WF 06

Ymchwiliad i gynaliadwyedd y gweithlu iechyd a gofal cymdeithasol

Inquiry into the sustainability of the health and social care workforce

Ymateb gan: Fferylliaeth Gymunedol Cymru

Response from: Community Pharmacy Wales

 

 

 

                                   

 

 

 

 

 

 

 

 

A Response

 

Health, Social Care & Sport Committee’s inquiry into the sustainability of the health and social care workforce

 

 

 

 

 

9 September 2016

 

 

 

 

 

 

Contact Details:

Russell Goodway

Chief Executive

Community Pharmacy Wales

3rd Floor, Caspian Point 2

Caspian Way

CARDIFF, CF10 4DQ

Tel: XXXXXXXXXXXX

E-Mail XXXXXXXXXXXXXXXXXXX

 

__________________________________________________________________________

 

CPW agrees that the content of this response can be made public. CPW are happy to provide further information as required by the Committee either by additional written or oral evidence or to facilitate a Committee visit to a community pharmacy. CPW welcomes communication in either English or Welsh.

 

 

Part 1:  Introduction

 

 

  1. CPW is the only organisation that represents all 716 community pharmacy contractors in Wales. It works with Government and its agencies, such as local Health Boards, to help protect and develop high quality community pharmacy based NHS services and to shape the NHS Community Pharmacy Contractual Framework (CPCF) and its associated regulations. It is the body recognised by the Welsh Assembly Government in accordance with Sections 83 and 85 National Health Service (Wales) Act 2006 as ‘representative of persons providing pharmaceutical services’.

 

  1. CPW represents a network of of community pharmacies across Wales which provide essential and highly valued health and social care services at the heart of local communities. Community pharmacies operate in almost every community across Wales, including in rural communities, urban deprived areas and large metropolitan centres. It is currently estimated that on an average day the network of community pharmacies across Wales will, between them, deal with more than 50,000 individual patients.

 

Part 2:  Priorities for the Committee

 

  1. CPW believes community pharmacies have a major role to play in contributing to a sustainable health service in the future. Despite widespread recognition of the massive potential of the community pharmacy network across the political and health professional spectrum, for reasons unknown it remains a hugely under-exploited healthcare asset, with a wide variation in commissioning of community pharmacy based services across Wales. Although CPW understands the need for planning care locally, we feel there is a need for the development of core services available from every community pharmacy in Wales in order to increase the awareness and confidence of the general public in relation to the full range of community pharmacy based services in order to reduce pressures elsewhere in the primary and secondary care sectors.  

Text Box: Chronic Conditions Support: Respiratory disease is the cause of one in seven deaths in Wales. Studies have shown that the majority of patients prescribed inhalers have poor inhaler technique and are therefore not getting the full benefit of their medication. A community pharmacy based Respiratory Enhanced service has been developed in several Health Board Areas. These services support patients to understand their medication and how to use it and have been shown to improve patient’s disease control, thereby reducing additional costs to the NHS as well as the patient’s quality of life. An additional service has also been developed and piloted in Powys where COPD patients were supported through a community pharmacy to self manage their condition, this service led to a 77% reduction in GP appointments compared to the previous year and a 24% reduction in steroid and antibiotic usage over the same period. Similar services could be developed to support patients with other chronic conditions to self care and self manage their conditions.

4.     Community pharmacies could make a significant contribution to releasing GP colleagues to focus on those patients that really do need to be seen by a doctor. For example, community pharmacy based common ailments services and emergency supply services can reduce the pressure on GP practices by releasing the need for these patients to otherwise require appointments. Chronic conditions management services and associated medicines management services can support people to live with a condition which could otherwise result in the requirement of hospital admission and treatment. This will also help to reduce the number of expensive hospital beds and secondary care treatments needed to support an ageing population. An important part of the development of these services would also be a relaunch and re-focus of the under-utilised “batch” prescribing service which forms part of the current community pharmacy contract as the Repeat Dispensing Essential Service.   Taken together, these measures could have a significant impact on the GP practice workload.

 

Text Box: Repeat Dispensing Implementation: Two thirds of prescriptions issued in primary care are repeat prescriptions. These repeat prescriptions account for nearly 80 per cent of NHS medicine costs for primary care. The management of these prescriptions and the time involved in processing them can be significant. There are over 30 million repeat prescriptions generated every year – equivalent to an average of more than 200 per GP per week. It is estimated that approx. 24 million, or 80 per cent, of all repeat prescriptions could eventually be replaced with repeat dispensing or “batch” prescribing; this could save 0.2 million hours of GP and practice time.

5.     Community pharmacy services could be further transformed by utilising community pharmacist’s skills in medication adherence and reducing polypharmacy.

