Health and Social Care Committee
Inquiry into the contribution of community pharmacy to health services in Wales
CP 29 – Age Cymru
Consultation Response
Inquiry into the contribution of community pharmacy to health services in Wales
Health and Social Care Committee
September 2011
Introduction
Age Cymru is the leading national charity working to improve the lives of all older people in Wales. We believe older people should be able to lead healthy and fulfilled lives, have adequate income, access to high quality services and the opportunity to shape their own future. We seek to provide a strong voice for all older people in Wales and to raise awareness of the issues of importance to them.
We are pleased to respond to the Health and Social Care Committee’s inquiry into the contribution of community pharmacy to health services in Wales. We are not in a position to provide evidence on all the areas identified by the Committee in its call for evidence; however we have outlined the areas in which we believe there is potential to further develop the services offered by some community pharmacies, which are of benefit to older people.
We believe there is significant scope to further develop the provision of health services by community pharmacies, in addition to the essential services within the current NHS Community Pharmacy service (such as dispensing of NHS medicines and appliances). In particular we feel that increasing the provision of advanced and enhanced services in community pharmacies would benefit older people by ensuring services are delivered within communities and are easily accessible.
In particular we believe that would be value in extending services in the following areas:
Minor ailments schemes
Age Cymru believes that there is the potential for community pharmacies to deliver minor ailments schemes in a way which beneficially reduces pressure on GPs and improve access and choice for patients. A shift towards providing more identification and treatment of minor ailments in community pharmacies could reduce pressure on GP appointments and therefore improve access for patients with more severe health conditions. This will require greater commissioning of such services by local health boards, increased referral by GP surgeries so that they can better prioritise GP and nurse appointments, and improved public awareness of the services which can be provided by community pharmacies.
Statistics from Community Pharmacy Wales[1] indicate that an estimated 5 million GP consultations every year concern minor ailments that could be dealt with at a pharmacy in Wales. An independent review concluded that almost 40% of these consultations could have been effectively handled in a community pharmacy. Research has also indicated that if patients with minor ailments were seen by their pharmacist instead of their GP, then potentially £30 million could be saved by the NHS in Wales each year.[2]
Managing chronic conditions
Wales has the highest rates of long-term limiting illness in the UK, accounting for a large proportion of unnecessary emergency admissions to hospital.[3] We believe that community pharmacies already play a significant role in supporting people living with chronic conditions through medicines management services combined with regular monitoring and support, but that this could be used in a more consistent and comprehensive way. Community pharmacies could be fully integrated into chronic conditions pathways providing easily accessible facilities for testing a range of morbidities, delivering flu vaccinations, supporting people living with diabetes, heart disease and respiratory conditions.
Flu vaccination
Older people (65+) are a key target group for the Welsh Government’s ‘flu vaccination programme. However much more needs to be done to improve and facilitate improved take-up of the free vaccination during winter. During winter 2010/11 take-up of the winter ‘flu vaccine amongst over 65s was 65.7%, short of the 70% target. Take-up by other at risk groups was substantially lower.[4]
It is quite possible that take-up of the ‘flu vaccine could be improved if it was made available through community pharmacies who have regular contact with many of those in at risk groups. We believe that the Welsh Government should explore the potential for enabling community pharmacists to administer the seasonal ‘flu vaccine to at risk groups under the NHS.
Hospital discharge
Over a long period of time Age Cymru has heard many examples of poor practice in relation to the discharge of older people from hospital. A frequent concern relates to older people being discharged without a suitable after-care package in place (including medication reviews), sometimes with an assumption that the family will provide support. A lack of support, including in medication management, can result in side-effects, deterioration of patient’s conditions and hospital re-admission.
As a result we would support a much greater role for community pharmacy in hospital discharge and after-care, and greater publicity around the role that a community pharmacist can play in providing regular medication reviews. In Wrexham, a community pharmacy-based pilot scheme involving medicines information exchange on patient discharge from hospital resulted in clinically significant interventions in 19% of patients.[5] There is also greater scope to be explored in the role of community pharmacy in the management of medication in care homes.
We are supportive of the Post Discharge Medicines Service, which is currently under Welsh Government consideration as a new advanced service to be delivered by community pharmacy.
Preventative measures
Many community pharmacies already deliver a range of routine health checks and preventative advice and services (defined as enhanced services in the NHS Community Pharmacy services agreement). These include:
- blood pressure testing
- cholesterol testing
- blood sugar level testing
- sexual health advice services
- vascular health checks
- obesity and weight management advice
- support services and medicine reviews.
Age Cymru welcomes in principle the Welsh Government’s pledge that everyone aged over 50 in Wales should receive a free annual health check. We believe that annual health checks for older people can support a greater emphasis on prevention and early intervention within health services. With regular ‘MOTs’ health issues can be identified, monitored and treated at an earlier stage before they become more severe and require more intensive treatment.
We do, however, need to see greater detail on the practicalities of such a scheme and how this will impact on current capacity and workload within the NHS. Older people in many areas of Wales are already concerned about the difficulty they face in accessing GP appointments and capacity concerns could increase still further with the likelihood that regular checks lead to the identification of more conditions and greater pressures on all health services. We believe that community pharmacies could play an important role in mitigating some of these concerns by further developing their capacity and scope for undertaking many routine tests. These will identify whether someone requires a more in depth consultation with a nurse or GP.
Conclusion
We believe there is scope for community pharmacies to make a greater contribution to health services in Wales in a way which will be of benefit to older people. In addition to the specific services and opportunities identified above, we believe that further work is also needed to raise the profile and awareness of services which are available from pharmacies, as people are often simply unaware of the services they can access at their local pharmacy.
We hope that these comments will prove useful to the Health and Social Care Committee and would be more than happy to provide any further information as required.