The Pharmacist’s roleThe Pharmacist’s role
In the delivery of Diabetes careIn the delivery of Diabetes careAnd the NSFAnd the NSF
Irene GummersonIrene Gummerson
Pharmacist with a Special Interest in DiabetesPharmacist with a Special Interest in Diabetes Member of the Diabetes UK Advisory CouncilMember of the Diabetes UK Advisory Council
Drivers for ChangeDrivers for Change
Government:Government:– Wants better valueWants better value
‘ ‘Pharmacists under-used’Pharmacists under-used’– ‘‘Choice, access, responsiveness & equity’Choice, access, responsiveness & equity’
NHS Pharmacy PlanNHS Pharmacy PlanChoosing Health through PharmacyChoosing Health through PharmacyVision for PharmacyVision for PharmacyNew Contract New Contract Other national & local policy documentsOther national & local policy documents
Drivers for ChangeDrivers for Change (Contd)(Contd)
Profession bodiesProfession bodiesRPSGB, PSNC, NPARPSGB, PSNC, NPAOther Professions Other Professions
Diabetes UKDiabetes UKPharmacy Diabetes Network Pharmacy Diabetes Network
Pharmacists Pharmacists Hospital, Community, PCT, GP practiceHospital, Community, PCT, GP practicePhwSIsPhwSIs
National Service Framework National Service Framework (NSF for Diabetes)(NSF for Diabetes)
Standards for Diabetes Services Standards for Diabetes Services (2001)(2001)
Std.1Std.1 Prevention of Type 2 diabetesPrevention of Type 2 diabetesStd.2Std.2 Early Identification (Screening)Early Identification (Screening)Std.3Std.3 Empowerment Empowerment Std.4/5/6Std.4/5/6 Clinical care of adults/ childrenClinical care of adults/ childrenStd.7Std.7 Management of diabetes emergenciesManagement of diabetes emergenciesStd.8Std.8 Care during admission to hospitalCare during admission to hospitalStd.9Std.9 PregnancyPregnancyStds.Stds.10/11/12 Detection/management of L.T. complications10/11/12 Detection/management of L.T. complications
NSF Delivery StrategyNSF Delivery Strategy (2003)(2003)
To achieve the Standards by 2013:To achieve the Standards by 2013:
Clinical diabetes networksClinical diabetes networks
Workforce planning & developmentWorkforce planning & developmentPCTs to assess training needs PCTs to assess training needs
NSF - Standard 1NSF - Standard 1Reducing Risk Of Type 2Reducing Risk Of Type 2
Health Promotion Health Promotion – raising awareness of benefitsraising awareness of benefits
Primary and secondary carePrimary and secondary care
Posters/ LeafletsPosters/ LeafletsVerballyVerbally
Opportunistic/ ReactiveOpportunistic/ ReactiveMedicines review, MURMedicines review, MUR
NSF - Std 1 NSF - Std 1 Reducing Risk Of Type 2Reducing Risk Of Type 2
Health Promotion Health Promotion
– Healthy eating Healthy eating – Increasing physical activityIncreasing physical activity– Stopping smokingStopping smoking
Be organisedBe organisedHave the ‘tools’ readyHave the ‘tools’ ready
New Contract & Std.1New Contract & Std.1 Reducing Risk Of Type 2Reducing Risk Of Type 2
Essential ServicesEssential ServicesPublic Health: health promotionPublic Health: health promotion
– 6 campaigns6 campaignsSignpostingSignposting
Enhanced ServicesEnhanced ServicesWeight management clinicWeight management clinic
NSF - Standard 2NSF - Standard 2Early IdentificationEarly Identification
‘‘When community pharmacists….. see When community pharmacists….. see people with symptoms suggestive of people with symptoms suggestive of diabetes, diabetes, they should advise them to see their GP they should advise them to see their GP for diagnostic testing’for diagnostic testing’
NSF - Standard 2NSF - Standard 2Early Identification Early Identification
‘‘..there is currently uncertainty as to what ..there is currently uncertainty as to what is the best way to identify people with is the best way to identify people with undiagnosed asymptomatic Type 2 undiagnosed asymptomatic Type 2 diabetes..’diabetes..’‘‘..targeted..’..targeted..’‘‘..combined with CVD.’..combined with CVD.’
