The Pharmacist’s roleThe Pharmacist’s role

In the delivery of Diabetes careIn the delivery of Diabetes care

And 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 Plan

Choosing Health through PharmacyChoosing Health through Pharmacy

Vision for PharmacyVision for Pharmacy

New 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, NPA

Other Professions Other Professions

Diabetes UKDiabetes UKPharmacy Diabetes Network Pharmacy Diabetes Network

Pharmacists Pharmacists Hospital, Community, PCT, GP practiceHospital, Community, PCT, GP practice

PhwSIsPhwSIs

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 diabetes

Std.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/ children

Std.7Std.7 Management of diabetes emergenciesManagement of diabetes emergencies

Std.8Std.8 Care during admission to hospitalCare during admission to hospital

Std.9Std.9 PregnancyPregnancy

Stds.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/ Leaflets

VerballyVerbally

Opportunistic/ ReactiveOpportunistic/ Reactive

Medicines 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 organised

Have 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 campaigns

SignpostingSignposting

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 etc

Diabetes 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, HbA1c

Diabetes/CVD medicines optimisedDiabetes/CVD medicines optimised

Guardian medicines eg aspirinGuardian medicines eg aspirin

Other 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 rules

Carrying identificationCarrying identification

Early recognitionEarly recognitionHypo-, hyper-glycaemiaHypo-, hyper-glycaemia

Patients, 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 advice

OTC salesOTC sales

NephropathyNephropathyCheck for renal impairmentCheck for renal impairment

Drugs 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 Practice

New 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