001)
Std.1
Prevention of Type 2 diabetes
Std.2
Early Identification (Screening)
Std.3
Empowerment
Std.4/5/6 Clinical care of adults/ children
Std.7
Management of diabetes emergencies
Std.8
Care during admission to hospital
Std.9
Pregnancy
Stds.
10/11/12 Detection/management of L.T. complications
NSF Delivery Strategy
To achieve the Standards by 2013:
Clinical diabetes networks
Workforce planning & development
PCTs to assess training needs
(2003)
NSF - Standard 1
Reducing Risk Of Type 2
Health Promotion
– raising awareness of benefits
Primary and secondary care
Posters/ Leaflets
Verbally
Opportunistic/ Reactive
Medicines review, MUR
NSF - Std 1
Reducing Risk Of Type 2
Health Promotion
– Healthy eating
– Increasing physical activity
– Stopping smoking
Be organised
Have the ‘tools’ ready
New Contract & Std.1
Reducing Risk Of Type 2
Essential Services
Public Health: health promotion
– 6 campaigns
Signposting
Enhanced Services
Weight management clinic
NSF - Standard 2
Early Identification
‘When community pharmacists….. see
people with symptoms suggestive of
diabetes,
they should advise them to see their GP
for diagnostic testing’
NSF - Standard 2
Early Identification
‘..there is currently uncertainty as to what
is the best way to identify people with
undiagnosed asymptomatic Type 2
diabetes..’
‘..targeted..’
‘..combined with CVD.’
NSF - Standard 2
Early Identification
RPSGB guidance
– Essential Practice
Monitoring OTC sales – support staff
New Contract
– Enhanced service
Diabetes screening
NSF - Standard 3
Empowering
Education, motivation & advice
All pharmacists in contact with patients
National resources
Hand held cards
Medicines Partnership
Ask about Medicines Week
RPSGB guidance
– check understanding
– extended/ reinforce information
Diabetes care, medication
NSF - Standards 4,5,6
Clinical care of adults/ children
RPSGB - first script
– Essential Practice
Check they have diabetes
Dosage regime, DIs, CIs etc
Diabetes UK membership
– Desirable Practice
Pro-actively - answer questions & concerns
NSF: Standards 4,5,6
Clinical Care of adults/ children
RPSGB - repeat script
– Essential Practice
Anomalies, side effects, concordance
– Desirable practice
Remind, clarify, educate
NSF: Standards 4,5,6
Clinical Care (contd)
LPS
New Contract
– Advanced Services
Medicines Use Reviews (MURs)
Interventions
NSF: Standards 4,5,6
Clinical Care (contd)
New Contract
– Enhanced Services
Medicines reviews - medical records/ or not
– Pharmacy, care homes, domiciliary settings
– Not just target diabetes
Supplementary prescribing
– BP, tests
– bloods by pharmacist, nurse, phlebotomist
NSF for Diabetes
‘Delivery Strategy’
‘pharmacists are a regular point of contact
for people with diabetes and can play a
central role in improved medicines
management’.
– recognition of the pharmacist’s role
Medicines Management
Monitoring
BP, BMI, U & Es, lipids, HbA1c
Diabetes/CVD medicines optimised
Guardian medicines eg aspirin
Other medicines?
Side effects, concordance
NSF - Standard 7
Management of diabetes emergencies
Sick day rules
Carrying identification
Early recognition
Hypo-, hyper-glycaemia
Patients, carers, pharmacists, pharmacy staff
Know what to do
– E.g. hypoLucozade/ Dextrosol followed by a sandwich
NSF - Standard 8
Hospital Care
Be alert to diabetes cases on non-diabetic
wards
Inexperienced staff
Pharmacist-led clinics
Pharmacist input into protocols/ guidelines
DKA, hypoglycaemia, ward insulin policies, care
plans
Research/ audit work
NSF - Standard 9
Pregnancy
Planning Pregnancy
– medication review
– folic Acid; stop smoking; tight BG control
During Pregnancy
– checking for problems/ referring
– ketone testing strips
NSF - Standards 10,11,12
Reducing the Complications
Early detection, investigation &
treatment
Good clinical care & concordance
– Glycaemia & Blood Pressure
Encouraging attendance at clinic
appointments
NSF - Standards 10,11,12
(contd)
Retinopathy
Large labels (Essential Service)
Lower Limb
Foot care advice
OTC sales
Nephropathy
Check for renal impairment
Drugs to avoid or reduce dose
Smoking Cessation
Relevant to:
Management of L.T complications
– (Standards 10,11,12)
Many government documents
RPSGB - Desirable Practice
New Contract – Enhanced Service
Smoking Cessation Clinic
NSF – Standard 11
Reducing Complications - CVD
RPSGB
Guidance on testing (MEP)
New Contract
– Enhanced Service
Questionnaire risk assessment,
Blood pressure, lipid monitoring, BMI, waist
measurement
Referral
MURs, Medicines reviews – identify cases
Pharmacist’s role
in the delivery of Diabetes Care?
Expanding
– Increasing opportunities
– Challenging
The New Contract & RPSGB guidance
– Guide implementing Diabetes NSF
Pharmacy Diabetes Network
Sharing experience
–
–
–
–
All sectors
Pharmacists & pharmacy technicians
Strengthening pharmacy’s role in diabetes care
Document Consultation group
– pharmacydiabetesnetwork-subscribe @smartgroups.com