Derbyshire Local Pharmaceutical Committee
Representing Community Pharmacy Contractors in Derby City and Derbyshire County
Chairman: John Sargeant MRPharmS
Email: john.sargeant@derbyshirelpc.org
Secretary: Graham Archer B.Pharm. (Lond.), GPhC Registered Pharmacist Tel: 01246 433600 Fax: 01246 431897
Email: graham.archer@derbyshirelpc.org
www.derbyshirelpc.org
Address for LPC correspondence: Gunwalloe, 1 Rectory Close, Eckington, North Derbyshire, S21 4GL
November 2012
Dear Pharmacist,
Re: NHS targeted MUR Service (asthma) – developing synergies with GPs [Hardwick CCG ]
Dr Tim Parkin, of Limes Medical Centre, Alfreton (and prescribing lead for Hardwick CCG) hosted an
event for local community pharmacists on Wednesday 22nd August, 2012 to discuss how collaborative
working could support improved patient outcomes for Asthma and COPD patients. There are
approximately 800 patients with asthma registered at this practice and they fall into two groups: (A) 1020% who have unstable asthma symptoms & require a lot of clinical support; and (B) 80-90% who are
fairly stable and generally need less support.
Pharmacists will also be aware that Derbyshire LPC has been running a series of Pharmacy Development
Group meetings focussing on tMURs and NMS, including respiratory, and has been promoting an
structured evidence-based approach to conducting t-MURs and NMS consultations with these patients.
This Limes meeting therefore considered how this structured approach could be applied to support its
asthma patients.
It was agreed to pilot a multidisciplinary team approach to Asthma Reviews to test how pharmacy
(Medicines Use) Reviews and GP (Clinical) Reviews could be better co-ordinated to improve outcomes
for asthma patients, whilst optimising the contractor interests of both the local pharmacies and the
Practice. The following protocol was agreed:





Limes Medical Centre [Limes MC] will identify those patients that have generally well-controlled
asthma (i.e. stable patients)
When such a stable patient is due for their annual asthma medical review they could be signposted
to their regular community pharmacy for a t-MUR in the first instance.
Community pharmacist will conduct a t-MUR and provide feedback to the Limes MC using a
modified NHS MUR Feedback Form (example enclosed)
The pharmacist will check & record smoking status, inhaler technique using an In-Check device,
peak flow meter reading (not essential, but best practice), and get the patient to complete an
Asthma ACT Questionnaire. The pharmacist may also provide additional information that might
support the patient in the management of their condition – including lifestyle and education
leaflets where appropriate.
The completed t-MUR (modified) feedback form should be returned the surgery at the earliest
opportunity for all asthma patients including those without any clinically significant matters
arising, and the GP will have regard for the pharmacists comments when making their medical
review considerations.


The Limes GP will also use the information provided (especially smoking status, ACT Score and
inhaler technique competency, as required by GP QoF and QIPP incentives) to update patient
records and to provide feedback to the pharmacist on any recommendations they may have made.
Limes MC to contact patient where issues are identified that require an appointment with a GP for
further investigation.
The above protocol will provide an opportunity for pharmacists to work more closely with this practice
and also for the pharmacy to benefit from the surgery actively signposting patients for such structured tMURs (and NMS). And unstable patients will especially benefit as the practice will be able to spend more
time on them, as they need extra clinical support. In addition, the t-MUR dataset captured for Group “B”
(the relatively stable) patients will help the practice to maintain a more up-to-date patient record which is
in the patients interests as well.
This is a fantastic opportunity to support asthma patients and so Derbyshire LPC would encourage all
pharmacists in the catchment area of this Practice to fully support this pilot. Additional information on the
LPC’s structured approach can be found on the presentations that were made at the Respiratory PDG
Events earlier this year – http://www.lpc-online.org.uk/derbyshire_lpc/respiratory.html
Next Steps: Please complete the sign-up agreement form to indicate that you wish to participate in the
pilot. The Limes MC will then be confident in referring asthma patients to you for such t-MURs. The
form should be returned to Dr. Tim Parkin, Limes Medical Centre, Limes Avenue, Alfreton, Derbyshire,
DE55 7DW.
I look forward to working with you all to make this pilot a success. Collaborative working will benefit
patients through improved outcomes and benefit the wider health economy as a whole at a time when
NHS resources are increasingly under pressure.
Yours sincerely,
John
John Sargeant MRPharmS,
Derbyshire LPC Chairman
Mob: 0786 628 1798
Email: johnsargeant@derbyshirelpc.org
Encs. Pharmacist Asthma Review Pilot Sign-up Form
NHS MUR Feedback Form for Asthma Review Patients
Asthma Control Check Questionnaire
Multidisciplinary Asthma Reviews
Agreement to work with the Limes Medical Practice
[Hardwick CCG and Derbyshire LPC - August 2012]
I / We*
_________________________________________________ please print
Of
(Pharmacy Name and Address)
_________________________________________________ please print
_________________________________________________ please print
_________________________________________________ please print
Telephone
_________________________________________________
Fax
_________________________________________________
Email
_________________________________________________
I agree to provide those asthma patients referred to my/our pharmacy from Limes Medical
Practice with the following service:


