February 2014
The Carer-Friendly Pharmacy Project
The Carer-friendly Pharmacy Project, led by Carers Trust and the Pharmaceutical Services Negotiating Committee, is part of a programme of work funded by the
Department of Health and forms part of the ‘Supporting Carers in General Practice Programme’ involving Carers Trust, the Royal College of GPs and Carers UK. The
aim of the Programme is to increase the identification and support of unpaid carers within primary care and community settings so that carers receive support before
they reach crisis point.
What do we want to achieve?
Over recent years a number of carer-identification initiatives have been developed that have involved community pharmacies and local carers support organisations
such as Carers Trust’s network partners. These have made use of the accessibility of community pharmacies, the frequency with which many carers visit their local
pharmacy and the supportive and professional relationship many carers already have with their community pharmacy team.
Carers Trust and the Pharmaceutical Services Negotiating Committee (PSNC) would like to see whether this local activity could be developed and replicated in
other areas of the country, where local pharmacies, Local Pharmaceutical Committees (LPCs) and carers centres and schemes are willing to collaborate in
identifying, referring and supporting carers.
In designing the proposal we have involved a wide range of stakeholders and maintained their involvement on an ongoing basis to enable us to produce a proposal
that is realistic, achievable, measurable and outcome-focused. We have been particularly mindful of the competing demands on participants’ time and resources, as
well as the barriers carers may face in accessing support. Our aim is to ensure that the model we test dovetails with the ethos and practice of the organisations
involved, the people delivering services on the front line such as staff from carers services, pharmacies and GP practices and the patients and carers in receipt of
services. In particular, by replacing or reducing the use of time-consuming paper-based referral forms and recording mechanisms with a PharmOutcomes1 tool, it is
our intention to reduce the time currently spent on the referral process from both the carer’s perspective and that of the pharmacy team while simultaneously
providing an impeccable audit trail and clear outcome measures.
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A web-based system which helps community pharmacies provide services more effectively and makes it easier for commissioners to audit and manage these services. By collating
information on pharmacy services it allows local and national level analysis and reporting on the effectiveness of commissioned services, helping to improve the evidence base for
community pharmacy services.
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What is a Carer Friendly Pharmacy?
The project will test the concept of a ‘Carer-Friendly Pharmacy’, which pharmacies participating in the project will seek to become. We propose to define a Carer
Friendly Pharmacy as one where:
1. all staff are trained to be carer aware, sensitive to carers’ needs and the challenges they face and have developed enhanced communications skills to enable
them to engage effectively with carers;
2. all staff are pro-active in identifying, referring and supporting carers;
3. the pharmacy identifies a member of the team who takes on the role of Carers Champion along with a deputy (see appendix 1). Their role is to lead and
facilitate carer referrals, act as a contact point for external agencies such as the local carers centre and GP practices to support a multi-disciplinary approach
and to maintain stocks of resources;
4. posters and/or other related materials make it clear to the customer that the pharmacy is carer-friendly and encourage them to self-identify; NB. It is
acknowledged that displaying materials will be easier in larger pharmacies and Healthy Living Pharmacies where there is a dedicated notice board to display
such information;
5. there are agreed carer pathways in place, including those associated with the services the pharmacy offers such as Medicines Use Reviews and prescription
collection and delivery. Using these carer pathways, the pharmacy will be able to offer a range of existing services to carers in a manner that is relevant to
the carer;
6. where participating pharmacies can provide additional services to carers, whether as a result of being commissioned locally to do so or by pharmacies
providing the service in order to demonstrate ‘proof of concept’ these will be promoted to carers as well;
7. with the carer’s consent, the pharmacy will refer the carer to their local carers services;
8. there are agreed pathways in place to refer the carer from the pharmacy to their GP practice and - within the pharmacy – a pathway to services that could
support carers to enjoy improved health and well-being and improve their ability to care; and
9. the pharmacy follows agreed procedures to obtain the consent of the carer and, where relevant, the consent of the person they care for, where referrals
are being made or where the carer is going to be present while the person with care needs is having a Medicines Use Review or other pharmacy provided
service.
The core model could, in some localities, be augmented by add-ons such as pharmacy delivery driver engagement with carers, pharmacy-based carers’ health checks
and free flu vaccinations for carers where the pharmacy has been commissioned to do so or where the pharmacy agrees to provide such services free of charge as a
proof of concept trial2.
