Northern Ireland’s health crisis: can pharmacists relieve the pressure on GPs?
The growing pressure on primary healthcare services is reported in the media on an almost daily basis – a key reason being that people are living longer, often with chronic and complex healthcare needs. This article looks at how an enhanced role for community pharmacists in health promotion and medicine management is intended to help deliver the vision for healthcare delivery in Northern Ireland over the next ten years.
Reviews of general healthcare delivery in Transforming Your Care (TYC) in 2011, and the Donaldson Report in 2014, recognised that an enhanced role for community pharmacies could ease some of the pressures on primary care services, particularly in managing patients with long-term conditions. A key proposal of TYC was for an ‘expanded role for community pharmacy in the arena of health promotion both in pharmacies and in the community.’
The report of an expert panel led by Professor Bengoa in 2016 concluded that if the healthcare system resisted change, services would continue to deteriorate and eventually collapse. Transforming the system will involve working to create a modern and sustainable service that helps people to stay as healthy as possible and provides the right type of care when and where it is needed. Particularly within primary care there is a need to move from the predominantly GP-led model of care to a more blended approach:
…Our future model of primary care is to be based on multidisciplinary teams embedded around general practice. The teams will work together to keep people well by supporting self-management and independence, providing proactive management of high risk patients…. These teams will include GPs, Pharmacists, District Nurses, Health Visitors, Allied Health Professionals and Social Workers, and new roles as they develop, such as Advanced Nurse Practitioners and Physician Associates.
The Health Minister at the time, Michelle O’Neill, published Health and Wellbeing 2026, Delivering Together in October 2016, which is the outworking of the expert panel’s recommendations.
What do local pharmacies offer?
Although many people in Northern Ireland (NI) visit their local pharmacy regularly, they are often unaware of the full range of services community pharmacies are able to offer. Apart from advice and treatments for minor ailments, some offer a range of services that include checks for blood pressure, cholesterol and blood glucose levels, pregnancy testing, sexually transmitted infection services, and a smoking cessation service.
For over a decade Building the Community-Pharmacy Partnership (BCPP) has been running projects throughout NI. Projects funded under the programme involve local community and voluntary organisations partnering with a local pharmacy to deliver advice and training in managing personal health and wellbeing. Projects take account of wider impacts on public health such as socio-economic factors, educational attainment, employment and housing. Community pharmacy-partnership projects have been developed to address a range of issues working with early years, women’s and older people’s groups, and addiction and mental health programmes. The projects aim to increase skills, encourage community activity, provide knowledge of health issues, develop self-help strategies, and encourage and equip local people to promote health and wellbeing in their wider community.
In 2014 a five-year strategy, ‘Making it Better Through Pharmacy in the Community’ provided a clear direction for the delivery of pharmacy services, enabling pharmacists to play a greater role in supporting GPs, managing medicines, and contributing to the health and wellbeing of local communities.
Pharmacists in GP practices
Additional investment in the health service in NI proposes to provide pharmacists to work alongside GPs. By 2020 it is intended to have approximately 300 pharmacists based in GP surgeries. Giving GPs access to a practice based pharmacist will improve safety in prescribing and allow GPs to have more time to spend with patients.
Some medicines that could only be administered in hospitals can now be managed in a patient’s home due to advances in the design of medicines and technology. In the future a key driver for closer integration of pharmacists in the community and primary care services will be the growing complexity of medicine. For example, stratified medicine is a developing concept that uses medicines tailored to an individual patient’s genetic make-up leading to specific targeting of drug treatment.
A recent innovation in NI has been the introduction of the Health+Pharmacy. Managed by the Health and Social Care Board (HSCB) and Public Health Agency (PHA), it recognises the important role pharmacies play in keeping communities healthy. Health+Pharmacies will display a sticker and certificate and have a ‘health and wellbeing advisor’.
By the end of January 2017, there were 21 accredited Health+Pharmacies in NI. When the scheme was launched in early 2015, the then Health Minister Simon Hamilton said, ‘…We cannot afford to stand still and must continue to look for opportunities presented by new models of care, such as Health+Pharmacy, that will support people to manage their own health.’
To be accredited Health+Pharmacy status, a pharmacy must demonstrate it meets sixteen separate quality standards relating to public health. These include having suitable premises where people can speak confidentially to a member of staff, carrying out staff development, and working with a range of organisations to support health and wellbeing in the local community.
The role of staff in Health+Pharmacies will not be confined to the community pharmacy. Information and advice will also be taken out into community settings such as schools, organisations supporting young mothers, and community groups. Advice can be offered on a range of public health issues including childcare, smoking cessation, addiction issues, or obesity and nutrition. Health+Pharmacies will also signpost people to other health services or support organisations.
Pharmacists already, and will continue to, play a more prominent role in delivering a healthcare service that allows people to be treated nearer to home, manage often complex medicines effectively, ease pressures on GP services, and improve community health. A Memorandum of Understanding (MoU) was approved by the Health Minister Michelle O’Neill in January 2017 between the Department of Health (DoH), the Health and Social Care Board (HSCB), and Community Pharmacy NI (CPNI). The MoU sets out a shared commitment for the three parties to engage in negotiations aimed towards developing a new framework for community pharmacy services by the end of March 2017.
The capacity already exists in community pharmacies to support primary care services. By raising public awareness of the services already available, pressures on primary care could be eased. Pharmacists working closely with GPs in prescription management and medication reviews will mean GPs having more time for those in most need. With an increasing complexity of medical conditions and treatments, pharmacists in surgeries with access to patients’ records will be able to review medications for those with long term conditions to ensure patients are getting maximum benefits from their prescribed medication.