National Assembly for Wales

Health and Social Services Committee

Review of Cancer Services for the People of Wales

Name of respondent:

Steve Simmonds

Are you responding on behalf of an organisation?

Yes.

If so please give the name

Community Pharmacy Wales (CPW)

Address:

3rd Floor,
2 Caspian Point,
Pier Head Street,
Cardiff Bay,
CARDIFF
CF10 4DQ

Telephone number:

029 2044 2076

Would you be willing to give oral evidence to the Committee?

Yes

If the evidence you give below is your personal view, rather then that of an organisation, please state whether or not you are willing for your evidence to be published by putting a X in the appropriate box below:

The information provided is the view of CPW

I am content for my evidence to be published

Yes

I am not content for my evidence to be published N/A

1	How can information technology be used more effectively to track and facilitate the patient’s journey?
Response	CPW are strong supporters of the introduction of an 'Individual Health Record’ (IHR) and would ask that it remains a priority to connect all health providers via e-mail as soon as is practicable. A combination of electronic communication and access to electronic patient information will increase the speed and ease of decision making and improve the patient experience. One of the most frequently encountered problems for community pharmacy is obtaining authorisation for controlled drugs dose adjustments (especially for medication administered via a syringe driver) out of hours and on Saturdays. Having electronic access to NHS systems would allow an audit system to be put in place where Macmillan/district nurses, pharmacists and on-call doctors can reach a consensus on appropriate action and record the decision making process electronically. This would enable the LHB to audit the process and reduce the likelihood of a 'Shipman’ like decision being taken alone while also creating flexibility in controlling pain.
2	How effectively is research and good practice being integrated with service delivery? What can be done and by whom to improve this?
Response	It is essential that pharmacists are recognised as an integral member of the primary care team and as such need to enjoy the same access to training, research and briefing on good practice that is available to other members of the primary care team. Pharmacists are the only group of health professionals that are not provided with protected learning time or part of the co-ordinated approach to NHS skills development. We believe that NLIAH should extend their role to include community pharmacists and community pharmacy technicians. In terms of good practice integration LHBs in the old Gwent HA area have recently updated an Out of Hours Palliative Care Service using local community pharmacies that provides access to palliative care medication within two hours. Despite being hailed as a 'Gold Standard Scheme’ by oncology consultants commissioning of the service has not moved outside of the initial trial area. CPW feel that there is the potential for pain management in palliative care to be addressed by community pharmacists who are supplementary or independent prescribers and should be looked at as a future working model. It is also worth noting that chemotherapy is now being offered from a community pharmacy consultation room in Clerkenwell in a bid to improve access to cancer care. The Greenlight Pharmacy has teamed up with Whittington hospital and Macmillan Cancer Support as part of a study into cancer services in North London. In addition community pharmacists have been involved in schemes to raise the awareness of oral cancer and in referring patients to cancer services.

3	What are your views on the complexity of commissioning services? Is the process hampered by the involvement of the local health boards, cancer networks and Health Commission Wales? How could it simplified?
Response	CPW have for some time been concerned by the high degree of variance in the quality of commissioning at LHB level and feels that part of the answer lies in the extension of the remit of the regional/ health economy commissioning groups, proposed in the Designed to Deliver strategies, to cover the commissioning of primary care services. There is little evidence on the ground that nGMS funding is being made available to other professions and growing evidence that community pharmacy enhanced services are continually being bumped to the back of the commissioning queue. CPW are also disappointed with the willingness of WAG to actively support the introduction of National Enhanced Services and Directed Enhanced Services for community pharmacy.
4	What evidence is there of the value of screening and immunisation?
Response	CPW are unable to comment on the value of screening and immunisation in relation to cancer care. CPW do however feel that the potential of the community pharmacy network to become involved in population screening is regularly overlooked. In a recent review of bowel cancer services we recommended that the distribution of testing kits should be carried out through the community pharmacy network. Community pharmacies are the most accessible of all of the health outlets and are ideally placed to support population screening and the provision of public health advice.
5	What are the barriers to the NHS in Wales keeping abreast of, and responding to, developing technologies and therapies? How might these barriers be overcome?
Response	CPW is not able to comment on this section.
6	How can the NHS and the voluntary sector work together more effectively to deliver services?
Response	CPW is not able to comment on this section.
7	How can the collection and use of data on where the terminally ill spend their last weeks or months be improved better to inform service provision for those people?
Response	CPW is not able to comment on this section
8	There are a number of issues around prescribing and the cost of drugs:
8(i)	What should be done and by whom to reduce continued prescribing of inappropriate drugs?
Response	A 'Medicines Use Review’ service has been introduced as part of the New Community Pharmacy Contract and a clinical medication review service is available for commissioning as an enhanced service. If supported by specialist training this Enhanced Service could be used to review patient’s cancer medication on a domiciliary visit by a community pharmacist. This would reduce the incidents of inappropriate prescribing and improve patient concordance. Independent Prescribing rights have recently been extended to community pharmacists and over time this will provide community pharmacists with the opportunity to become more involved in the management of patients suffering from chronic conditions. This will facilitate community pharmacists in becoming an integral part of a multidisciplinary response to the management of cancer patients.
8(ii)	Should people who are prepared to pay privately for drugs not available to them on the NHS, be able to do so without having to become private patients and having to pay for all their treatment?
Response	CPW feels that the act of prescribing by a GP should be an act of confirmation that the medicines being planned for the patient are in their opinion both necessary and appropriate. CPW believes that all medication that will be of benefit to cancer patients, or will improve their quality of life, should be available to the patient. If the NHS in Wales is unable to make this medication available to patients as part of the NHS service then it should facilitate access to these medicines by patients who are able or willing to cover the cost of the medicines themselves with the minimum of additional barriers and bureaucracy.
8(iii)	Do doctors, pharmacists and other health professionals have adequate access to independent advice and guidance on the prescribing of drugs?
Response	Community pharmacists have access to independent advice through many sources including an in-house journal, NICE Guidelines, the Wales Medicines Partnership and access to the Medicines Information Service provided by the trusts. Recent moves to provide community pharmacists with access to the Electronic Library for Health have further improved their access to independent information although we have recently been made aware that planned funding for this element has been withdrawn. With such a wide range of resources available to prescribers many prescribers will need training on how to judge the appropriateness of the information that is available and how to best access the information.

Are services centred on the patient, with service users consulted? If not what are the reasons for this and how patient involvement be improved?

Response

CPW is not able to comment on this section from the patient involvement perspective. From the perspective of a stakeholder and member of the primary care team CPW are regularly disappointed with the level of engagement with the profession. Engagement is often limited to that of commenting on the outputs of reviews and strategies rather than being involved as a full and valued member of the original working group.