nhs pharmaceutical care services planning...nhs pharmaceutical care services planning moray...

NHS Pharmaceutical Care Services Planning

Moray Community Health And Social Care Partnership

December 2012

This document is also available in large print and other formats and languages on request. Please call NHS Grampian on 01224 551116 or 01224 552245 or e-mail [email protected]

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NHS Pharmaceutical Care Services Planning Moray Community Health And Social Care Partnership – Version 2 - 1 -

Introduction to Moray CHSCP Area Geography and Demographic profile of Moray

One of the key components to the NHSG 2020 Vision is the development of a population based approach to health and health care supported by the creation of 11 cluster-areas across Grampian. The clusters are built around Grampian citizens and will allow services and resources to be integrated for the delivery of care as close to the service user as possible; at home, a homely setting or in the local community. Furthermore the 2020 Vision describes a significantly higher degree of integration (than currently) between service users, providers, health & care agencies, 3rd and private sectors – locality clusters will facilitate this integration and become the route through which transformation of services will occur. Since late 2011 Grampian, as a region, consists of 11 cluster-areas; 4 in Aberdeen City, 6 in Aberdeenshire and Moray. Locality populations range from 40,000 to 90,000 (Moray) with a similarly wide geographical range; relatively compact geography in Aberdeen City to a significantly greater spread in Aberdeenshire, Each cluster-area has dedicated GP Leadership supported by aligned CHP management and functional areas (pharmacy, public health, nursing, AHP, etc). Formal structures exist within all eleven localities, for regular cluster-area meetings (all locality stakeholders – NHS/Council), clinical leadership meetings (GP Leads/local senior management) and Grampian-wide senior clinical and executive leadership meetings. It is envisaged that a dedicated pharmacy lead post will be appointed in the near future in order for community pharmacy issues to be included within the cluster discussions mentioned above. The Moray cluster is the biggest in Grampian with a population of 90,000. Further details of the citizens within the Moray cluster are given in the table below:

Age Group Population %

0-4 years 4,782 5.3% 5-14 years 9,757 10.8% 15-24 years 10,752 11.9% 25-44 years 21,010 23.3% 45-64 years 26,010 28.9% 65-74 years 9,868 11.0% 75-84 years 5,887 6.5% 85 up 1,981 2.2%


As Moray CHSCP is one of the biggest clusters in Grampian it is useful to break it down to smaller localities. These will be useful for planning purposes. The current localities are

Locality Population % Elgin / Lossiemouth 40,183 44.6% Buckie / Fochabers 18,523 20.6% Forres 15,451 17.2% Keith and Speysdie 15,890 17.6%

Through the Health and Care Framework, NHSG has already started a process of assessing the needs of localities across Grampian. Forres was one of the pilots and the process there is nearing completion. A similar process in Keith and Speyside is about to be launched and other localities will follow in due course. In terms of landmass, Moray is the 8th largest Council area in Scotland, covering an area of 2238 square kilometres, from the Cairngorm Mountains in the south to the coast of the Moray Firth in the north. The area is mostly rural comprising 70% of open countryside and a further 25% of woodland.


The estimated population of Moray in 2010 was 87,660 – just 1.7% of the Scottish population. The average population density is low at just 39 people per square kilometre compared to a Scottish average of 66 per square kilometre. However, approximately 57% of the population live in the 5 main towns of Elgin, Forres, Buckie, Lossiemouth and Keith, where the population density is approximately 2500 people per square kilometre. The area has a 0.9% ethnic minority population, which is significantly lower than the Scotland average of 2.0% Overall, Moray is one of the least deprived areas in Scotland, as defined by the Scottish Index of Multiple Deprivation (SIMD), having no data zones in the 15% most deprived in Scotland and just 2 in the 20% most deprived areas, both of which are in Elgin. This represents just 1.7% of Moray’s data zones, the lowest in Scotland with the exception of the three island groups. By comparison, Aberdeenshire has 8 data zones in the 20% most deprived and Angus has 9, representing 2.7% and 6.3% of their data zones respectively. However, the rural nature of Moray means that 27.6% of its data zones are within the 15% most access deprived in Scotland, due to the financial cost, time and inconvenience of travelling to basic services. This compares with 42.5% of data zones in Aberdeenshire and 26.1% in Angus. TRENDS Major demographic change is underway in Scotland and the population is projected to rise over the next 25 years before declining slowly. Some of the significant challenges are summarised below and will impact Moray: • Scotland’s population is aging; between 2004 and 2031 the number of people aged 50 plus is projected to rise by 28 % and the number of people aged 75 and over is projected to increase by 75 % . • Between 2005 and 2010 there is an expected 29.5% increase in people aged 85 years plus in Moray, (national average 17%). • Fewer children aged 0-15 years and people aged 16-64 years; the numbers are projected to decrease by 15% and 11% respectively by 2031. • The number of births in Moray has declined by 2.79% between 2007 and 2010. • People living longer; life expectancy at birth is projected to increase from 74.3 years for males and 79.4 years for females for those born around 2004 to 79.2 years and 83.7 years respectively by 2031 (Ref All Our Futures 2007). • Scotland’s carers population is increasing; Scotland has an estimated 660,000 unpaid carers but this is expected to increase by more than 50% by 2037. (Ref Carers Scotland 2009)