NSF - Standard 2 NSF - Standard 2 Early IdentificationEarly Identification
RPSGB guidance RPSGB guidance – Essential PracticeEssential Practice
Monitoring OTC sales – support staffMonitoring OTC sales – support staff
New ContractNew Contract– Enhanced service Enhanced service
Diabetes screeningDiabetes screening
NSF - Standard 3NSF - Standard 3EmpoweringEmpowering
Education, motivation & adviceEducation, motivation & advice
All pharmacists in contact with patientsAll pharmacists in contact with patientsNational resourcesNational resources
Hand held cardsHand held cardsMedicines PartnershipMedicines PartnershipAsk about Medicines WeekAsk about Medicines Week
RPSGB guidanceRPSGB guidance– check understandingcheck understanding– extended/ reinforce informationextended/ reinforce information
Diabetes care, medicationDiabetes care, medication
NSF - Standards 4,5,6NSF - Standards 4,5,6 Clinical care of adults/ children Clinical care of adults/ children
RPSGB - firstRPSGB - first script script
– Essential PracticeEssential PracticeCheck they have diabetes Check they have diabetes Dosage regime, DIs, CIs etcDosage regime, DIs, CIs etcDiabetes UKDiabetes UK membership membership
– Desirable PracticeDesirable PracticePro-actively - answer questions & concernsPro-actively - answer questions & concerns
NSF: Standards 4,5,6NSF: Standards 4,5,6Clinical Care of adults/ childrenClinical Care of adults/ children
RPSGB - RPSGB - repeat scriptrepeat script
– Essential PracticeEssential PracticeAnomalies, side effects, concordanceAnomalies, side effects, concordance
– Desirable practice Desirable practice Remind, clarify, educate Remind, clarify, educate
NSF: Standards 4,5,6NSF: Standards 4,5,6Clinical Care Clinical Care (contd)(contd)
LPSLPS
New ContractNew Contract– Advanced ServicesAdvanced Services
Medicines Use Reviews (MURs)Medicines Use Reviews (MURs)InterventionsInterventions
NSF: Standards 4,5,6NSF: Standards 4,5,6Clinical Care Clinical Care (contd)(contd)
New ContractNew Contract– Enhanced ServicesEnhanced Services
Medicines reviews - medical records/ or notMedicines reviews - medical records/ or not– Pharmacy, care homes, domiciliary settingsPharmacy, care homes, domiciliary settings– Not just target diabetesNot just target diabetes
Supplementary prescribingSupplementary prescribing– BP, testsBP, tests– bloods by pharmacist, nurse, phlebotomistbloods by pharmacist, nurse, phlebotomist
NSF for Diabetes NSF for Diabetes ‘Delivery Strategy’‘Delivery Strategy’
‘‘pharmacists are a regular point of contact pharmacists are a regular point of contact for people with diabetes and can play a for people with diabetes and can play a central role in improved medicines central role in improved medicines management’.management’.
