Community Pharmacy Future
Four-or-more medicines support service
Update on progress and next steps
Approved
This version
18th June 2012
6th July 2012
For amendments, please contact Jonathan Buisson, Alliance Boots
Private and confidential
Community pharmacy future – why are we doing this?
• NHS commissioners are changing focus and looking to providers (including
community pharmacies) to demonstrate that they are making real improvements to
patient outcomes.
• Evidence of better outcomes will influence future commissioning and funding.
• The Community Pharmacy Future project, which is being funded by the four largest
pharmacy multiples, is aiming to demonstrate how community pharmacies can make
a difference to patients using medicines for long-term conditions, in ways that are
complementary to other NHS services.
• The results from the planned pharmacy implementation phase will be evaluated by
health economists to show the benefits that can be derived.
• The new NHS Commissioning Board will control the community pharmacy contract for
England from April 2013.
• Our objective is to gather powerful evidence that will convince the Board to
commission new national services through community pharmacies.
• Our work will also inform the development of pharmacy services outside England.
Private and confidential
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Four-or-more: why we selected this pathway
Persons aged over 65 years old taking four-or-more medicines (Four-or-more)
• Patients in this group may have more than one long-term condition
• They make extensive use of NHS resources but may not be getting optimal use from
the medicines they have been prescribed
• Care of people with long-term conditions accounts for 70% of health and social care
budget
• The Department of Health is developing its strategy for long-term conditions
• There are large opportunities for reducing medicines waste in this group
• We have developed STOPP START criteria that focus on prescribing for older
persons
These patients already extensive users of pharmacies, but the pharmaceutical care
they receive may not be optimal for delivering the best outcomes
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STOPP START criteria
STOPP – Screening Tool of Older Persons’ potentially inappropriate Prescriptions
65 indicators relating to drug interactions and therapeutic duplication
START – Screening Tool to Alert to Right (appropriate, indicated) Treatment
22 indicators of common prescribing omissions
• Clinically-validated, evidence-based indicators for appropriate prescribing in over-65s
• Developed and trialled by Cork University Hospital and University College Cork1
• Produces significant and sustained improvements in prescribing appropriateness
The four-or-more service uses 31 STOPP criteria and 2 START criteria
This selected sub-set of STOPP START indicators is appropriate for interventions made
by community pharmacists using the clinical data from their own patient records
1. Gallagher, PF et al. Prevention of potentially inappropriate prescribing for elderly patients: a randomised controlled trial using
STOPP/START criteria. Clin Pharmacol Ther 2011; 89: 845-54.
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Four-or-more: the patient’s journey through the year
Patient
recruitment
and initial
assessment
Patient enrols onto the service – this can be via the pharmacy or by healthcare professional
referral. Baseline information is collected and the patient is issued with a ‘patient personal record’
which details the patients repeat medication and due dates. The baseline information also allows
the pharmacist to decide whether the patient would benefit from any public health services
including smoking cessation and weight management.
Pharmacist reviews the patients medication in line with the STOPP START rules and discusses
potential issues with the patient’s GP. Pharmacist also identifies whether the patient requires any
specific support in relation to their medicines, eg, falls risk or pain management, and schedules a
follow up where required.
Regular
assessment
Patient collects their prescription regularly. The pharmacist carries out a quick review checking for
any signs of compliance issues.
Any changes to medication are reviewed in line with the STOPP START rules.
Annual
medicines
use review
Each year the pharmacist will schedule an appointment with the patient to carry out a medicines use
review. This will incorporate a more detailed conversation around the use of medicines and will
identify any medicines use issues. Where appropriate further support will be provided to help
achieve compliance. An action plan will be agreed and where considerable medicines issues arise
regular follow-up will be scheduled. If appropriate a MUR with the patient’s carer will take place to
help aid medicines administration.
Annual
assessment
12 months post recruitment an annual assessment is carried out with the patient. Outcomes
measures will be recorded and certain measures such as smoking status will be retaken. If
appropriate to the time of year, seasonal issues will be discussed including vaccination.
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Pharmacy implementation – next steps
• Four-or-more – Wigan Borough area (c30 pharmacies)
• Area chosen after analysis of demographic data
• Implementation to start from 17th September 2012 for an initial six months
• The service has been presented to the Local Pharmaceutical Committee
• Local NHS organisations, local authorities and clinical groups are being engaged
• There will be full training for our pharmacy teams prior to launch
• Further details will be shared as they are available
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Contact details
For Boots:
Kath Gulson (T: 07834 497427; E: [email protected]
For the Co-operative Pharmacy
Catherine Cox (T: 07713 315065; E: [email protected])
For Lloydspharmacy
Shaun Fernandes (T: 07795 335581; E: [email protected])
For Rowlands Pharmacy
Nicky Grundy (T: 07717 580889; E: [email protected])
Private and confidential
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