The impact of the elderly population in Moray is important to note:

Projected Over 65s Population Breakdown - Scotland

0%10%20%30%40%50%60%70%80%90%

100%

2008 2013 2018 2023 2028 2033

75+65-74

Table 1 – Projected over 65s population breakdown – Scotland – 2008-31

Projected Over 65s Population Breakdown - Moray

0%10%20%30%40%50%60%70%80%90%

100%

2008 2013 2018 2023 2028 2033

75+65-74

Table 2– Projected over 65s population breakdown – Moray – 2008-31 Comparison of data in tables 1 and 2 shows that the percentage of over the 75+ cohort is at an increasing rate in Moray – the over 75s become predominant in Moray from 2023, whilst this takes place for the Scotland five years later in 2028.


Current Health and Care Service Provision in Moray: Moray has a fully integrated Community Health and Social Care Partnership led by a joint management team. It has a common set of aims and objectives, which are set out in the Moray Community Health and Social Care Partnership Performance Management Plan 2012-2013. Dr Grays, a 145 bedded District General Hospital provides acute services to the greatest density of the Moray population. There are five Community Hospitals in the towns of Aberlour, Buckie, Dufftown, Forres and Keith providing 89 in-patient beds in total and deliver a range of acute and intermediate care services for the aforementioned local areas. There are 14 General Practices, 17 dentists, 26 community pharmacies and 9 opticians. Primary and community care services are built around the Community Hospitals with community based health and social care teams where possible. Health and social care teams in Elgin are aligned to GP practices and co-located where possible. The Linkwood (Elgin) and Lossiemouth general practices have co-located health and social care service provision. Health The Moray population’s perception of their general health is the same as Angus and Aberdeenshire, with 93% of the population reporting good or fairly good health and just 7% reporting not good health. The percentage of the population that has a limiting long-term illness is also very similar to both Angus and Aberdeenshire, representing around 1/6 of the total population in all 3 authorities. However, prevalence data from general practices indicates that Moray has some of the highest disease prevalence in Scotland, particularly with respect to diabetes, obesity, chronic kidney disease and hypothyroidism. The relationship between health and tenure indicates that 88% of occupants of social rented accommodation report good or fairly good health compared with 94% of occupants of owned or privately rented/rent free accommodation. This is reflected in the incidence of limiting long-term illness, which is 10% higher is for occupants of social rented accommodation, at 24%, than for occupants of owned or privately rented/rent free accommodation. The spread across age groups is comparable, with 65-84yr olds representing the largest proportion of each tenure type having a long-term illness. Deprivation Health Deprivation Moray has fewer areas in the 40% most deprived in Scotland for health compared with income, employment and education The areas of Moray with the most multiple health deprivation are predominantly in Elgin (north and east and New Elgin) There are areas of multiple health deprivation in Buckie (east), Forres (central, north and south) and Lossiemouth (south west).


Fochabers, Rothes and other rural areas (Dufftown, Aberlour, Cullen, Garmouth, Keith, Mosstodloch, Portknockie and Tomintoul) have slightly higher figures for anxiety/depression/psychosis medication prescribing than the majority of Moray’s areas. Lhanbryde (east) has among the highest incidence of both alcohol and drug-related hospital admissions in Moray. Rothes, Fife Keith and Keith (Balloch Road area) have among the highest incidences of alcohol-related hospital admissions in Moray. Dufftown and Fochabers (south) have among the highest incidences of drug-related hospital admissions in Moray. Burghead and Cullen, Findochty (east), Lhanbryde, Mosstodloch and multiple areas of Keith have among the highest figures for low birth weight babies in Moray. Income Deprivation The areas of Moray with the most significant concentrated income deprivation are Elgin (eastern side of the town and New Elgin), Buckie (town), Lossiemouth (central and west of town), Lhanbryde (eastern side of town) and Forres (north and west). There are also concentrated areas of income deprivation in Keith (Balloch Road/Den Crescent area) and Rothes (Provost Christie Drive area). Employment Deprivation