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In such cases, measures will be put in place to demonstrate the outcome of providing the service with a view to providing evidence to commissioners that will inform future
commissioning decisions.
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Evaluation and wider dissemination
Some of the areas participating in the project will be the subject of monitoring and an evaluation by the research team at CIRCLE (University of Leeds). The number of
people being referred and the percentage of the total actually making contact with the carers centre will be an important outcome measure for community
pharmacies. It will also be important to demonstrate the outcomes for those carers identified and referred by pharmacists to carers centres and schemes and also the
outcomes for those referred to their GP practice.
It is anticipated that the results of this evaluation will add to the evidence base for community pharmacy services and their role in supporting people to live
independent lives in the community. This may then provide the evidence for wider roll out of the concept and commissioning of such services from community
pharmacies at either a local or national level. It will also demonstrate the benefits of adopting an integrated, partnership approach to carer identification, referral and
support in community settings and pinpoint key success factors that will enable this approach to be adapted and adopted by other public-facing businesses, agencies
and groups within the community including those in non-health settings.
The detail
Planning and implementation
1. Expressions of interest for participation in the project have already been received from a number of areas. To be involved in the project, the local carers
centre or other relevant organisation, the LPC on behalf of community pharmacy and the local authority Carers Lead need to agree to work together.
2. Following local agreement to work together, other local stakeholders need to be identified and approached to inform them about the project and to seek
their support and / or involvement. Local stakeholders / partners would include:
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Clinical Commissioning Groups (CCGs)
NHS England Area Team (ATs)
NHS England Local Professional Networks (LPNs)
The Centre for Pharmacy Postgraduate Education (CPPE) and its local tutor
Local Medical Committees (LMCs)
Royal Pharmaceutical Society Local Practice Forum (RPS LPF)
To support initial contact with these partners a template briefing on the project, setting out the benefits of their involvement and what would be required of
them, will be created. They will also be provided with regular stakeholder updates.
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3. The geographical areas involved in the project will be determined along with which pharmacies will be invited to be involved and when.
4. Carers Trust will produce a communications strategy and action plan in consultation with national and local stakeholders to support the successful
implementation of the pilot. Issues to be addressed within the strategy will include local GP buy-in, increasing awareness amongst carers of services available
to them, public engagement with the pilot, maintaining interest in the project and regular updates to stakeholders.
5. Selected pharmacies will be invited to be involved in the project. A template invitation letter and briefing on the project will be produced centrally which can
then be personalised for local use. This will set out the benefits of pharmacies taking part in the project and what would be required of them. Unless local
resources can be found to fund time for staff training and other costs that may be incurred by the pharmacy, the information will need to make it clear that
involvement is voluntary and is part of a project to develop future community pharmacy services. A lot of the activity to be undertaken in the pharmacy will
fall within the scope of Community Pharmacy Contractual Framework Essential Services (i.e. support for self-care, public health and signposting). PSNC will
brief the national multiple pharmacy groups on the project to ensure head offices are aware of it.
6. Training sessions for pharmacy staff will be organised, using the carers centre’s staff to lead the training. Materials to support the provision of training
sessions will be developed centrally (including an invitation letter, draft agenda and session guide for facilitators/trainers, hand-out materials and PowerPoint
presentation). It is expected that training will normally take place in the evening and that wherever possible carers would be involved in the training. If this is
not possible, video footage will be available to provide real-life examples of caring for someone.
7. A starting date for the active phase of the project and its duration will be agreed.
8. Resources and engagement tools will be produced and distributed to pharmacies for use in the project. A template leaflet (A4 bi-fold or A4 tri-fold), countertop leaflet dispensers, sash or badge to identify the Carer Champion, referral form/letter and posters (A4 or A3) will be developed centrally, some of which
could be personalised for local use. PharmOutcomes will be the principal mechanism through which data will be captured and referrals made to local carer
organisations.
9. Following commencement of the active phase of the project the carers centre and the LPC will monitor the number of carer referrals being made by the
pharmacy to local carers services and GP practices. Ongoing communications about the project will be sent to participating pharmacies to keep interest in the
project high and to provide feedback on success stories, where applicable. In the case of the latter, the local carers centre will be asked to provide
anonymised case studies of carers who have been referred by local pharmacies to feed back the positive outcomes for the carers in question. Template
project newsletters or other communications will be drafted centrally to detail progress across the country. These could then have local project news added
prior to distribution to local pharmacies and other stakeholders.