Text Box: Community Pharmacy Independent Prescribers: Each day numerous GP appointments are taken up by patients with uncomplicated minor acute conditions and minor ailments. In addition, a number of these appointments have already been signposted to the GP surgery from the local pharmacy, for patients needing to obtain a Prescription Only Medicine for a minor ailment. This multiple step process means that the patient may have seen a healthcare professional on 3 or 4 occasions to finally obtain a single treatment for a minor ailment or acute condition. By training a local community pharmacist to assess and prescribe treatment for minor ailments and acute conditions, a patient could be dealt with at first contact with the pharmacy. In addition, it would be possible for the surgery or other healthcare professionals to signpost straight to the local pharmacy thereby reducing the demand for GP appointments. This would release significant GP time, reduce GP and practice workload and enable GPs to see other and higher priority patients. Patients would have improved access and service, but would also benefit from preventative advice and potentially wider services that could eventually be offered through local pharmacy.

6.     The workload of some hospital based services and GP services could also benefit from using the capacity of the community pharmacy network to triage and signpost patients to the most appropriate health care professional. Making community pharmacies the first port of call for patients accessing NHS services would make a massive contribution to the delivery of a prudent healthcare regime.

7.     CPW welcomes the integration of health and social care services and would like to seek to understand what opportunities there are for community pharmacies to work closer with social care to support the development of domiciliary care medication support to preserve a patient’s independence and allow them to remain in their own home. Community pharmacy services are currently only commissioned through Local Health Boards but local authorities too could benefit from the support that community pharmacy could provide to those in receipt of social services care.

8.     CPW believes that hospital discharge and outpatient services could benefit from the dispensing of related hospital prescriptions in a community pharmacy.  This could make a significant contribution to releasing capacity in hospital based pharmacy services as well as leading to significant improvements in releasing hospital beds and in the overall patient experience.

9.     CPW understands the importance that primary care clusters have in transforming primary care. CPW would like to see the role of all primary care contractors as an integral part of primary care clusters. Community pharmacy contractors can significantly support the primary care agenda helping to support the long-term sustainability of primary care by using pharmacists’ skills and abilities according to the prudent healthcare principles and releasing capacity in GP practices and in A&E departments. Community pharmacies have the largest daily footfall of all the stakeholders within a primary care cluster and as such should have a significant role to play in relation to supporting the health and wellbeing needs of the local community they serve. However, to date the integration of community pharmacy within the 64 primary care clusters across Wales has been variable and in the majority of cases is unfortunately so far non-existent.

Text Box: Integration with other Health Care professionals: Patients requiring treatment for eye conditions that are seen by an optometrist require referral from the optometrist to the GP to obtain a prescription that will then require to be taken to the pharmacist for dispensing. CPW believe that this doesn’t fit with prudent healthcare objectives and is working with an LHB to develop a service that will allow the community pharmacy to provide treatment under the NHS following a request from an optometrist. The development of the Common Ailments service (CAS) has also developed closer working relationships between health care professionals and has seen GPs and optometrists both referring to community pharmacy and vice versa. An example given by a pharmacist in Gwynedd is of a patient referred by the GP surgery to the pharmacy for treatment for an eye condition under CAS where it became clear that the condition wasn’t a simple condition, the patient was referred to an optician through the Wales Eye Care Service, who then referred direct to hospital as the patient was suffering a serious eye infection.

10.     CPW is aware of the various on-going work streams currently being undertaken across Welsh Government and NHS Wales and in particular regarding the recruitment and retention of healthcare professionals.  CPW believes that there is an urgent need to explore how the existing capacity of the Wales based community pharmacy network might contribute to the delivery of NHS services to inform the scale of the recruitment and retention challenges across the NHS.  To that end CPW would seek representation on all the working groups to help inform their discussions and deliberations.

 

Part 3:  Conclusion

 

11.     CPW is pleased that the Committee is seeking to understand the challenges facing NHS Wales in securing a sustainable workforce across all sectors. The report produced by the committee in the fourth Assembly set out a series of recommendations which, if implemented in full, would increase the contribution that community pharmacy could make to the NHS and which would impact upon the workload of other healthcare professionals which could have a significant and positive influence on achieving the sustainable workforce to which all NHS service providers aspire.

t:18.0pt;text-align:justify; text-indent:-18.0pt'> 23.   The research also found that 69% of our members said they had caring responsibilities. This gives us a good indication about the balance that many members (and NHS staff overall) have to find in their daily lives. While 35% of respondents had made a request to change their shifts in the last two years, unfortunately 37% of these said their request to change their hours was rejected. Many respondents reported that they were not given the reason for why their request was rejected but many said it was due to staffing and workload.