The most significant concentrated employment deprivation is in Forres (central and north, including Applegrove Primary School area, Burdshaugh and Waterford), Elgin (Cathedral and Lesmurdie areas) and Buckie (Millbank Primary School area, Milton Drive, Douglas Crescent to Linn Crescent). There are also concentrations of employment deprivation in Lossiemouth (Boyd Anderson Drive) and Rothes (Provost Christie Drive). Areas in the 40% most employment deprived in Scotland almost all have high proportion of social rented housing. Areas of Moray in the 40% most employment deprived in Scotland all have a high concentration of Incapacity Benefit/Severe Disablement Allowance claimants. Education, Skills And Training Deprivation The most significant deprivation in Moray is in Buckie (predominantly in the east), Elgin (east and New Elgin) and Forres (central and south-west) There is also a significant education deprivation in Lossiemouth, Lhanbryde (east of primary school), Keith (Fife Keith and Balloch Road), Portknockie and Rothes (Provost Christie Drive). Buckie: Education deprivation in Buckie is largely due to high percentages of the working age population with no qualifications, although directly school-related results (particularly absences and percentage not in education, employment or training) play an important part. Elgin: Education deprivation in Elgin is a combined result of directly school-related and high percentage of working age population with no qualifications, dependant on the area. Forres: Education deprivation in Forres is largely due to high pupil absences and percentage not in education, employment or training.


Lossiemouth: Education deprivation in Lossiemouth is largely due to directly school-related results, namely pupil performances and absences. Lhanbryde: Education deprivation in Lhanbryde is a combined result of directly school-related and high percentages of the working age population with no qualifications. Keith: Education deprivation in Keith is largely due to high percentages of the working age population with no qualifications. Portknockie: Education deprivation in Portknockie is a combined result of directly school-related (particularly absences and percentage not in education, employment or training) and high percentages of the working age population with no qualifications. Rothes: Education deprivation in Rothes is largely due to a high percentage of the working age population with no qualifications, with high pupil absences contributing. Areas in the north east and south east of Elgin (Kingsmills, South Lesmurdie, Manitoba) and Lhanbryde (east) are in the 20% or 40% most education, skills and training deprived in Scotland and also in the 30% most public transport deprived in Moray. Areas in the north east of Elgin and Lhanbryde (east), and a variety of large rural areas around Craigellachie, Cullen (east), Dufftown (north-east), Spey Bay and rural Rothes are among the 30% most public transport deprived as well as having the 30% highest proportions of 16-19 year olds not in education, employment or training in Moray. Public Transport Areas in the north east of Elgin (Kingsmills, South Lesmurdie) and the east of Lhanbryde (east of primary school) are in the 20% or 40% most income and/or employment deprived in Scotland and also in the 30% most public transport deprived in Moray. Some rural areas with among the highest public transport deprivation also show high figures for certain income and employment related benefits; these include Portgordon (south west), Dufftown (north east), Elgin (south-west) and Forres (south -west). Lone parents: Areas with high concentrations of lone parents claiming income support include multiple areas of Elgin, Buckie (central and east), Fochabers (south), Forres (central and south), Keith (Balloch Road and Fife Keith), Burghead, Lhanbryde (east), Lossiemouth (south-west) Portknockie and Rothes. Pension Credit: Areas with high concentrations of older people claiming the guaranteed component of pension credit include multiple areas of Buckie, Elgin, Forres, Burghead, Findochty, Hopeman (east), Keith (central and east), Lossiemouth (south-west) , Portgordon, Portknockie, Rothes (west) and the Tomintoul/Glenlivet surrounding area.


NHS Grampian Strategic Vision for primary care services 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. 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“. Pharmacy in 2020: Directors’ View outlines the vision for pharmacy that would see patients registering with community pharmacies, akin to the way they are currently registered with GP practices for medical services. Community pharmacy would be a primary source of medicines information and would have a more clinically focussed role, with the majority being independent prescribers. Most community pharmacies would have dedicated space for other members of the health and social care team. Pharmacy assistants would be trained in health promotion as well as advising on minor ailments and general medicines and healthcare advice, pharmacy technicians will be checking technicians able to manage the whole dispensing process, and with pharmacists only performing clinical checks on prescriptions, releasing time for other clinical roles. All of this aims to provide better outcomes for patients, with improved compliance with medicines leading to efficiencies in the healthcare systems.


Description of Primary Care Pharmaceutical Service Provision in Moray CHSCP Overview of Pharmacy Services Community pharmacies are independent contractors who provide a service to the NHS in accordance with national regulation and locally-negotiated contracts. Community pharmacies are very accessible to individual patients. They see patients regularly when they come in to collect prescriptions, and provide a ‘no appointment necessary’ service for giving advice on managing illness and improving health. Premises registered with the General Pharmaceutical Council, and supervised by a pharmacist, can advise about and sell Pharmacy Only (P) medicines, General Sales List (GSL) medicines, and health care products. 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. Premises Standards – The General Pharmaceutical Council (GPhC) is responsible for the regulation of pharmacists, pharmacy technicians and pharmacy premises. They have recently issued new ‘Standards for Registered Pharmacies’, one of which relates specifically to the physical environment of the pharmacy: Principle 3: “The environment and condition of the premises from which pharmacy services are provided, and any associated premises, safeguard the health, safety and wellbeing of patients and the public.” The responsibility for meeting the standards lies with the pharmacy owner and the GPhC are developing a new way of inspecting pharmacies to ensure that they are being adhered to. The GPhC also state “The standards can also be used by patients and the public so that they know what they should expect when they receive pharmacy services from registered pharmacies.” Community Pharmacies within NHS Moray CHSCP Historically the central role of NHS Pharmaceutical Care Services has focused on the supply function i.e. supplying patient medication in response to prescriptions and supplying advice on taking these medicines to the patient. The shift from this historical supply function to a more comprehensive Pharmaceutical Care Service has been occurring for a number of years. In Scotland, it 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, and the pharmacist’s role in health improvement. There are26 Community Pharmacies (‘Chemist shops’) in Moray providing a network of NHS Pharmaceutical Care Services across the CHSCP area. All provide NHS dispensing services under agreement with NHS Grampian.


