Community pharmacists in Northern Ireland are playing a central role as part of a multidisciplinary approach to helping older people to live at home and plug into activities that will support their wellbeing. IMPACTAgewell® is a social prescribing project across Mid & East Antrim that gives equal importance to the social needs of older people as for their health needs.
And as Jonathan Lloyd, a community pharmacist and Director in Primary Care and Community Together (PACT), explains, it was all possible because pharmacists were already working together.
The IMPACTAgewell® programme is a three-year pilot programme which began in April 2017. Funding from The Dunhill Medical Trust allowed the appointment of an IMPACTAgewell® Project Officer working across the communities served by six GP practices across Mid & East Antrim. At its heart is a different model of social prescribing for a group of vulnerable older people with long term conditions who live at home and risk becoming isolated. The approach is about far more than simply referring people to local nonclinical services provided by the community and voluntary sector.
An important issue that we found early on in the project was that it can take weeks to build up the trust between an older person and the IMPACTAgewell® officer and, without that trust, if you simply signpost somebody to somewhere, the likelihood is that they won’t go. So, the IMPACTAgewell® officer will routinely work with someone for up to six months, visiting them in their home, discussing their needs and indeed their strengths and assets thoroughly, perhaps going with them to something new the first time. Crucially, the project is funded in such a way that when a person is referred to a social prescribing type service, like a telephone befriending call or a local luncheon club, funding follows that person into the service, which also helps build up sustainability within the community and voluntary sector.
Community Pharmacy’s role in this has been made much easier as we can already work together as part of PACT, a community interest company made up of a unique network of community pharmacies within different localities. PACT was set up to allow community pharmacy to deliver targeted local patient-centred public health services in partnership with other healthcare professionals, care providers and the voluntary sector organisations. With the evolution of GP federations, we have been working with them to develop a new model of care where, for instance, a PACT pharmacist can represent a group of community pharmacies surrounding a ‘hub’ GP surgery. One major benefit of community pharmacies working together like this is the opportunity to plug gaps in community pharmacy service provision. PACT has allowed community pharmacy to integrate because no community pharmacy can work well in isolation and not every community pharmacy will necessarily offer all the new services expected of us.
In our regular meetings as community pharmacists within Integrated Care Partnerships and with other partners, it was becoming clear that a wider, integrated population-wide approach was needed as no single professional and no single approach was going to work for a growing population of older people living at home.
IMPACTAgewell® was co-designed using a community development approach with Mid & East Antrim Agewell Partnership (MEAAP), a local community and voluntary sector organisation, taking the lead alongside partners from Primary Care, Secondary & Social Care, Health Commissioning & local Council. Once a person has agreed to be signed up, we work across the hub team to assess their medical and social needs, with the IMPACTAgewell® officer feeding in the personal information they’ve gathered speaking to the person. It’s really just trying to join the dots between the different providers to find the right way to fix that person’s problems.
The IMPACTAgewell® hubs are made up of a GP practice, a social worker, a PACT community pharmacist and an IMPACT officer. We started with six hubs and have now built the project to include eleven hubs within the Mid and East Antrim council area.
So what value has community pharmacy brought to what is essentially a social prescribing project? One of the things often identified by the IMPACTAgewell® officer, using a medicines questionnaire, is that the person is not managing their tablets properly or there is a problem with the optimisation of their medicines. The PACT pharmacist then decides if a commissioned community pharmacy service would be helpful or appropriate. Examples of a commissioned services available are Managing your Medicines, Medicines Use Reviews or Smoking Cessation. The PACT pharmacist, working on behalf of all the local pharmacies knows which service will be best for that person and where it is offered locally, either by the person’s normal community pharmacy or another. What we’re finding is that, as barriers are being broken down within the multi-disciplinary hub, and as our colleagues across different professions begin to understand what community pharmacy can offer, people of all ages are being referred to community pharmacy services more often.
We think we are adding value, but we need to prove it. So, alongside an evaluation of the entire IMPACTAgewell® project, we are working with the Medicines Optimisation Innovation Centre to deliver a two-year independent evaluation of the community pharmacy element within the project: the types of interventions that the community pharmacy is actually making and what these are delivering for people. This evaluation is being funded by Northern Pharmacies Ltd Trust.
Jonathan Lloyd will be leading a session on the National NSAID communication bundle at the Celtic Conference for Pharmacy in Scotland, Wales and Northern Ireland, being held in Edinburgh on Tuesday 26 March. Registration is free for healthcare professionals at www.pharman.co.uk/celtic-conference.