 

24.   Part time work is common and clinical midwives are experiencing a higher level of stress and burnout than ever before. Service demands can make higher-banded positions less attractive, which means the talent pool can shrink. We must focus not only on ensuring raw numbers of midwives are sustainable but also think about how to support midwifery careers for life and support emerging leaders.

 

25.   While at times this report makes for troubling reading about the level of burn out and stress amongst midwives and maternity support workers it does offer solutions too. The evidence we present shows that when Heads of Midwifery and RCM Health and Safety Representatives work in partnership and take action on health, safety and wellbeing it does make a difference. Stress levels are lower, health and wellbeing is better and importantly, care for women and their families improves.[6] We are thrilled that Powys Teaching Health Board was the first health board in Wales to sign up to the RCM’s Caring for You Charter and they have been joined by three other boards in recent weeks. We hope all the boards will sign up to the Charter to improve health and wellbeing of staff which will help create happier and healthier workplaces, with positive working cultures that always deliver quality care for women and families.

 

26.   In regards to pay and terms and conditions, the Royal College of Midwives is committed to UK wide pay bargaining, through the NHS Staff Council, and the independent Pay Review Body. We believe that Agenda for Change is the most transparent, fair and equal system as it is underpinned by the job evaluation system which is based on equal pay for work of equal value. Our expectation is that this will continue.

 

27.   The independent NHS pay review body makes recommendations to the Welsh Government on the pay of midwives, nurses and other staff employed by the NHS, with the exception of doctors, dentists and very senior managers. Unlike the Scottish Government, which has consistently followed the pay body’s recommendations, the Welsh Government has failed in the past to honour them in full. This is a shame, and has left midwives in Wales out of pocket and they continue to be paid less than their Scottish equivalents.

 

28.   Midwives are drawn into the profession for many reasons, they may have had children themselves, they may follow family members into the profession but mostly they are driven by a desire to work with women and families and to provide the best care possible. Financial reward is frequently not the primary driver; however, it is unrealistic to expect them to work without adequate financial reward. Midwives have bills to pay just like everyone else. That is why it is important that they are paid a fair salary for the work they do, and the fairest way of determining that salary is through an independent process like the one we have. It is so important that all sides honour the pay review body’s recommendations even when midwives might think it is too low or employers think it is too high.

 

29.   Q: Whether there are there particular issues in some geographic areas, rural or urban areas, or areas of deprivation for example.  

 

30.   The latest statistics on breastfeeding in Wales show the massive variation between areas which the RCM believes must urgently be addressed to tackle life-long health inequalities.

 

31.   The highest breastfeeding rates were seen for babies of women resident in Powys Teaching Local Health Board (72%) and lowest for those in Cwm Taf University Local Health Board (50%). There is a clear need for more breastfeeding support, especially for young mothers, and midwives must be able to have the time to work with women to enable them to breastfeed safety and comfortably. Breastfeeding lays the foundations for an individual’s future health and wellbeing. It brings great benefits for society as a whole in terms of reduced spending on ill health. Previous surveys into our members views on postnatal care found there is not usually enough time our resources to support new mothers with important aspects of breastfeeding, according to 25% of our members.[7] With the increase in complex care needs the labour ward has often been seen as the priority for midwifery staffing with the result that post natal care has not been given the value/attention that it should have had.

 

The Royal College of Midwives

August 2016


[1] Royal College of Midwives. State of Maternity Services Report 2015. https://www.rcm.org.uk/sites/default/files/RCM%20State%20of%20Maternity%20Services%20Report%202015.pdf

[2] Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, Marlow N, Miller A, Newburn M, Petrou S, Puddicombe D, Redshaw M, Rowe R, Sandall J, Silverton L, Stewart M. ‘Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study’. British Medical Journal. 2011;343.

[3] ‘Design the future workforce – ensuring that the future workforce is in line with service and financial planning; Develop the future workforce – includes education commissioning, staff development, and recruitment and retention process; Deliver the future workforce – ensuring plans are delivered, processes are effective, clinicians are engaged and best practice is shared’. See Making Prudent Healthcare Happen.  http://www.prudenthealthcare.org.uk/workforce/

[4] Welsh Government (2011). A Strategic Vision for Maternity Services in Wales. http://wales.gov.uk/docs/dhss/publications/110919matstrategyen.pdf

[5] The RCM’s Caring for You survey was conducted during March 2016 with RCM members using Survey Monkey. In total there were 1,361 responses. The survey asked questions about midwives’, maternity support workers’ and student midwives’ health, safety and wellbeing at work.

[6] Royal College of Midwives.  Caring for You Campaign: Survey Results. May 2006. https://www.rcm.org.uk/sites/default/files/Caring%20for%20You%20-%20Survey%20Results%202016%20A5%2084pp_5%20spd.pdf

[7] Royal College of Midwives. Pressure Points: Infant feeding, Supporting parent’s choice. May 2014.