These contractors may be individuals with one outlet, individuals or partnerships with more than one outlet or national multiples that generally have many outlets. The profile of providers differs from area to area as can be seen in the table below: Community Pharmacies within Contractor Categories at CH(SC)P level.

CHP area

Contractor Category

Single Outlet

Independent Multiple Outlet

National Multiple Outlet

Total

Aberdeen City CHP Pharmacies 6 24 21 51 Aberdeenshire CHP Pharmacies 11 29 14 54 Moray CHSCP Pharmacies 4 14 8 26 Of the 26 community pharmacies, 4 provide pharmaceutical services for only part of the day, serving small local communities in Burghead, Hopeman, Portknockie and Findochty In addition, two rural GP practices provide dispensing services to their patients – Glenlivet and the Tomintoul branch of the Rinnes practice. Community Pharmacy Dispensing The number of items dispensed in NHS Grampian in the last full year available at time of printing was 8,396,767 items at a Gross Ingredient Cost (GIC) of £90,942,573. These data have been broken down into the volumes in each of the three Community Health Partnership areas. CHP - Dispensing October 2010 to September 2011

Dispenser CHP Name No of Items (Dispensed) GIC (Paid)

Patient Population Size

items/1000 patients CHP

ABERDEEN CITY CHP 3,199,949 36,314,828 244,205 13,104 ABERDEENSHIRE CHP 3,671,570 38,936,097 239,440 15,334 MORAY CHSCP 1,525,248 15,691,648 88,495 17,235 TOTAL 8,396,767 90,942,573 Dispensing in NHSG by CH(SC)P October 2010 to September 2011 MORAY COMMUNITY

HEALTH & SOCIAL CARE PARTNERSHIP

ABERDEENSHIRE COMMUNITY HEALTH

PARTNERSHIP

ABERDEEN CITY COMMUNITY HEALTH

PARTNERSHIP


Interface with other providers Acute Sector (Secondary Care – principally Dr Gray’s Hospital) The interface between community pharmacy and secondary care is an area of increasing focus as Scotland pursues its policy of shifting the balance of care. A Grampian initiative whereby community pharmacies supply medicines that were previously only supplied from hospital pharmacy is being developed. The first medicine, imatinib, is now being supplied by community pharmacies and the initiatiove will be further developed. Communication between community pharmacists and their hospital colleagues in Moray is improving. Dr Gray’s pharmacy staff inform community pharmacies when a patient with a compliance aid is being discharged from Dr Gray’s and updates on any medicine changes. A patient who requires a new compliance aid will also be discussed with community pharmacy staff prior to discharge. Where there is uncertainty over the medication being taken by a patient admitted to Dr Gray’s Hospital, hospital pharmacy staff are likely to confirm with the patient’s community pharmacy their current medication. Health and Social Care Services Community pharmacies support the Home Carers Medicine Management scheme by providing medicine administration record sheets along with the dispensed medicines to enable council contracted home carers to administer medicines to their service users. Residential Care establishments (‘Care Homes’) Pharmaceutical services provided by community pharmacies to residential care homes are defined by good practice guidance from both the Royal Pharmaceutical Society and Care Commission Scotland. Care Homes generally have an arrangement with a single community pharmacy to provide dispensed medicines for all their residents in patient specific metered dose systems. The Moray CHSCP Care Homes Pharmacy Technician supports community pharmacies, care homes and medical practices to provide safe, appropriate, cost effective medicine management processes. Community Hospitals Patients being discharged from Moray community hospitals have their medication reviewed prior to discharge by a GP who will organise a prescription for continuing medication. This prescription will be dispensed by the community pharmacy who will ensure the medicines are sent to the hospital prior to discharge, or will make arrangements to have the meicines available at the patient’s home. GMed/NHS24 Community pharmacists have direct access to GMEDS/NHS 24 through the professional-to professional phone line. This facility is used in order to refer a patient directly to a medical doctor for confirmation of diagnosis and treatment of a minor illness. NHS 24 will also refer patients to a service provided by a pharmacy, where appropriate e.g. Community Pharmacy Urgent Supply (CPUS), Minor Ailment Service (MAS) or Emergency Hormonal Contraception (EHC).