10. At the end of the active phase of the pilot, a report will be produced by CIRCLE and Carers Trust capturing key learning points and recommendations with a
view to the Carer Friendly Pharmacy model being rolled out more widely across the country.
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Engaging pharmacy staff in the pilot
1. To ensure that pharmacy staff are fully engaged with and committed to the pilot, a social marketing campaign will be developed and implemented.
2. To this end, Carers Trust and PSNC are working with the University of Brighton’s Business School who offer charities the services of their final year marketing
communications students who will be tasked with creating a number of campaigns aligned to the pilot’s objectives from which one will be selected.
What needs to happen in the participating pharmacies and carers centres?
NB We plan to implement the project in two sites initially in order to test the approach to training and the template materials. All other sites will then
commence involvement a few months later, in order that the learning from the two pilot sites can be shared with all other sites and any amendments to
the template materials can be made.
1. The local carers centre will appoint a member of their team to take part in the pilot.
2. Each participating pharmacy (from now on referred to as ‘the pharmacy’) will identify two members of their team to take on the role of Carers Champion and
Deputy.
3. Staff from participating pharmacies will attend a condensed carer awareness training session delivered by the local carers organisation.
4.
Carers Trust will provide, in partnership with expert stakeholders such as pharmacy teams and carers service providers who have already developed
successful training resources and engagement tools:
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An introductory letter including an invitation to attend the training event;
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Training and a trainer’s toolkit to enable the carers centre to deliver training to the Carer Champions and Deputy Carer Champions;
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Resources for participating pharmacies.
5. Staff from the carers centre will deliver training to the pharmacy staff and provide them with the contact details of a named person who can answer any
queries they have and offer support in relation to the successful implementation of the pilot.
6. The local carers centre will agree to monitor referrals over an agreed period of time so that those from pharmacies can be recorded and tracked. This is to
include case studies of individual carers and the outcomes that result from the referral.
7. Following the training session, details of the project and what needs to be done will be disseminated to other members of the team who were not present at
the training. This may include delivery drivers, if they are agreed to be part of the scope of the project locally.
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8. Each pharmacy will agree a list of their services which are relevant to carers so that Carers Trust can produce a ‘menu’ of support options for use when
engaging with carers.
9. From the starting date for the active phase of the project, community pharmacy teams will seek opportunities to identify carers and will discuss whether:
a) they are aware of local support for carers; and
b) whether they access any of the support that is available.
Identification of carers could be undertaken based on pharmacy knowledge of their patients, particularly where patient’s representatives regularly collect a
patient’s prescriptions. Use of posters and leaflets in the pharmacy could also prompt identification of carers.
10. Carers will be provided with written information about local support available to them and where they wish to access that support. A referral to the carers
centre will be made by the pharmacy staff, with the consent of the carer. The carers centre will then contact the carer to offer further support.
11. Carers will be asked whether their GP knows about their caring role. If the GP is not aware that they are a carer and they would like their GP to be informed,
the pharmacy staff will pass that information to the GP practice using an electronic standardised referral form from PharmOutcomes which can be provided
free of charge to all sites. PharmOutcomes complies with GPs’ request to eliminate paper ‘moving around the system’ and will also help data collection to be
more robust. The referral form will need to be designed according to the data we need to collect.
12. A record of carer status and any referrals will be made on the pharmacy records, where a record exists for the individual.
13. Where appropriate, consent for the pharmacy to discuss the patient’s medicines with the carer will be sought from the patient (template wording for a leaflet
will be produced centrally).
14. The pharmacy will offer to discuss the menu of services they have available with the carer. Where such a conversation takes place, the carer and pharmacy
staff will agree what the pharmacy will do to support the carer and this could be annotated on any leaflet provided to the carer and on the pharmacy records.
Pharmacy services may include:
 support with re-ordering medicines from GP practices or use of the repeat dispensing service (where appropriate and with GP agreement);
 collection of prescriptions from the GP practice;
 delivery of prescriptions to the carer/patient;
 provision of appropriate aids to support medicines taking by the patient;
 carer’s health checks (where commissioned);
 free flu vaccination (where commissioned as in the case of PHE Greater Manchester’s pilot).
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15. Ideally the pharmacy team will receive feedback on whether the referred carer had accessed the support of the carers centre, in order to provide positive
reinforcement of the value of making referrals and to allow pharmacy follow-up with the carer, if they are a regular visitor to the pharmacy.
