A Study of Pharmore+: Pharmacy Walk-in Service Pilots

Annex A: Workshop Reflections on Findings

This annex sets out key questions that emerged from the study. These questions were then considered by the pharmacies participating in the pilots and key national stakeholders at a workshop held in June 2012. The workshop noted, in order to demonstrate the contribution to NHS health priorities, pharmacies need to gather evidence of effectiveness of the services they deliver, not just patient numbers but also impact on patient outcomes. These need to be agreed with key stakeholders at local level.

Q1 What are the local NHS priorities and how might community pharmacies help to address these in terms of opening up access and complementing service delivery?

The workshop identified the following key points:

• NHS Boards need to be engaged and consider what the local health priorities are and how pharmacies might contribute. The NHS clinical and managerial leads are viewed as essential to engage and secure support to enable pharmacies to be considered a part of planning local services.
• Pilots are small scale and short term and unlikely to be sustainable longer term therefore we need to find ways to "grow your own" staff.
• Pharmacies need to gather evidence of effectiveness of the services they deliver, not just patient numbers but also impact on patient outcomes. These need to be agreed with key stakeholders at local level.
• Professional and public perceptions of the pharmacist need to be challenged and awareness raised about the potential of pharmacy to be part of the health service. (understanding skills, role and potential to link to other services). Key services to engage when considering the contribution of community pharmacy include Out-of-hours, A&E, Unscheduled care, NHS community services (mental health, drug and alcohol).

Q2 Professional practice: who delivers the service and how are they trained and supported?

The workshop identified the following key points:

• Core vs. specialist services: what are the core skills for a pharmacist and where are potential areas for specialist training and development?
• Are pharmacy independent prescribers working to their full potential?
• What are the potential links between pharmacists and other health professionals to refer patients into our pharmacy services?
• How can pharmacists deliver on existing commitments and expand their roles? If it is not possible, what should pharmacists do more of, what should they do less of? How to manage organisational priorities and staff resources?
• What current/future opportunities are there for more multidisciplinary training and learning across disciplines? How might specialist training be recognised and understood by other professionals? Is there a need for recognised career structure for community pharmacists?
• How might pharmacies link with other professionals for ongoing training and support (e.g. peer review)?
• What is the potential role of the pharmacy technician?

Q3 What infrastructure needs to be in place (location/facilities/IT)?

The workshop identified the following key points:

• Current pharmacy infrastructure will determine what services can be delivered (e.g. the availability of private consulting rooms). However, need to think about what services are required first then where most appropriate to deliver them (rather than infrastructure determining the service able to provide).
• IT systems between NHS and multiples are extremely problematic. Need national guidance on IT systems and organisational requirements.
• Community pharmacies are businesses - need to balance priorities: equitable distribution of services but with potential to change model (retail/services).
• Need to revisit the NHS contract to enable additional/new services through community pharmacies.

Q4 Engaging Health Boards and other services: what are the opportunities and challenges for planning, implementing and service delivery?

The workshop identified the following key points:

• National pilot with central funding enables testing new models of services however pilots need to increase awareness at NHS local level (pilots' findings need to be shared with key local stakeholders).
• Need capacity to enable new services to develop (for example a project management to link with NHS services and keep things moving forward).
• Need to link to initiatives across NHS Health Boards to share information and learning about new models of service delivery.

Top Priorities: Workshop recommendations

The workshop participants suggested the following key recommendations to inform future development:

• Services need to respond to local NHS priorities and be designed around local needs and priorities. Pharmacy needs to raise awareness amongst health professionals and the general public about the skills and expertise available, making links with local services and organisations to work in collaboration as part of the wider health service.
• Pharmacies need to be clear about the role/remit for providing generalist services (such as smoking cessation, sexual health, substance misuse) and the potential for specialist services (such as support for out-of-hours).
• Pharmacist roles need to be supported by specialist training and ongoing professional development. Training has potential to support multidisciplinary team working and foster greater understanding between professionals. The role of pharmacy technician needs to be considered as part of the range of skills/expertise available with a pharmacy team.
• The essential test of any service development is: Does this benefit the patient? Pharmacy services need to demonstrate their contribution to wider services though generating evidence of their impact on patient outcomes.