Tom Bisset, superintendent pharmacist at Ward Green Pharmacy in Barnsley, talks to Saša Janković about being part of a PCN-wide medication management service.
Service type: Medication management service
Name and location of pharmacy: Ward Green Pharmacy, Barnsley
Name of (superintendent) pharmacist: Tom Bisset
When did you start offering this service?
The Barnsley Medication Management Service (MMS) is a locally commissioned service that has been running across the whole of Barnsley since 2007.
Why did you start offering this service?
Barnsley MMS supports Domiciliary Care Services to adhere to and comply with safe working practices. When individuals, or their families, are unable to manage to take medication as prescribed (time, dose etc.) and are in receipt of a care package, those employed to assist them need an effective framework to ensure their capability to undertake this responsibility.
The MMS is intended to support service providers to meet the Care Quality Commission (CQC) 'Fundamental standards' and following the NICE and Quality standards (NG67 & QS171) for managing medicines for people receiving social care in the community, ensuring patients are receiving appropriate treatment and are supported in using it correctly and communicating that medicines support has started.
The aim of our MMS is largely to keep patients in their own homes rather than having to go into care homes, by helping carers with the medication plan for patients. This can be as simple as if patients going into respite for the day, so the people looking after them know what the plan is for that patient, that also fits in with the plan they have at home.
What, if any, training did you or other team members have to undergo?
If the MMS requires an MDS we work with the care service to train up their staff to be aware of what is in the tray and what not, so nothing gets missed.
In a nutshell, what does the service involve?
The service in Barnsley works as a collaboration between social care services, GP practices and community pharmacies.
It starts with a referral to the pharmacist from the care service, nursing or memory team, or from the hospital prior to discharge – indeed, from anyone identifying a patient with a need – to see if the patient is appropriate for the MMS, which could include arranging an MDS for them. The pharmacist has 10 days to look into that patient and find out what their needs are and what appropriate plan can be put in place, and district nursing can look after them in the interim.
The plan is then agreed between social services and the pharmacist after we’ve looked at if it’s appropriate or not. For each patient in receipt of the service, the pharmacist writes a medication care plan. We work collaboratively with the care service and the patient’s GP to make sure they have continuity of supply and everyone knows everyone else is happy. The GP practice is involved from an oversight perspective, and as the GP may change the prescribing needs for that patient it’s also about recognising that the surgery has to contact the pharmacy to let them know about any changes.
The medication plan could be something as simple as how the medication is delivered to the patient or if they are collecting it, is it monthly medication or a ‘when required’, as well as looking at the timings of the patient’s medication – and it may change what they are on to fit when they are getting their care visit(s). If the pharmacist has decided that MDS is appropriate then the plan will also pick up when something is not necessarily appropriate to go in the tray – such as inhalers or eye drops – to make sure the care service doesn’t miss this, as what is in the tray as important as what is out of it.
This gives us the opportunity to put better planning in place so we can avoid something becoming an emergency and the whole service is also linked into DMS as well. Barnsley has a fully integrated hospital so when someone is admitted their records flag that they are on this service, so when they are discharged their community pharmacist is automatically alerted rather than it having to come through the hospital pharmacist first. If community pharmacy can pick up the supply this means the hospital pharmacy can discharge without a delay.
Roughly how often each month do you carry out the service?
There are 53 pharmacies across Barnsley and 30 of those deliver the service, with 600 people registered for it.
Roughly how much a month do you make from offering the medication management service?
It’s a locally commissioned service so to do the initial assessment the pharmacy gets paid £75 whether the patient goes onto the service or not. Once the patient is up and running, if there are any changes during the course of a month the pharmacy gets paid £25 to keep the medication plan up to date, or £11 a month for ongoing continuity of care – with only one of those claims allowed per month per patient.
Patients are expected to have their medicines plan reviewed at least annually, with everything done through PharmOutcomes and a copy of the plan sent to the care agency whenever updated.
Would you recommend offering this service to other contractors?
If these patients can’t be looked after by a carer they are either going to a nursing home or needing domiciliary nurses. But if you’ve got 600 patients like we have in Barnsley, there’s simply not enough nurses to do it, or enough money to pay them even if there were. Obviously the best option would be having nurses or carers going in to people’s homes but as there is neither the money or the people in the system to do that, this option is something we can do that is as safe as possible and still affordable from a CCG perspective.