The Pharmacist’s role

1. The Pharmacist’s role In the delivery of Diabetes care And the NSF Irene Gummerson Pharmacist with a Special Interest in Diabetes Member of the Diabetes UK Advisory Council

3. Drivers for Change • Government: • Wants better value • ‘Pharmacists under-used’ • ‘Choice, access, responsiveness & equity’ • NHS Pharmacy Plan • Choosing Health through Pharmacy • Vision for Pharmacy • New Contract • Other national & local policy documents

4. Drivers for Change(Contd) • Profession bodies • RPSGB, PSNC, NPA • Other Professions • Diabetes UK • Pharmacy Diabetes Network • Pharmacists • Hospital, Community, PCT, GP practice • PhwSIs

5. National Service Framework (NSF for Diabetes) • Standards for Diabetes Services (2001) Std.1 Prevention of Type 2 diabetes Std.2 Early Identification (Screening) Std.3 Empowerment Std.4/5/6 Clinical care of adults/ children Std.7 Management of diabetes emergencies Std.8 Care during admission to hospital Std.9 Pregnancy Stds. 10/11/12 Detection/management of L.T. complications

6. NSF Delivery Strategy(2003) To achieve the Standards by 2013: • Clinical diabetes networks • Workforce planning & development • PCTs to assess training needs

7. NSF - Standard 1Reducing Risk Of Type 2 • Health Promotion • raising awareness of benefits • Primary and secondary care • Posters/ Leaflets • Verbally • Opportunistic/ Reactive • Medicines review, MUR

8. NSF - Std 1 Reducing Risk Of Type 2 • Health Promotion • Healthy eating • Increasing physical activity • Stopping smoking • Be organised • Have the ‘tools’ ready

9. New Contract & Std.1Reducing Risk Of Type 2 • Essential Services • Public Health: health promotion • 6 campaigns • Signposting • Enhanced Services • Weight management clinic

10. NSF - Standard 2Early Identification • ‘When community pharmacists….. see people with symptoms suggestive of diabetes, • they should advise them to see their GP for diagnostic testing’

11. NSF - Standard 2Early Identification • ‘..there is currently uncertainty as to what is the best way to identify people with undiagnosed asymptomatic Type 2 diabetes..’ • ‘..targeted..’ • ‘..combined with CVD.’

12. NSF - Standard 2 Early Identification • RPSGB guidance • Essential Practice • Monitoring OTC sales – support staff • New Contract • Enhanced service • Diabetes screening

13. NSF - Standard 3Empowering • Education, motivation & advice • All pharmacists in contact with patients • National resources • Hand held cards • Medicines Partnership • Ask about Medicines Week • RPSGB guidance • check understanding • extended/ reinforce information • Diabetes care, medication

14. NSF - Standards 4,5,6Clinical care of adults/ children • RPSGB - first script • Essential Practice • Check they have diabetes • Dosage regime, DIs, CIs etc • Diabetes UK membership • Desirable Practice • Pro-actively - answer questions & concerns

15. NSF: Standards 4,5,6Clinical Care of adults/ children • RPSGB - repeat script • Essential Practice • Anomalies, side effects, concordance • Desirable practice • Remind, clarify, educate

16. NSF: Standards 4,5,6Clinical Care (contd) • LPS • New Contract • Advanced Services • Medicines Use Reviews (MURs) • Interventions

17. NSF: Standards 4,5,6Clinical Care (contd) • New Contract • Enhanced Services • Medicines reviews - medical records/ or not • Pharmacy, care homes, domiciliary settings • Not just target diabetes • Supplementary prescribing • BP, tests • bloods by pharmacist, nurse, phlebotomist

18. NSF for Diabetes ‘Delivery Strategy’ • ‘pharmacists are a regular point of contact for people with diabetes and can play a central role in improved medicines management’. • recognition of the pharmacist’s role

19. Medicines ManagementMonitoring • BP, BMI, U & Es, lipids, HbA1c • Diabetes/CVD medicines optimised • Guardian medicines eg aspirin • Other medicines? • Side effects, concordance

20. NSF - Standard 7 Management of diabetes emergencies • Sick day rules • Carrying identification • Early recognition • Hypo-, hyper-glycaemia • Patients, carers, pharmacists, pharmacy staff • Know what to do • E.g. hypo- • Lucozade/ Dextrosol followed by a sandwich

21. NSF - Standard 8Hospital Care • Be alert to diabetes cases on non-diabetic wards • Inexperienced staff • Pharmacist-led clinics • Pharmacist input into protocols/ guidelines • DKA, hypoglycaemia, ward insulin policies, care plans • Research/ audit work

22. NSF - Standard 9Pregnancy • Planning Pregnancy • medication review • folic Acid; stop smoking; tight BG control • During Pregnancy • checking for problems/ referring • ketone testing strips

23. NSF - Standards 10,11,12Reducing the Complications • Early detection, investigation & treatment • Good clinical care & concordance • Glycaemia & Blood Pressure • Encouraging attendance at clinic appointments

24. NSF - Standards 10,11,12(contd) • Retinopathy • Large labels (Essential Service) • Lower Limb • Foot care advice • OTC sales • Nephropathy • Check for renal impairment • Drugs to avoid or reduce dose

25. Smoking Cessation Relevant to: • Management of L.T complications • (Standards 10,11,12) • Many government documents • RPSGB - Desirable Practice • New Contract – Enhanced Service • Smoking Cessation Clinic

26. NSF – Standard 11 Reducing Complications - CVD • RPSGB • Guidance on testing (MEP) • New Contract • Enhanced Service • Questionnaire risk assessment, • Blood pressure, lipid monitoring, BMI, waist measurement • Referral • MURs, Medicines reviews – identify cases

27. Pharmacist’s role in the delivery of Diabetes Care? • Expanding • Increasing opportunities • Challenging • The New Contract & RPSGB guidance • Guide implementing Diabetes NSF

29. Pharmacy Diabetes Network Sharing experience • All sectors • Pharmacists & pharmacy technicians • Strengthening pharmacy’s role in diabetes care • Document Consultation group • pharmacydiabetesnetwork-subscribe @smartgroups.com