Core Services All pharmacies are required to provide all 4 core pharmaceutical care services • Minor Ailment Service • Public Health Service. • Acute Medication Service • Chronic Medication Service Minor ailment service (MAS) Minor ailments can be generally described as common, often self limiting conditions. They normally require little or no medical intervention and are usually managed through self-care and the use of appropriate products that are available to purchase without a prescription. This service aims to support the provision of direct pharmaceutical care within the NHS by community pharmacists. The service allows eligible people to register with the community pharmacy of their choice for the consultation and treatment of common self-limiting conditions with over-the-counter medicines, free of charge. The pharmacists advises, treats or refers the person (or provides a combination of these actions) according to their needs. A person must be registered with a Scottish GP practice and belong in a current exemption category to be eligible for the service. CHP Level - Minor Ailment Service Items Dispensed

Minor Ailments Service - CHPs Items Dispensed

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

ABERDEEN CITY COMMUNITY HEALTHPARTNERSHIP

ABERDEENSHIRE COMMUNITY HEALTHPARTNERSHIP

MORAY COMMUNITY HEALTH & SOCIAL CAREPARTNERSHIP

Item

s Di

spen

sed

2009/10 Q4 2010/11 Q1 2010/11 Q2 2010/11 Q3 2010/11 Q4


Public Health Service (PHS) There are two patient service elements of the public health service. Smoking Cessation Services This service consists of the provision of a smoking cessation service comprising advice and supply of nicotine replacement therapy (NRT) and other smoking cessation products over a period of up to 12 weeks, in order to help smokers successfully stop smoking. All community pharmacies are contracted to provide this service. A further development of this service is the supply of varenicline under a Patient Group Direction. This is still in the early stages of roll-out but there are early adopter community pharmacies in Elgin (Bishopmill Pharmacy), Aberlour, Keith (Clarks Pharmacy) and Dufftown.


There is good geographical availability of this service from community pharmacies in Moray. However, as can be seen from the table below, there is a significant variance in the number of customers utilising the pharmacy smoking cessation service. It is not known if this is due to low demand for the service in some areas, customers accessing this service from alternative providers, or if there is no promotion of the service by the community pharmacies.

Contractor

Moray NRT Items dispensed 10 11

0

20

40

60

80

100

120

140

160

180

200

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

NRT Items


Sexual Health Services This service comprises of the provision of a sexual health service comprising the supply of emergency hormonal contraception (EHC) to women 13 years and above. Where a contractor decides not to supply emergency hormonal contraception (EHC), they should give notice in writing to the Health Board and advise the Agency of their decision and ensure prompt referral of patients to another provider who they have reason to believe provides that service. In addition, a pharmacist who chooses not to supply EHC on the grounds of religious, moral or ethical reasons must treat the matter sensitively and advise the client on an alternative local source of supply (such as another pharmacy, GP or sexual health service).

Moray EHC Activity per Pharmacy 10 11

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Contractor

No. EHC patients treated


Acute Medication Service (AMS) The Acute Medication Service is the provision of pharmaceutical services for acute prescriptions. The Acute Medication Service represents the provision of pharmaceutical care services for acute episodes of care and supports the dispensing of acute prescriptions and any associated counselling and advice. Prescribing and dispensing data is available to NHS Boards in the form of the national database PRISMs. Chronic Medication Service (CMS) The Chronic Medication Service is the continuity of pharmaceutical care of patients with long term medical conditions. CMS provides personalised pharmaceutical care by a pharmacist to patients with long term conditions. It is underpinned by a systematic approach to pharmaceutical care in order to improve a patient’s understanding of their medicines and to work with the patient to maximise the clinical outcomes from the therapy. There are three stages to CMS: • Stage 1. Reviewing patients medicines • Stage 2. CMS patient care record and plan • Stage 3 Serial prescriptions All community pharmacies in Moray are now contractually committed to stages 1 and 2. A number of community pharmacies are also now dispensing serial prescriptions, principally from Linkwood Medical, Elgin and Keith Medical Group who are early adopter practices. Other GP practices have now indicated an interest in developing this service and this will be facilitated by the IT Facilitators, the Pharmacy and Medicines Directorate and the Moray CHSCP Pharmacy team. Additional Pharmaceutical Care Services Additional Services are those locally negotiated with community pharmacy contractors at individual NHS Board level, but with reference to nationally agreed indicative benchmarks for both service specification and payment. NHS Grampian is currently reviewing the contract process for these Additional Services. The Pharmacy and Medicines Directorate Team, Primary Care Contracts Team, and Primary Care Redesign Team are working together to prepare a more standard method of defining, implementing, monitoring and paying for additional services. In view of this all of the services mentioned in the following paragraphs will be reviewed over the coming year. The services available currently within NHS Grampian are:


Domiciliary Oxygen Service With the transition of the supply arrangements for Domiciliary Oxygen to a single integrated national route, community pharmacies will no longer stock or provide oxygen cylinders as part of a Domiciliary Oxygen Service. A small number of pharmacies will, in the meantime, continue to hold a limited stock of oxygen cylinders as part of local contingency planning, should the national supply route fail. Community pharmacies providing this contingency service will be chosen on the basis of geographical accessibility and flexibility of opening hours i.e. to include a least one pharmacy with opening hours 7 days a week. Methadone Supervision and Provision The pharmacist supervises the consumption of methadone (a heroin substitute) on the pharmacy premises, or supplies methadone in set quantities defined by the GP or Substance Misuse Service for a patient to take home.

