THE DEVELOPING ROLE OF PHARMACY IN MANAGING CVD HELEN WILLIAMS FFRPS, FRPHARMS, PGDIP (CARDIOL), IPRESC CONSULTANT PHARMACIST FOR CVD, SOUTH LONDON CVD CLINICAL LEAD, LAMBETH AND SOUTHWARK CCGS CLINICAL DIRECTOR FOR ATRIAL FIBRILLATION, HEALTH INNOVATION NETWORK
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THE DEVELOPING ROLE OF PHARMACY IN MANAGING CVD
HELEN WILLIAMS FFRPS, FRPHARMS, PGDIP (CARDIOL), IPRESC
CONSULTANT PHARMACIST FOR CVD, SOUTH LONDON
CVD CLINICAL LEAD, LAMBETH AND SOUTHWARK CCGS
CLINICAL DIRECTOR FOR ATRIAL FIBRILLATION, HEALTH INNOVATION NETWORK
WHY PHARMACY?
• NHS frontline services struggling to cope with increasing demand
• GP numbers falling, HCPs leaving the NHS, funding cuts….
• Pharmacy is the only healthcare profession with predicted oversupply by 2025
• No cap on training places – increasing numbers of pharmacy schools and pharmacists in training
• Extended roles embedded in acute care – opportunity to utilise skills in new settings
• Medicines optimisation will deliver improve outcomes, reduce demand, save £££
DID YOU KNOW…..?
• CVD is still the most common cause of premature mortality
• CHD alone accounts for >43,000 deaths per annum in the UK
• One in every THREE prescriptions issued is the UK is for a CV drug
• We spend £1.2billion on CV drugs each year
• Half of all CV drugs are probably never taken as prescribed
• Strategies to improve adherence to drug therapies would have a bigger impact on outcomes then any new medical advance
ROLE OF PHARMACY IN CVD
1.Community pharmacy
2.GP practice-based pharmacists
3.Clinical Leadership
WHY USE COMMUNITY PHARMACY?
• Available on the high street & in supermarkets
• 99% of patients can access a pharmacy within 20 minutes by car and 96% by walking or public transport
• Longer opening hours, evenings and weekends
• Usually no appointments necessary – this may have to change!
• Most adults in the UK use pharmacies
• 84% of adults visit pharmacy at least once per year, 75% have visited within the last 6 months; most visit for health-related reasons
• = 1.6million visits to UK pharmacies daily
• = an average of 16 visits per user per year
• In London alone there are 1,800 community pharmacies
COMMUNITY PHARMACYOPPORTUNITIES
• DETECTION:
• NHS Health checks: Hypertension, diabetes, high CV risk
• AF case-finding using new technologies
• MANAGEMENT:
• Health Living Pharmacies, smoking cessation, weight management programmes, lifestyle advice & signposting
• Pharmacist prescribers managing LTCs – hypertension, anticoagulation in AF
• Adherence support – New Medicines Service / Medicines Use Review
New Medicine Service (NMS)
Improve adherence10%
PHARMACISTS IN GENERAL PRACTICE
General practice provides safe, high quality and efficient care, with very high levels of patient satisfaction. It has a unique and vital place in the NHS…
Accessible, personal care built on a relationship from cradle to grave
Community based responsible for prevention and care of a registered population
Holistic perspective understanding the whole patient not just a disease
Comprehensive skills to diagnose & manage almost anything
Personal and population-orientated primary care is central …
if general practice fails, the whole NHS fails. Simon Stevens, General Practice Forward View
First port of call and
central point of care
for all, for life
#GPforwardview
The problems
www.england.nhs.uk
• Launched in November 2015
• Investment of £31.5 million over three years
• In February 2017: >490 pharmacists in >650 practices across 90 pilot sites
• Deadline for practice involvement in pilot has ended.
• Evaluation
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Clinical pharmacists in General Practice Pilot
www.england.nhs.uk
The role of pharmacists in general
practice
13
Clinical patient facing
roles
Long term conditions
Clinical Medication
Reviews
Home visits/care homes
Others: common ailments,
care plans, triage
Clinical Post/Pathology
Checking and reviewing
Action
Signposting/triage
Medicines optimisation
Repeat prescribing
Medicines
queries/requests
Liaising with others
Patient safety
Reducing admissions
Signing prescriptions
Productivity and access
Leadership/Management
Research
Health and social care
Vulnerable population
QOF/DES/LES
Extended hours
OOH
Medicine support
Telephone
Medicines related issues
Discharge/ reconciliation
Medicines information
Clinical effective audits
CQC
Education for staff
Integration
Further integration of GP
with primary and
secondary care
Community Pharmacy
Hospital pharmacy
Southwark Snapshot: Pharmacist Interventions in more detail