Conduct a t- MUR and provide feedback to Limes MC using the modified NHS MUR Feedback
Form
Check smoking status, inhaler technique (using an In-Check device), peak flow meter reading (not
essential, but best practice), ask the patient to complete an Asthma ACT Questionnaire, and
provide additional information including lifestyle and education leaflets where appropriate.
Return the completed feedback form to the Limes MC (fao Dr Parkin) at the earliest opportunity
Signed:
____________________________________________ Pharmacy contractor
Position:
____________________________________________
Date:
____________________________________________
Pharmacy Stamp
Return a copy of this form to Dr. Tim Parkin, Limes Medical Centre, Limes Avenue, Alfreton,
Derbyshire,DE557DW.
NHS Medicines Use Review Service – Asthma Review
Pilot [Hardwick CCG and Derbyshire LPC]
To: Limes Medical Practice, Limes Avenue, Alfreton
Date:
Re:
NHS Number:
Patient Name:
Patient Address
DOB
This patient recently received a Medicine Usage Review [MUR] in line with the agreed Asthma
Review Pilot and the results of the review are detailed below:
Smoking Status
Inhaler Technique
Peak Flow Meter
Asthma ACT Score
Patient Education
Lifestyle Leaflets
Education Leaflets
Smoker / Never Smoked / Ex-Smoker
Excellent / Good / Poor
Below range / In range / Above range
litres/min
out of 25
Medicine Names:
o
o
o
o
o
o
o
o
o
o
Potential Drug interaction(s)
Potential side effects/adverse drug reaction preventing use of the medicine
Patient reports not using the medicine any more
Patient reports not using the medicine in line with directions
Patient reports difficulty using the medicine – issue with device
Patient reports difficulty using the medicine – issue with the formulation
Patient reports lack of efficacy
Patient reports problem with drug regimen
Patient reports unresolved concern about the medicine
Other (see comments below)
Further information/Comments/Possible Action:
I have advised the patient that, where appropriate, the practice will contact them regarding this
matter after considering the above information.
Please provide any necessary feedback to me on the outcome.
Pharmacist Name:
Pharmacy Name:
Telephone:
CONFIDENTIAL
Asthma Control TestTM
Your answers to this 5-question quiz will provide you a score that may help you and your doctor
determine if your treatment plan is working or if it might be time for a change.
1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at
work, school or at home?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
2. During the past 4 weeks, how often have you had shortness of breath?
More than once a day
Once a day
3 to 6 times a week
Once or twice a week
Not at all
3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of
breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
4 or more nights a week
2 or 3 nights a week
Once a week
Once or twice
Not at all
4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as
salbutamol)?
3 or more times per day
1 or 2 times per day
2 or 3 times per week
Once a week or less
Not at all
5. How would you rate your asthma control during the past 4 weeks?
Not controlled at all
Poorly controlled
Somewhat controlled
Well controlled
Completely controlled
Total Score
□
Each question is scored from one (poor control) to five (good control) and the scores added to give a final
score with a maximum of 25.
Copyright 2002 by QualityMetric Incorporated.
ASTHMA CONTROL TEST is a trademark of QualityMetric Incorporated.
ASTHMA ACTION AMERICA is a trademark of GlaxoSmithKline.