This service is widely available within Moray with no major geographical gaps. Generally there is availability for new service users when required. Service users in the Glenlivet / Tomintoul areas will to travel to avail themselves of this service.


Buprenorphine Supervision The pharmacist supervises the consumption of buprenorphine tablets (a heroin substitute) on the pharmacy premises.

This service is widely available within Moray, with the major geographical gap being Forres and only limited provision in Speyside, at Dufftown. Service users in the Glenlivet / Tomintoul areas will have to travel to avail themselves of this service.


Syringe and Needle Exchange The pharmacist supplies packs of clean needles and paraphernalia on request to clients and collects used needles and syringes for safe disposal.

There is limited availability of this service from community pharmacies in Moray. There is no pharmacy provision east of Elgin on the A96 corridor, and only limited availability in Speyside, in Dufftown. Service users in the Keith, Buckie/Cullen, Glenlivet / Tomintoul areas will need to travel to avail themselves of this service.


Palliative Care Network Pharmacists specifically trained in palliative care, provide service out of hours where required and maintain a set minimum stock of medicines used regularly to treat palliative patients. These pharmacies are known to the community nursing teams to ensure patients requiring urgent palliative medicines can be treated promptly.

This service is widely available within Moray, with only minor geographical gap being in Fochabers, but there is availability from Elgin, Buckie and Keith.


Influenza Vaccination Service Specially trained pharmacists provide influenza vaccination to at risk patients and NHS Staff under a Patient Group Direction (PGD) and Occupational Health agreement and to non-at risk patients privately.

There is limited availability of this service in Moray. Major gaps in provision are in Forres, Lossiemouth and Buckie, with limited availability in Speyside. However, it must be noted that all GP practices also provide influenza vaccination services.


Stoma Appliance Service All community pharmacies in Moray provide supply, customisation and delivery services on stoma products via a nationally agreed additional contract. Travel Medicine Clinics It is hoped this service will shortly be available from community pharmacies in Hopeman and Burghead. The pharmacist will provide holiday and travel medicine advice and treatment including vaccinations (with the exception of Yellow Fever) privately to patients requesting the service. Chlamydia Testing and Treat Services All community pharmacists in NHS Grampian can provide treatment for chlamydia for any person with a positive test result for chlamydia infection if the pharmacist is signed up to an azithromycin PGD. In addition, community pharmacies in Aberlour, Elgin, Keith and Lossiemouth provide a ‘test’ and treat’ service as part of a national pilot. The outcome of a review of this service is awaited to inform the continuation of this service by community pharmacies. Collection and delivery service Lhanbryde community pharmacy collects prescriptions from an agreed, distant, collection point within a particular area. The dispensed medicines are then delivered back to this point for collection by the patient within an agreed timeframe. Unscheduled Care Community pharmacies provide an important access route for people requiring unscheduled care, particularly during weekends and public holidays. One of the tools available to pharmacists is the National PGD for the Urgent Supply of Repeat Medicines and Appliances (CPUS). Community pharmacies can directly refer to local Out of Hours services when the patient requires a more specialist consultation with another healthcare professional.


CPUS Prescriptions Dispensed for Moray Patient Oct 11 - Sept 12

020406080

100120140160

Moray 1

Moray 2

Moray 3

Moray 4

Moray 5

Moray 6

Moray 7

Other G

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Other H

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Other S

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Contractor

No.

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363 CPUS prescriptions were dispensed for people registered with Moray GP’s by seven Moray community pharmacies over the period October 2011 – September 2012. A further 29 CPUS prescriptions were dispensed by community pharmacies elsewhere in Scotland. The three community pharmacies with the highest usage of this system are all located in Elgin.


