NHS Grampian Pharmacy and Medicines Directorate

and
NHS Grampian Pharmacy and Medicines Directorate

Introduction
This document provides a general overview of the initial phase of the NHS
Grampian (NHSG) Pharmaceutical Care Services Planning process and is a summary for consultation purposes.
The NHSG Pharmaceutical Care Services Plan May 2012 consists of three documents:
 Pharmaceutical Care Services Plan (Phase One) May 2012

NHS Grampian: Pharmaceutical Care Services Plan: Technical
Information and Analysis for NHS Staff and Contractors (Phase One) May
2012

NHS Grampian Services from Community Pharmacies May 2012
Electronic copies of each document can be found on the NHS Grampian website at www.nhsgrampian.org/involvingyou and by clicking on 'current consultations'.
Whilst happy to receive comments on any part of the plan, there is a consultation response form at the end of this document highlighting some specific areas on which we would appreciate feedback.
Please use the consultation response form (Appendix B or available to download online on the NHS Grampian website at www.nhsgrampian.org/involvingyou and by clicking on 'current consultations'.
The consultation period ends on 13 th July 2012.
NHS Pharmaceutical Care Services Plan
The planning process aims to assess the current provision of pharmaceutical care services in the community setting within NHS Grampian, to ensure that the services are meeting the needs of the Grampian resident population.
The purpose of the plan documentation is to inform service providers and planners about the care services currently provided by community pharmacies across NHS Grampian.
The plan was prepared by a multi-stakeholder Working Group under the guidance of a Steering Group and details of the membership of both groups can be found in Appendix A
The planning process will be ongoing and there is a commitment to update the information about what services are available from community pharmacies in NHS Grampian each year.
NHS Grampian Strategic Direction
The overall health of the people of Grampian is described in documents such as the NHS Grampian Health Plan 2010 and the vision for future service delivery in the Health and Care Framework. The Health Plan gives details of what the Board is trying to do to improve health and the way in which people are treated. It focuses on patient-centred, safe and effective working and
Pharmacy is one sector of healthcare trying to achieve this.
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In the Health Plan Richard Carey, Chief Executive for NHS Grampian outlined the vision for improving services, including community pharmacy.
“Our plans for delivering the best possible services for a healthier
Grampian will focus on "shifting the balance of care". In other words, moving care to where it is most appropriate, and putting more emphasis on what happens outside hospitals.
Our aim is to ensure the care you receive is high quality, which means, safe, with good clinical outcomes and improved patient experiences. This is what we mean by putting people at the centre of everything we do. At the same time, the services we provide and the way in which we work must be efficient and affordable. This does not mean one-off savings, but long term financial stability.
Shifting the balance of care will mean ongoing changes to how we deliver health and healthcare services in the future.
In Grampian we will improve public access across primary care, making greater use of all service providers, pharmacy, dentistry, optometry and general medical services”
Medicines continue to be the most common treatment provided by the health service in NHS Grampian. Getting the most benefit from these medicines, and reducing the harm associated with medicines, is a core function of the Grampian
Pharmacy Service.
What is Community Pharmacy?
Community pharmacy is probably better known to most people as ‘The local or High Street Chemist’. Historically the central role of the community pharmacy has focused on supply to the patient i.e. supplying patient medication in response to prescriptions or over-the-counter requests and providing advice on taking these medicines.
In the year January to December 2011, 8.5 million prescription items were dispensed in Grampian at a gross ingredient cost of almost £92million.
Although this historical supply function continues to be provided, community pharmacies have, over the last 5-10 years been contracted to provide more comprehensive Pharmaceutical Care Services. In Scotland, this was cemented in health policy with the publication of ‘ The right medicine: a strategy for pharmaceutical care in Scotland
’, in 2002. The strategy emphasised the role of pharmacists in delivering pharmaceutical care for patients with chronic conditions, improving access to pharmaceutical care services in general, and prescribed and over-the-counter medicines in particular, along with expanding the pharmacist’s role in health improvement.
Community pharmacies are independent contractors who provide a service to the NHS in accordance with national regulation and locally-negotiated
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contracts. Community pharmacies are very accessible to individual patients and research in Scotland demonstrates that for the vast majority of people access to a local community pharmacy is good. Patients are seen regularly when t hey come in to collect prescriptions, and a ‘no appointment necessary’ service for giving advice on managing illness and improving health is always available.
Pharmacy premises must be registered with the General Pharmaceutical
Council, and supervised by a pharmacist. From these premises advice about and sale of Pharmacy Only (P) medicines, General Sales List (GSL) medicines, and health care products takes place. This activity is an important and increasing aspect of ‘ self care
’. Pharmacies have been identified by the
Scottish Government as the future ‘ walk-in healthy living ’ centres for Scotland.
There are 131 Community Pharmacies (
‘Chemist shops’) in NHS Grampian,
51 in Aberdeen City, 53 in Aberdeenshire and 27 in Moray which together act as a network providing Pharmaceutical Care Services across the Health
