Supplementary Prescribing in Practice 26 September 2005

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Supplementary Prescribingin Practice26
September 2005

• Mr. Mahesh Sodha, M.Sc. F.R.Pharm.S.
• Community Pharmacist and Member of Professional
  Executive committee and Board Chelmsford PCT

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Mahesh Sodha

• Community Pharmacist with an extensive experience
  of both secondary and primary care. A generalist
  with a special interest in Oncology, Palliative
  Care, Urology and Diabetes. Worked as a Practice
  Research Pharmacist and as a Primary Care Cancer
  Lead for Harlow and Epping Forest PCTs
• Member of the Executive Committee and Board of
  Chelmsford PCT and works as a GP Practice
  Pharmacist

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Setting

• 6 partner GP Practice 2 branches in Chelmsford
  - 2 sessions per week
• Qualified Summer 2004
• Started 1st surgery in September 04 and currently
  manage some 70 to 80 patients
• One generic CMP agreed by all GPs
• Electronic CMP on IT system approval
• IT link in Pharmacy with GP system

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Supplementary Prescribing

• In theory Implementation of a Clinical
  Management Plan
• In Practice Doctors do not warm up to CMPs
  Hence one generic CMP
• My CMP
• Conditions BNF Class
• Type ll diabetes 6.1
• Hypertension 2.2,2.4,2.5,2.6,
• Dyslipidaemia 2.11 and 2.12

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Case Study 1st Patient
My Initial Action My Subsequent Action Outcomes
53-year-old male type II diabetes. HBA1C 8.71 (previous value 11.3). On gliclazide 40mg recently changed to 80mg. BP 146/86 and cholesterol 4.32 mmol/lit Patient NEVER treated for hypertension Initiate Metformin 500mg od increasing to bd. To t.d.s. Initiate Ramipril 1.25 mg. and titrate upwards. Increase Ramipril to 2.5mg . Can only tolerate metformin bd NOT tds. 16.11.04 BP 132/84 and HBA1c 6.3 Ramipril now 5mg od to aim for BP under 130/80
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Evaluation

• Patient Satisfaction Questionnaire
• 28 out of 32 returned
• PACT data to look at prescribing trends
• Evaluation and feed back from a consultant
  diabetologist

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What do the patients think?

• My overall satisfaction with this visit to the
  pharmacist

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What did the patients think

• My confidence in the ability of this pharmacist

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What did the patients think

• The recommendation I would give to my friends
  about this pharmacist would be

Excellent
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What do the GPs think?

• My Mentor and other GP Comments
• Increased patient access and choice
• Efficient use of skill mix in Primary care
• Significant contribution to high QOF practice
  achievement
• This successful model can be disseminated to
  other practices and other areas of clinical
  management.

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Hurdles/Challenges

• Selling the idea to the PCT and obtain some
  funding for training
• Locum expenses to get protected time for study
  was not possible
• Personal effort to study a course that is
  non-scientific (cf to Pharmacy)
• The biggest obstacle even today is the funding to
  run the actual clinical sessions who pays?

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Worth It WHY?

• Patient benefits
• Longer unrushed appointments
• Thorough counselling
• Full monitoring
• Holistic treatment
• Satisfaction survey
• GP work load can concentrate on tackling
  complex cases requiring high clinical skills and
  for which they are trained
• Good use of skill mix

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Some Minor Problems

• Computer generated prescriptions and Signing
  repeats
• Prescribing for minor ailments independent
  prescribing?
• Where should the funding for the pharmacists come
  from? They are independent contractors like GPs

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Next Steps

• Develop further skills and initiate type II
  diabetes patients on insulin and monitor them
• Provision of services to other GPs
• Development of CMPs in other areas of care e.g.
  Chronic Pain
• Extend to independent prescribing particularly in
  the area of minor ailments.

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Successful Prescriber

• A clear focus on exactly how, when and where you
  want to practice.
• Have good clinical practice skills.
• Have the support of the key people in your local
  Primary Care Trust
• Have the respect and support of clinicians whom
  you want to work with (independent prescribers)
• Above all, enthusiasm and motivation to pursue
  this ambition to manage patients in a clinical
  practice. NEEDS not only good therapeutic skills
  but also excellent consultation skills, which
  focus on psycho- social aspects of disease
  management.
• NOT ROCKET SCIENCE

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• Thank You