Accessibility of Pharmaceutical Services Community pharmacy catchment areas and populations are not currently defined. Under current Pharmaceutical Care Services regulations for Scotland, services provision by contractors on the pharmaceutical list should be assessed within a defined ‘neighbourhood’. The NHS Board Pharmacy Practices Committee (PPC) determines the appropriate local area boundaries. However, there are no national standards for the number of community pharmacies required to meet the pharmaceutical care service needs of defined geographical populations, as this will vary depending on local factors including the size, structure and health-related characteristics of the population served and existing infrastructure such as transport networks. There is no target number of community pharmacies, either nationally or within NHS Grampian (or Moray). Other external influences on community pharmacy capacity to deliver services can include commercial and market factors, economies of scale or unavoidable costs, and cross-boundary flows. Importantly, an individual has the choice to access any community pharmacy for routine advice without appointment, and can register or transfer between contractors for specific care services. Previous Pharmaceutical Care Strategies for NHS Scotland 1, 2 suggest that an ‘average’ community pharmacy serves a diverse population of approximately 4,500 people including: • 1,000 people with long-term conditions, such as asthma, diabetes and hypertension; • 1,000 smokers; • 750 elderly people and 600 carers; • 200 people with physical or mental disability; • 300 children under 5; • 50 pregnant women; • 20 people suffering from cancer, of whom four are receiving active treatment and care; • 6 drug misusers; and • 2 people with HIV/AIDS. 1) Scottish Executive Health Department. The Right Medicine: A Strategy for Pharmaceutical Care in Scotland. Edinburgh: 2002. 2) Public Health Institute of Scotland. Pharmacy for Health: The Way Forward for Pharmaceutical Public Health in Scotland. Glasgow: 2002 Moray has 26 community pharmacies serving its population of approximately 90,000, approximately 3500 population per pharmacy, well within the Scottish average. Taking account of the four part-time pharmacies in Burghead, Hopeman, Findochty and Portknockie, the 24 whole time equivalent community pharmacies serve approximately 3750 people each.


Community pharmacies are geographically spread across all localities within Moray (see map below), focussing on the main centres of population. The only geographical gap in provision of pharmaceutical services is in South Speyside where the low density of population receives dispensing services from the Glenlivet Medical Practice and the Tomintoul branch surgery of Rinnes Medical Group.


Community pharmacies are required to open at certain times by their terms of contract to provide NHS pharmaceutical services. Detail of individual community pharmacy opening hours is detailed within the NHS Grampian Pharmaceutical list – attached to this document as an appendix. It should be recognised that the contracted hours may not necessarily be the actual hours of opening as the contracted hours represent the minimum service provision. Generally, community pharmacies in Moray provide services between 0900hrs and 1730/1800hrs Monday to Friday, many closing for an hour at lunchtime. Some community pharmacies close on a Wednesday afternoon. The four part-time pharmacies work as linked pairs – Hopeman with Burghead, and Findochty with Portknockie. Each pair effectively provide a full-time service over the paired sites. All community pharmacies in Moray provide a pharmaceutical service on Saturdays, but many close at lunchtime due to the lack of need for the services in their location on Saturday afternoons. Evening and Sunday pharmaceutical services in Moray are provided by a single contractor situated in an Elgin retail park. From the map below, it is apparent that the majority of the main population centres in Moray are within 30minutes travelling time of this contractor. Outwith community pharmacy opening times, GMed, the out of hour’s medical service, are able to provide medicines required to treat urgent acute conditions or a prescription which can be dispensed from a community pharmacy the following day.


Description of General Medical Service Provision in the NHS Board Area General Medical Services There are 14 GP Practices in Moray providing General Medical Services to the citizens of Moray. Two of these practices are dispensing practices, though one of the dispensing practices is restricted in the area in which it dispenses. The details of all the practices are given in the table below:


Practice Location Locality Population Dispensing? Maryhill Medical Practice

Elgin Elgin / Lossiemouth

15,026

Elgin Community Surgery


4,516

Linkwood Medical Practice


11,381

Moray Coast Medical practice

Lossiemouth Elgin / Lossiemouth

9,260

Ardach Medical Practice

Buckie Buckie / Fochabers

9,441

Seafield and Cullen Medical Practice

Buckie and Cullen

Buckie / Fochabers

5,076

Fochabers Medical Practice

Fochabers Buckie / Fochabers

4,006

Forres Medical Practice

Forres Forres 7,618

Varis Medical Practice

Forres Forres 7,833

Keith Medical Practice

Keith Keith & Speyside

7,337

Rinnes Medical Practice

Dufftown and Tomintoul

Keith & Speyside

3,000 Yes (Tomintoul only)

Aberlour Medical Practice

Aberlour Keith & Speyside

3,217

Glenlivet Medical Practice

Glenlivet Keith & Speyside

729 Yes

Rothes Medical Practice

Rothes Keith & Speyside

1,607

There is also a medical practice at RAF Lossiemouth with which Moray CHSCP maintain a link. Whilst this practice will look after the serving personnel in the RAF, their families and partners will be cared for by one of the above practices. An army regiment moved to Kinloss Barracks and the family and partners of this new regiment will be cared for by one of the above practices.