Board area. All provide NHS dispensing services under agreement with NHS
Grampian.
Community Pharmacy contractors (those who own the community pharmacy) across Grampian may be individuals or partnerships with one outlet (23), individuals or partnerships with more than 1 outlet (67) or national multiples that generally have many outlets (41). All Community pharmacies are contracted to provide NHS Pharmaceutical Care Services and appear on what is called the Health Board Pharmaceutical List. As private contractors to the
NHS, community pharmacies often also provide other goods and private services to purchase.
What are Pharmaceutical Care Services?
All community pharmacies in Grampian provide NHS prescription dispensing services and the following Core NHS Services directly from their premises:
 The Minor Ailment Service (MAS) provides appropriate advice, treatment, or onward referral to another NHS healthcare practitioner free of charge to eligible individuals (those who previously were exempt from prescription charges).
 The Chronic Medication Service (CMS) provides ongoing pharmaceutical care support for patients with stable long-term conditions (including dispensing of prescriptions, counselling, and advice).
 The Public Health Service (PHS) aims to encourage the pro-active involvement of community pharmacists and their staff in supporting selfcare, offering suitable interventions to promote a healthy lifestyle and establishing a health-promoting environment.
These Core Services are provided by all community pharmacies. Additional services which may be available from some community pharmacies include support for palliative care, methadone supervision, or syringe and needle exchange.
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In certain circumstances, providers other than community pharmacies may deliver pharmaceutical care services in the community setting.
In specified areas where there is a serious difficulty in accessing dispensed medicines from a pharmacist, NHS Grampian has contracted General
Practitioners (GPs) to provide a medicine dispensing service to some, or all, of their registered patients.
Some products such as stoma appliances, elastic hosiery and some other specialist hospital medicines may be supplied by external companies either under a direct contract to the NHS or by dispensing an NHS prescription.
Who should read the NHSG Pharmaceutical Care Services Plan?
The NHSG Plan documents are available as a resource for all public, professional and policy stakeholders within Grampian.
The documentation will be used to inform the development of a strategic vision for Pharmaceutical Care Services within Grampian, and the prioritisation of available resources.
Community Health Partnerships (CHPs), defined groups of GP practices
(known as Clusters) and individual contractors will be able to use the documentation to inform planning for local pharmaceutical care services.
Individuals will be able to use the planning documentation to find out about pharmaceutical care services in their local community.
What is the process for NHSG Pharmaceutical Care planning?
The NHS (Pharmaceutical Care Services) (Scotland) Amendment Regulations
(2011) require each NHS Scotland Health Board to prepare an annual
Pharmaceutical Care Services Plan. This should comprise a summary of the pharmaceutical care services provided by NHS Grampian together with an analysis of the areas where a lack of adequate provision has been identified.
The NHSG Pharmaceutical Care Services Plan documents have been prepared by a multi-stakeholder Working Group under the guidance of a
Steering Group as identified in Appendix A.
The first phase of the NHSG pharmaceutical care services planning process
(September 2011 to March 2012) has focused on describing and characterising the local needs for core and additional pharmaceutical care services delivered in the community setting.
Up-to-date information about the services provided by community pharmacies in Grampian has been collected and collated, and will be published on the
NHS Grampian website.
Information has been sourced from the National Records of Scotland, the
Scottish Public Health Observatory (ScotPHO) databases to describe variations in demography (age, sex and deprivation) and other health-related characteristics across the population of Grampian.
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Linking specific geographical populations to specific community-based pharmaceutical care services is difficult. Previous research in Scotland suggests that access to current community pharmacy locations is appropriate and convenient for the majority of individuals. Using a 20 minute travel time threshold, variation in travelling times by motor vehicle to community pharmacy locations and specific pharmaceutical services across Grampian has been examined to assess gaps in geographical access to community pharmacy services.
From April 2012 onwards, the next phase of the planning process will consider future service development and care pathways in the context of an agreed NHS Grampian strategic direction for community-based pharmaceutical care and other primary care services.
What are the key findings from the initial phase of the planning process?
On the basis of the available information and analyses:

The vast majority of people living in Grampian have access to a community pharmacy less than 20 minutes travel time, by road, from where they live.
 Where people have a serious difficulty in accessing a pharmacist
(specifically in rural areas), NHS Grampian has made accessible provision to dispensed medicines and appliances via dispensing doctor practices.
 In terms of additional services provided by community pharmacies, it was assessed that the general level of geographical access was reasonable.
Therefore, it was concluded that the current level of geographical access to pharmaceutical services provided by community pharmacies is acceptable.
Future pharmacy services will need to:

Have an increasing emphasis on medication review to help ensure patients are on the right medicines and understand how to get the best out of their medicines.