16. With guidance from CIRCLE at the University of Leeds, participating pharmacies and carers centres may be asked to consider targeting specific harder to reach
groups in their area such as older carers, carers from BME communities, carers of people with substance misuse problems, young carers and young adult
carers.
Which areas are involved in the pilot?
Carers Trust and the PSNC have identified the following Local Pharmaceutical Committees who have agreed to work in partnership with local carers services/centres
and other stakeholders:
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Bury and Rochdale LPC
Community Pharmacy West Yorkshire
Devon LPC
Bexley, Bromley and Greenwich LPC
Kent LPC
Gateshead and South Tyneside LPC
Northamptonshire and Milton Keynes LPC
East Sussex and Brighton LPC
Central Lancashire LPC
Community Pharmacy Humber
Additionally the LPCs in Berkshire, Buckinghamshire and Oxfordshire are undertaking a local project to identify and support carers, funded by the Local Education and
Training Board. There are opportunities for these LPCs to work alongside the above project sites.
National partners
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National partners for the project may include:
 CIRCLE, University of Leeds
 University of Brighton Business School
 Centre for Pharmacy Post-graduate Education3
 Department of Health
 Carers UK
 Royal College of GPs
 Royal Pharmaceutical Society
 Head offices of large multiple pharmacy groups
 Community Pharmacy Scotland and Community Pharmacy Wales
 Pinnacle Health Partnership
 Pharmacy Voice and its member organisations
 The Healthy Living Pharmacy Programme (National Lead is Deborah Evans)
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In 2014, the CPPE will start work on the development of online carer awareness training, as part of their existing Learning Pharmacy
http://www.cppe.ac.uk/sp/sp1.asp?pid=188&ID=182 comprising an additional ‘floor’ focused on supporting carers.
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Appendix 1
The Role of the Pharmacy Carers Champion
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Attend carer awareness training;
Attend Carers’ Champion meetings, a maximum of twice a year;
Maintain and refresh your Carers Notice Board or other information point for carers within your pharmacy;
Display and maintain supplies of carers’ leaflets and, where possible, posters in your pharmacy;
Identify yourself to customers as a Carers’ Champion by having your name displayed on your Carers’ Notice Board and wearing a Carers’ Champion badge or
sash;
Co-ordinate carer referrals and other initiatives relating to carers;
Read Carers Champion E-bulletins and brief colleagues.
Skills and knowledge
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Enthusiasm and motivation for the role;
Basic understanding of carers’ needs or a willingness to learn;
Empathy for carers.
A Carers Champion is not expected to be an expert on ‘carers issues’ or provide carers with one-to-one support.
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Appendix 2
Resources shopping wish list
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Training toolkit
o Trainer guide/training
o Invitation to training
o Agenda
o PowerPoint presentation
o Hand-outs
o Training evaluation form
o Certificate of attendance
Carer champion sash
Carer champion badge
Window stickers
Paper self-referral form to carers centre
Referral form to GP practice
Stakeholder briefing
Invitation letter
Leaflet
Leaflet dispenser
Monitoring form
Bulletin template
Caste studies form
Menu of pharmacy services for carers
Information-sharing consent form for MUR
Electronic referral form from pharmacy to carers centre (PharmOutcomes)
Electronic referral form from pharmacy to GP practice (PharmOutcomes)
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Appendix 3
Menu of pharmacy services of most relevance to carers
Core menu of pharmacy services
It is expected that participating pharmacies will be able to offer carers the following services:
 Electronic Prescription Service (subject to the patient’s GP practice also using the system)
 Medicines Use Review
 Home delivery of prescriptions
 Repeat dispensing
 Disposal of unwanted or out-of-date medicines
 New Medicine Service4.
 Prescription collection from local GP surgeries on behalf of patients
 Advice on minor ailments and injuries
Locally commissioned or charged-for services
Some participating pharmacies will also be able to offer the following services (either commissioned locally or charged to the carer):
 Flu vaccinations
 Health checks
 Incontinence supplies
 Stop smoking services
 Weight management
 Treatment of minor ailments, minor injuries, etc.
Available for people who have been newly prescribed medications for asthma, chronic obstructive pulmonary disease, type 2 diabetes, high blood
pressure and people who have been given a new blood-thinning medicine. The pharmacist supports the patient over several weeks to use the
medicine safely and to best effect.
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