Relationship with Community Pharmacy The relationship between pharmaceutical and medical services is strong and the location of GP practices has historically played a significant influence over the geographical location of community pharmacies. The manner in which the contracts for each of the contractor groups are now being developed indicates the need for a much more integrated approach across all primary care contractors. This pharmaceutical care service plan will take cognisance of the location of general medical services and what services are provided. Dispensing practices For the vast majority of patients in NHS Grampian, medicines are prescribed by GPs (General Practitioners) and dispensed by community pharmacists (local chemists). The NHS (General Medical Services) (Scotland) Regulations allow for the provision of arrangements for supply of drugs and appliances to be undertaken by doctors where the Board, after consultation with the Area Pharmaceutical Committee, is satisfied that ‘ a person, by reason of distance or inadequacy of means of communication or other exceptional circumstances, will have serious difficulty in obtaining from a pharmacist any drugs, not being scheduled drugs, or appliances required for his treatment under these Regulation.’ In these cases the NHS Board can require the general medical practice that is responsible for the treatment of the person to supply drugs and appliances to that person until further notice. In Moray this arrangement is applied to Glenlivet Medical Practice and the Tomintoul branch of the Rinnes Medical Group. Both these locations serve small rural areas which do have sufficient population to support a community pharmacy. The Primary Care Integrated Management Group agreed in June 2012 that a review of existing NHS Board arrangements for dispensing by GP practices in Grampian should be undertaken as part of the CHP led PCSP process.

Analysis of Pharmaceutical Needs Within the Moray CHSCP The Need for Additional Premises Moray is well provided for in terms of community pharmacy premises according to population – approximately 3750 people per community pharmacy is well within the Scottish average. This is on the proviso that it is acceptable to have to travel 20 minutes by road to access a community pharmacy. Due to this provision, it is unlikely that Moray Council current anticipated housing and infrastructure developments would result in the need for any additional community pharmacy contracts. Ground zoned for housing developments are principally in Elgin, Forres and Buckie which are all geographically well served by community pharmacies. It may, however, be appropriate for a community pharmacy to consider relocation in order to provide an improved service to these developing areas.


The Need for Additional Pharmaceutical Services from Existing Providers Core Services Provision of extended hours pharmaceutical services must be kept under review. Only one community pharmacy within Moray currently opens after 6pm during the week, and provides a Sunday service. The majority of the Moray populace are within a 30 minute drive of this community pharmacy, but some areas of the Forres, Buckie/Cullen and Speyside localities are out with this limit. Consideration should be given to investigating extended pharmacy opening hours with colleagues in Aberdeenshire and NHS Highland, Nairn area where perhaps joint working would benefit our populations. The minimum rate at which the Chronic Medication Scheme is being introduced is being determined by the Scottish Government. The majority of community pharmacies within Moray are maintaining this level of progress. Patients are being registered and the newer aspects of the scheme – high risk medicines and new medicines provide opportunities for community pharmacies to benefit patients by working more closely with GP’s. The serial dispensing aspect of CMS is being rolled out within Moray at rates dependant upon the community pharmacies and GP practices. Systems of improved communication, both electronic and personal, are developing to support this initiative. When the process is consistent and robust, review of patient benefit is required to ensure that all patient populations, geographical and disease based, can access the scheme if they desire.

It is the intention of Moray CHSCP to appoint a Community Pharmacy Clinical Lead to work closely with CHSCP management and the Pharmacy & Medicines Directorate (P&MD) to provide professional and clinical leadership/support to community pharmacies. In addition, it is intended this post will co-ordinate the overall development of community pharmacy services within the CHSCP, focussing on the implementation of the Community Pharmacy Contract specifically in relation to the Chronic Medication Service.


Action Plan

Topic

Actions Timescale

CMS - serial dispensing Share learning from early adopter practices with other practices in Moray

Work with IT Facilitators to

introduce prescribing/serial dispensing across Moray

In conjunction with

Pharmacy and Medicines Directorate, review impact of serial dispensing on community pharmacy workload

• Develop Moray strategy for

high risk and new medicine aspects of CMS.

April 2013 December 2013 March 2014 • March 2015

Community Pharmacy Clinical Lead

Develop a role profile Recruitment process to be

agreed with NHSG CHP colleagues

Agree contingency funding

should SG pharmacy champions funding be withdrawn

Appoint to post and

support personal development

February 2013 March 2013 • March 2013 • Review March 2014

Public Health activities Review PH activities delivered from community pharmacies and other health care providers with PH colleagues.

identify any gaps in service

and deliver action plan

October 2013 March 2014


Topic

Actions Timescale

Medicines Management for Care at Home Workers

Continue to work with Elgin / Lossiemouth council colleagues to simplify documentation

Refresh provision of

service in Speyside locality Introduce service to Forres

locality Identify additional funding

to enable CP payments for provision of MAR sheet by CP

May 2013 May 2013 October 2013 July 2013

Scottish Patient Safety Initiative

Provision of information to CPs

Updates on progress within

GP practices Roll out to CP

Apr-May 2013 Ongoing from Sep

2013 TBC depending on

pilot work being undertaken elsewhere

Health promotion Work with PH colleagues to develop culture of each CP patient contact being a health promoting opportunity

March 2014

Travel Vaccines Explore delivery of travel vaccine service from community pharmacy using independent prescriber status.

March 2014

nhs pharmaceutical care services planning...nhs pharmaceutical care services planning moray...

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