Service Specification for Dementia Friendly Pharmacies.
Background
Dementia is a big challenge 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 diagnosis. 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 communities 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
Provide dementia medication interventions. This will help identify medications contraindicated in dementia, that may cause the symptoms of dementia or exacerbate symptoms of dementia displayed by the patient. These interventions will help both patient and career to live well with dementia.
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, career 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 ≤ 2 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, 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.

Patients that have completed MiniCog and score is ≥ 3. Offer reassurance of the result and conduct medication intervention if side effects may be the cause of the patients perceived reduction in memory and cognitive function over the past 12 months.

All appropriate and required information will input PharmOutcomes.

Offer information, signposting and relevant advice and literature at every stage and record interventions on 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 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 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 for the service on an annual basis.
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 previous diagnosis (Tier One)
5.4
Number with no previous 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
Number of medication interventions made where GP action is required. (Tier 3)

5.13
Number of patients with a completed follow up 4 weeks.
5.14
Results of follow up

GP Consultation.

Attend recommended support service.

Referral on or further investigations from GP.

Medication changes as a result of intervention.

Did the patient attend suggested support group or read suggested materials etc?

Does the patient feel that the intervention in the pharmacy had a positive impact?