Health and Social Care Committee

Inquiry into the contribution of community pharmacy to health services in Wales

CP 19 – The Princess Royal Trust for Carers

The inquiry into the contribution of community pharmacy to health services in Wales

Response from The Princess Royal Trust for Carers, September 2011

1. Background

The Princess Royal Trust for Carers is the largest provider of comprehensive carers support services in the UK. Through its unique network of independently managed Carers’ Centres and interactive websites – www.carers.org and www.youngcarers.net - the Trust currently provides quality information, advice and support services to carers of all ages, groups and communities. This consultation response is based on the combined experience and knowledge of The Trust and its carers centre network here in Wales which currently supports over 22,000 carers.

2. Key Issues

Carers need to be recognised in all areas of society as partners in care. This will only ever be possible if at every stage in a carers journey they are recognised, identified and given the information they need to enable them to care in a manner that is both dignified and, where possible, aims to minimise any negative impact on their own health and well-being. Community pharmacists are a key player in achieving this aim for several reasons:

• They are a frontline provider, readily available and easily accessible.
• They hold key information on medicines & medication that carers may have sole responsibility for administering.
• They are experts in health knowledge and are well known primary care campaigners & educators, which is invaluable to carers both in their caring capacity and also as potential patients themselves.

Regarding the effectiveness of the Community Pharmacy contract in enhancing the contribution of community pharmacy to health and wellbeing services:

As part of the Community Pharmacy Contract, pharmacists have the following responsibilities to patients:

To ensure patients are able to use their medicines and appliances effectively, by;

· Pharmacy staff providing information and advice to the patient² on the safe

use of their medicine or appliance;

· Pharmacy staff providing when appropriate broader advice to the patient

on the medicine, for example its possible side effects and significant

interactions with other substances.

² For patient where appropriate read patient’s carer

What is not clear is whether the reference to ‘patient’ is co-terminus with the ‘patient’s carer’ in respect of all of the duties within the contract. The first point does make this distinction, but whether this applies to the remainder of the duties is in doubt. Certainly this subtle reference needs to be made much clearer together with details of how this can be achieved given that currently there are no universal system in places by which to identify patient carers. 

Under the essential service specifications there is scope not only to provide advice and information to carers re: medicines but crucially also to signpost & enable support for self care. Unfortunately the feedback from Carers Centres in Wales seems to suggest this is not common practice with centres repeatedly reporting poor engagement from community pharmacies. Several Carers Centres[1] have initiated pharmacy projects to increase carer awareness, working to help champion carers in community pharmacies in much the same way that is being done in GP surgeries and  with some success

The Trust would recommend the contract be strengthened to achieve maximum impact for patient and their carers by:

· Developing a clear patient carer identification and referral process

· Ensuring carers are offered medicine management training where necessary

· Initiating medication reviews and including carers as potential beneficiaries

· Targeting carers via Public health campaigns and referring to health & well-being services

· Signposting to local carers centres for further advice and support

With regard to questions 2-5 concerning the scope & scale of pharmacy services:

Given the scope and breadth of the consultation, it is vital that the role of community pharmacies in identifying and referring carers is recognised & utilised. The role of carers and community pharmacies, as with all health & social care, is mutually dependant. Carers need accurate and timely information, support and advice to help care for their loved ones, e.g. advice and support on medicine management and chronic conditions as well as their own health & well-being.

As noted in the recent report by The Princess Royal Trust for Carers ‘always on call, always concerned’ – carers’ health, particularly older carers, is significantly impaired due to caring responsibilities. Many of these carers, whilst they may fail to contact a GP for their own needs, will be in regular contact with their pharmacist e.g. collecting repeat prescriptions, over the counter self-help treatments. This is a prime opportunity, not only to identify carers, but offer advice and signposting.

Carers Centres would be keen to work with pharmacies and their staff to put in places strategies for identifying more carers, more effective signposting/referring on for help, for how medication reviews and other key interventions could help carers and those they care for, and how better links could be made between carers centres and pharmacy staff.

There are a few carers centres in mid and South Wales that have pharmacy projects working to help champion carers in much the same way that is being done in GP surgeries but it is very patchy. Anything we can do to plug the gap and make it easier for carers both in identifying them and ensuring pharmacists are more carer aware has to be explored. Details of pilot projects, including outcomes, are available on request.

Community Pharmacies Manifesto

“Community pharmacies will be a vital component in the delivery of modern, cost-effective, fit-for-purpose, outcome driven health and social care services in Wales.”

The Trust is in agreement with the manifesto’s aims and is in agreement with the premise that a network of community pharmacies – a community based Good Health network - is fundamental to achieving that outcome. What is missing or needs to be explored further is the extent to which community pharmacies can support carers of patients and carers who are patients and models for doing so. If the role of carers was recognised and advice/support/signposting were easily accessible, the additional ‘savings’ and human cost of caring would be significantly improved.

Points raised in the Manifesto pertinent to carers include:

· Medicines Management

· Chronic conditions management

“research has shown that between 30% and 50% of other patients fail to take their medicines correctly or are otherwise noncompliant with their prescribed medicines regime. This often results in unnecessary hospital admissions and other interventions, which costs the NHS in Wales almost £10million a year”.

The Trust would advocate introducing regular medicine & chronic conditions management training for carers by their local pharmacist and/or given 1:1 advice and support. Without carer recognition this advice and information is often overlooked which is not only negligent but could also be fatal – the Full of Care report commissioned by the Children’s Commissioners Office in 2009 reported that whilst young carers had a good understanding of the medical conditions and diagnosis of those that they cared for – many were directly involved in the treatment of these conditions. However many young carers also reported a lack of specific training in administering medication and understanding its effects. Of those polled 50% had administered medication yet a staggering 73% had been offered no training.

3. Other issues to consider:

Carers Strategies (Wales) Measure:

“The primary purpose of the Strategy is to ensure that carers receive appropriate information systematically to give practical effect to the requirement on the NHS to work with carers as key partners in the care management process and particularly at key stages of the patient/carer journey.  The Ministerial power to require the development of Information Strategies for carers seeks to deliver systematic carer identification and provision of information to carers, based on existing good practice.”

As part of the key community based services identified in the Measure, hospital and community based pharmacists will have a crucial role to play in ensuring that carers are identified and provided with information at first point of contact.  

The regulations are very prescriptive about the type of information carers will need and this includes, but is not restricted to, information about medication and, where appropriate, potential side effects. It also governs training & signposting all of which are within the scope of community based pharmacies. 

4. Supporting Evidence

There are 15 million people in England with longer-term health needs – a large and growing group. Many of these people – and their carers – will be regularly returning to their local Community Pharmacy to pick up repeat prescriptions.

The Princess Royal Trust’s research in Scotland - Focus on Carers and the NHS – identifying and supporting hidden carers: Good Practice Guide (71 KB) quotes the following statistics:

"600,000 people a day use the services of the 1150 pharmacies in Scotland. Of those collecting prescription medication, it is estimated that 80% will be for repeat prescriptions. It is also likely that a substantial number of these repeat prescription will be collected either for or by carers, thus placing community pharmacists in a pivotal position to establish contact with carers."

In summary

The importance of community pharmacies as information points hasn’t as yet been fully explored across Wales. Carers Centre and The Trust would be keen to work with pharmacies and their staff to put in places strategies for identifying more carers, more effective signposting/referring on for help, for how medication reviews and other key interventions could help carers and those they care for, and how better links could be made between carers centres and pharmacy staff.

Response prepared by:      Gill Winter

North Wales Development Manager

On behalf of:                         The Princess Royal Trust for Carers

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