– recognition of the pharmacist’s rolerecognition of the pharmacist’s role
Medicines ManagementMedicines ManagementMonitoringMonitoring
BP, BMI, U & Es, lipids, HbA1cBP, BMI, U & Es, lipids, HbA1cDiabetes/CVD medicines optimisedDiabetes/CVD medicines optimisedGuardian medicines eg aspirinGuardian medicines eg aspirinOther medicines?Other medicines?Side effects, concordanceSide effects, concordance
NSF - Standard 7 NSF - Standard 7 Management of diabetes emergenciesManagement of diabetes emergencies
Sick day rulesSick day rulesCarrying identificationCarrying identificationEarly recognitionEarly recognition
Hypo-, hyper-glycaemiaHypo-, hyper-glycaemiaPatients, carers, pharmacists, pharmacy staffPatients, carers, pharmacists, pharmacy staff
Know what to doKnow what to do– E.g. hypo-E.g. hypo-
Lucozade/ Dextrosol followed by a sandwichLucozade/ Dextrosol followed by a sandwich
NSF - Standard 8NSF - Standard 8Hospital CareHospital Care
Be alert to diabetes cases on non-diabetic Be alert to diabetes cases on non-diabetic wardswards
Inexperienced staffInexperienced staff
Pharmacist-led clinicsPharmacist-led clinicsPharmacist input into protocols/ guidelinesPharmacist input into protocols/ guidelines
DKA, hypoglycaemia, ward insulin policies, care DKA, hypoglycaemia, ward insulin policies, care plansplans
Research/ audit workResearch/ audit work
NSF - Standard 9NSF - Standard 9PregnancyPregnancy
Planning PregnancyPlanning Pregnancy– medication reviewmedication review– folic Acid; stop smoking; tight BG control folic Acid; stop smoking; tight BG control
During PregnancyDuring Pregnancy– checking for problems/ referringchecking for problems/ referring– ketone testing stripsketone testing strips
NSF - Standards 10,11,12NSF - Standards 10,11,12Reducing the ComplicationsReducing the Complications
Early detection, investigation & Early detection, investigation & treatmenttreatment
Good clinical care & concordanceGood clinical care & concordance– Glycaemia & Blood PressureGlycaemia & Blood Pressure
Encouraging attendance at clinic Encouraging attendance at clinic appointmentsappointments
NSF - Standards 10,11,12NSF - Standards 10,11,12(contd)(contd)
RetinopathyRetinopathyLarge labels (Essential Service)Large labels (Essential Service)
Lower LimbLower LimbFoot care adviceFoot care adviceOTC salesOTC sales
NephropathyNephropathyCheck for renal impairmentCheck for renal impairmentDrugs to avoid or reduce doseDrugs to avoid or reduce dose
Smoking CessationSmoking Cessation
Relevant to:Relevant to:Management of L.T complications Management of L.T complications – (Standards 10,11,12)(Standards 10,11,12)Many government documents Many government documents RPSGB - Desirable PracticeRPSGB - Desirable PracticeNew Contract – Enhanced Service New Contract – Enhanced Service
Smoking Cessation ClinicSmoking Cessation Clinic
NSF – Standard 11NSF – Standard 11
Reducing Complications - CVDReducing Complications - CVDRPSGBRPSGB
Guidance on testing (MEP)Guidance on testing (MEP)
New ContractNew Contract– Enhanced ServiceEnhanced Service
Questionnaire risk assessment, Questionnaire risk assessment, Blood pressure, lipid monitoring, BMI, waist Blood pressure, lipid monitoring, BMI, waist measurementmeasurementReferral Referral MURs, Medicines reviews – identify casesMURs, Medicines reviews – identify cases
Pharmacist’s role Pharmacist’s role in the delivery of Diabetes Care?in the delivery of Diabetes Care?Expanding Expanding – Increasing opportunitiesIncreasing opportunities– ChallengingChallenging
The New Contract & RPSGB guidanceThe New Contract & RPSGB guidance– Guide implementing Diabetes NSFGuide implementing Diabetes NSF
Pharmacy Diabetes NetworkPharmacy Diabetes Network
Sharing experienceSharing experience
– All sectorsAll sectors– Pharmacists & pharmacy techniciansPharmacists & pharmacy technicians– Strengthening pharmacy’s role in diabetes careStrengthening pharmacy’s role in diabetes care– Document Consultation groupDocument Consultation group
– pharmacydiabetesnetwork-subscribe @smartgroups.compharmacydiabetesnetwork-subscribe @smartgroups.com
