Service Specification for Dementia Friendly Pharmacies.
Background
Dementia is a big problem, both in respect to health and social wellbeing of our population and the
cost this incurs, the issue will only increase as the population ages in the UK. Currently it is estimated
that there are 800,000 people living with dementia in the UK and this is expected to be over 1
million by 2021. Currently the cost of this is £23 billion a year. This has not been ignored it was a
huge priority of the last government showcased in the 2009 paper Living Well with Dementia: A
National Dementia Strategy. The main improvements to dementia services this document outlined
were

An improved awareness,

Earlier diagnosis and intervention and

A higher quality of care.
This has been built upon again by this government with the release of The Prime Ministers Challenge
on Dementia released in March 2012. It gave key commitments

Drive improvements in health and social care.

Create dementia friendly communities that understand how to help.

Better Research.
Part of this paper set an ambition to improve diagnosis rates. By 2015, two thirds of people should
have a diagnosis with appropriate post diagnosis support. BANES is estimated to have 2575 people
living with dementia but only 41.8% currently have a diagnosis. Pharmacy is perfectly placed in the
heart of the community to improve the awareness of dementia, intervene to direct people to hep
they need to live well with dementia and direct people to where they need to go to start the process
of assessment and possibly diagnosed. This helps to fulfil some of the aims and objectives set out in
Living Well with Dementia: A National Dementia Strategy. It also feeds into the prime ministers
challenge supporting dementia friendly pharmacies and driving improvements in health and social
care.
1. Service Specification
1.1 Pharmacies will provide one to one support and advice to people over 18 years of age.
1.2 The service will identify persons with memory or cognitive difficulties and provide brief
interventions to give more information about memory problems and local support
services available.
1.3 The pharmacy will provide referral to GPs or specialist services for further assessment if
necessary.
1.4 This service will be provided in addition to the essential service “promotion of healthy
lifestyles” (Public Health) ES4.
2. Aims and Intended service outcomes
2.1 To improve access to support and advice for patients with memory and cognitive
difficulties.
2.2 To offer a simple intervention to identify patients with memory and cognitive difficulties
so they can be directed to their GP for further investigation.
2.3 Provide early intervention so patients are investigated at an early stage.
2.4 Provide the early intervention of patients to help increase the number of patients being
diagnosed.
2.5
2.6 Provide dementia medication interventions. This will help identify medications
contraindicated in dementia, may cause the symptoms of dementia or exacerbate
symptoms of dementia displayed by the patient.
3. Service Outline
3.1 The part of the pharmacy used for provision of the service provides a sufficient level of
privacy and safety and meets other locally agreed criteria.
3.2 The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the
provision of the service have relevant knowledge and are appropriately trained in the
operation of the service.
3.3 The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the
provision of the service are aware of and act in accordance with local protocols and NICE
guidance.
3.4 Access routes to this service will be determined locally, however they could include:

identification of need by the pharmacist/trained staff within the pharmacy;

pharmacy referral as a result of the ‘Promotion of healthy lifestyles (Public Health)’
or ‘Signposting’ Essential services;

direct referral by the individual; or

referral by another health or social care worker.

The pharmacy would have to confirm the eligibility of the person to access the
service, based on the service inclusion criteria. (appendix 1)
3.5 The initial assessment will include:

Use of CQUIN question to see if person’s memory has become worse over the past
12 months.

If there has been a worsening of memory have they seen GP

If they have seen GP has there been a diagnosis.
3.6 The initial consultation will include:

Gain patient consent for consultation.

If not seen by their GP gain consent to share information with their GP and conduct
MiniCog assessment.

If seen by their GP but no diagnosis given gain consent and conduct MiniCog
assessment.

If diagnosis in place move to medication intervention and general advise and sign
posting. Gain consent to share any relevant information with the GP as you would
with an MUR.

Patients who have completed MiniCog and score is XX suggest that they see GP.
Give them a letter which will explain that they have had a consultation with you and
your suggestions (this is not a GP referral). Gain consent and complete a medication
intervention and also ask for consent to share relevant information with other
health care professionals such as patients GP as you would in an MUR. Ask for
consent and a contact number so that you can follow up the patient in 4 weeks to
see if they have seen GP. (not sure if we just talked about this or of we were going to
include this for the measurable outcome data for conversion of how many
interventions we made resulted in a G.P appointment.)

Patients that have completed MiniCog and score is XX Offer reassurance of the
result and conduct medication intervention if you see side effects may be the
patients perceived reduction in memory and cognitive function over the past 12
months.

All appropriate and required information will input PharmOutcomes.
3.7 People not wishing to initially engage or those who choose not to complete the
programme may be offered appropriate health literature and information on contacting
GP or RICE for help and assessment.
3.8 The pharmacy will maintain appropriate records to ensure effective ongoing service
delivery and audit.
3.9 The LPC will need to provide a framework for the recording of relevant service
information for the purposes of audit and the claiming of payment via PharmOutcomes.
3.10
The LPC will be responsible for the promotion of the service locally, including the
development of publicity materials, which pharmacies can use to promote the service to
the public.
3.11
The LPC should consider obtaining or producing health promotion material relevant
to the service users and making this available to pharmacies.
3.12
The LPC will need to provide details of relevant referral points which pharmacy staff
can use to signpost service users who require further assistance.
3.13
The LPC should arrange at least one visit through the duration of the service pilot to
each pilot site to offer support in all aspects of offering the service.
4. Suggested Quality Indicators
4.1 The pharmacy reviews its standard operating procedures and the referral pathways for
the service on an annual basis. (will we provide these if so then they are appendix 2 and
3)
4.2 The pharmacy can demonstrate that pharmacists and staff involved in the provision of
the service have undertaken CPD relevant to this service.
4.3 The pharmacy participates in the LPC organised audit of service provision for the
collection of any data needed for the pilot.
4.4 The pharmacy co-operates with any locally agreed LPC-led assessment of service user
experience.
5. Measurable Outcomes
5.1 Number of patients completing initial counter intervention of the CQUIN question
(access into service)
5.2 Number then progressed to consultation (Tier One)
5.3 Number of patients with diagnosis (Tier One)
5.4 Number with no diagnosis but GP is aware. (Tier One)
5.5 Record Type of information given and if a recommendation given to see GP again. (Tier
One)
5.6 Number of patients completing MiniCog (Tier Two)
5.7 Number of negative MiniCog (Tier 2)
5.8 Number of positive MiniCog (Tier 2)
5.9 Number of recommendations made to see G.P (Tier 2)
5.10 Number of patients for whom a medication intervention is completed. (Tier 3 )
5.11 Number of recommendations made to see G.P due to medication intervention
(Tier3)
5.12
5.13
5.14
Number of medication interventions made where GP action is required. (Tier 3)
Number of patients followed up 4 weeks.
Results of follow up
 GP Consultation.
 Referral on or further investigations from GP.
 Medication changes as a result of intervention.
 Does the patient feel that the intervention in the pharmacy had a
positive impact?
I also was thinking that the appendix could have a flow chart (algorithm) to take you through the
service. Although PharmOutcomes should do this so it may complicate things. I can Just see that
patients that are already in the system may not require MiniCog (tier2) but the may be a reasonable
recruitment for medication intervention. Typically patient with a diagnosis but still on amitriptyline
or something like that.
We need a check list for the pharmacy’s running the service for completion of training, resources
and also completion of safe guarding type qualification.
David appendix would also I think be a good place for your list of all of the extra resources and
reading that can be done around the subject. Could this be combined with references.
Housekeeping note - we need to get folders and dividers to pull all this together and get it all ready
to distribute to pharmacies.