Be delivered in a more integrated way as greater emphasis is placed on continuity of care and care across the primary / secondary care interface.

Aim to provide medicines supply and other services within primary care wherever this is possible, sustainable and clinically appropriate.

Focus its activity to where it adds best health value and where it can contribute to the broader health strategy for services as laid out in the health and care framework.

Work with partners in healthcare, social care, third sector, carers and patients to deliver high quality pharmaceutical care to the patients of
Grampian.

Use technology to improve quality, patient experience, efficiency, safe systems and information transfer
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
Make sure it uses and develops its staff to maximise service outputs and make best use of the resources it has available.

Develop new areas of work and new ways of working to contribute to service aims e.g. expansion of pharmacist prescribing.
Further information
The complete set of NHS Grampian Pharmaceutical Care Services Plan
(March 2012) documents are available to download from the consultation section on the NHS Grampian website at www.nhsgrampian.org/involvingyou and by clicking on 'current consultations'.

Pharmaceutical Care Services Plan (Phase One),
 NHS Grampian: Pharmaceutical Care Services Plan: Information and
Analysis Technical Information for NHS Staff and Contractors (Phase
One)
 NHS Grampian Services from Community Pharmacies (April 2012)
Copies of NHS Grampian Pharmaceutical Care Services Plan (March
2012) documents may also be requested from:
The Pharmacy and Medicines Directorate
Westholme
Woodend Hospital
Queens Road
Aberdeen AB156LS
Telephone 01224 556527
E-mail nhsg.pmu@nhs.net
.
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Appendix A
Steering Group and Working Group Membership
Steering Group:
Linda Juroszek, Pharmacist, Area Prescribing Committee representative
Liz Kemp, Principal Pharmacist Pharmaceutical Care Services, NHSG.
Graeme Legge, Physical Planning representative.
Jean Mackenzie, Public representative
Neil MacRitchie, GP, Local Medical Committee representative
Martin McCrone, GP, Primary Care Integrated Management Group representative
William Moore, CPHM, Public Health representative.
Clark Paterson, Finance representative.
David Pfleger (Chair), Director of Pharmacy NHSG
Sandy Thomson, Lead Pharmacist (Acute Sector).
Stephen Watkins, Pharmacy Contractor Committee representative
Working Group:
Louise Black, Lead Pharmacist, Aberdeenshire CHP
Alison Davie, Lead Pharmacist, City CHP
Ken Hamilton, Business Manager, Moray CHP
Liz Kemp (Chair), Principal Pharmacist, Pharmaceutical Care Services,
NHSG.
William Moore, Consultant in Public Health Medicine (CPHM), NHSG
Rochelle Morgan, Specialist Analyst, Health Intelligence, NHSG.
Sandy Thomson, Lead Pharmacist, Moray CHP
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Appendix B
Pharmaceutical Care Services Plan
Public Consultation Response Form
The purpose of the Pharmaceutical Care Services Plan is to provide information on the pharmaceutical care services currently available within
NHS Grampian. This will help us find any potential gaps in service provision and identify where improved pharmaceutical services may be required.
A secondary function of the plan is to inform and engage members of the public, health professions, and planners in the planning of pharmaceutical services. We would appreciate if you could take the time to respond to the following questions and return your form to us (address at the end of the questionnaire). This will help inform the next step in the Pharmaceutical Care
Services Planning process.
1. Does the Pharmaceutical Care Services Plan explain clearly what pharmaceutical care services are? Yes No Don’t know
Please comment
2. Does the Pharmaceutical Care Services Plan explain clearly what pharmaceutical care services are available across Grampian?
Yes No Don’t know
Please comment
3. Does the available information in the Pharmaceutical Care Services plan meet your requirements? Yes No
Don’t know
Please comment
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4. Is the 20 minute travel time measure for geographical access appropriate?
Yes No
Don’t know
Please comment
5. Do you have any other specific comments about the Pharmaceutical Care
Service Planning process and Plan documentation?
Thank you for taking the time to respond to this consultation. All information provided is confidential and will only be used in an anonymised way to assist with pharmaceutical care service planning.
Responses are sought by the 13 th July 2012 at the latest and should be returned:
By e-mail to nhsg.pmu@nhs.net
Or faxed to Fax 01224 556002
Or posted to
Liz Kemp
Pharmacy and Medicines Directorate
Westholme
Woodend Hospital
Queens Road
Aberdeen
AB15 6LS
If you require additional information then you can telephone Liz on 01224
556684.
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