Our comments refer to Figure 3; Vascular checks and the use made of pharmacists in this flow chart. The DH in Pharmacy in England Building on strengths- delivering the future April 2008 recognises the potential roles for community pharmacists in delivering the vascular risk assessments and includes pharmacies in the list of stakeholders with whom it will discuss delivery arrangements and support implementation, section 4.40.
The document also recognises the role pharmacy has in supporting self care and the need to expand this (4.6) and in Section 4.13 detailed the method to identify a work programme ‘to accelerate pharmacy’s ongoing and expanding contribution to health’ including ’how it contributes reducing health inequalities’
The NPA is of the view that this flow chart (figure 3) should be revisited to make best use of pharmacist’s capabilities and the opportunistic nature of many of their interactions with the public. Pharmacists see patients when they are well as well as when they are suffering from ill health and they are open for longer hours than GP surgeries including Saturdays and possibly Sundays. Pharmacists frequently see older people and those with long term conditions frequently than any other health professional.
Pharmacists and their staff are therefore ideally placed to offer the first and possibly subsequent vascular screening appointments to those registered with GP practices as well as those not registered. Pharmacies may well be able to offer the checks opportunistically which means that patients cannot fail to attend their appointment.
Pharmacies can not only offer the risk assessment but also provide support to those who have a life style which if improved would reduce their risk of a cardio vascular event. Some PCTS commission enhanced services such as stop smoking support and weight management support from their community pharmacists. The lifestyle changes made by people, which have been identified during a vascular check, could be increased if best use is made of community pharmacists as providers of these and other lifestyle interventions such as direct referral to exercises classes. Full use should be made of pharmacist’s knowledge of medicines and their ability to become supplementary or independent non-medical prescribers, for instance to prescribe statins to those who, according to protocol, would benefit from them. As the number of pharmacists qualified as non-medical prescribers is still relatively low, pharmacist could supply statins to people who need them via a Patient Group Direction (PGD). A PGD enables a pharmacist, with the required competencies, to supply a medicine to a group of people who meet the criteria set out in the PGD. They are frequently used for supplying prescription only medicines for instance emergency hormonal contraception.
Making use of the advanced pharmacy service Medicines use Review (MUR) would enable compliance with treatment to be established, problems identified and patient knowledge and understanding of their treatment to be improved leading to improved concordance.
