In a letter to Scottish Directors of Pharmacy, Community Pharmacy Scotland and community pharmacy contractors in Scotland, the Chief Pharmaceutical Officer (CPhO) for Scotland Rose Marie Parr has communicated the Scottish Government plan for community pharmacy in Scotland.
This afternoon she has also announced that she will delay her planned retirement in July in light of the emerging COVID-19 crisis.
The CPhO outlined that COVID-19 is still a new and emerging disease and that there is still much uncertainty about its clinical presentation. She has said that early data suggests that, of those who develop an illness, the great majority will have a mild-to-moderate, but self-limiting illness. She added that so far, the data available suggests that the risk of severe disease and death increases amongst elderly people and in people with underlying health conditions.
The plan laid out in the letter revolves around four phases. They are as follows:
This involves detecting early cases, following up close contacts, and preventing the virus taking hold across the country for as long as is reasonably possible.
This involves slowing the spread of the virus across the UK, and if it does take hold, lowering the peak impact and pushing it away from the winter season.
This involves gaining a better understanding of the virus and the actions that will lessen its effect on the UK population; identifying innovative responses including diagnostics, medicines and vaccines; and using the evidence to inform the development of the most effective models of care.
This involves providing the best care possible for people who become ill; supporting hospitals to maintain essential services; and ensuring ongoing support for people ill in the community to minimise the overall impact of the disease on society, public services and the economy.
On the 12 March 2020, the Scottish Government announced the move to the delay phase. The purpose of this is to flatten the peak number of cases and protect the most vulnerable. The current advice is that as of 13 March anyone developing symptoms consistent with COVID-19, however mild should self-isolate for 7 days.
Community Pharmacy Scotland and Scottish Government have both said that they are in close contact and dialogue is ongoing as the crisis develops at pace.
As we are now in the ‘delay’ phase Rose Marie Parr has said that greater efforts will be made to delay the spread of the virus. This could include population distancing strategies, such as closing schools, postponing large scale gatherings and encouraging home working. In addition, there may be more people encouraged to self-isolate, for example, people who are a greater risk of a more severe response to the virus, such as the elderly and people with underlying health conditions. The delay phase also buys time for the testing of medicines and the initial development of vaccines and/or improved therapies or tests to help reduce the impact of the disease.
A summary of the implications of the ‘delay’ phase for community pharmacy in Scotland is as follows.
Community pharmacy teams have been told that they should ensure that COVID-19 patient information posters for NHS settings are displayed in community pharmacies, where they can be seen from outside the premises. This should reduce the likelihood of individuals with confirmed or suspected COVID-19 presenting in the pharmacy for advice.
Business continuity and prioritisation of pharmaceutical care
Community pharmacy contractors have been told that they should update their business continuity plans. As part of this, contractors will want to consider any specific roles and actions which could support managing local demand, including working in collaboration with other local pharmacies and the wider multi-disciplinary primary care team. In addition to this, community pharmacists should draw up a list of any vulnerable patients, for example, those receiving additional services such as supervised methadone consumption, other patients receiving weekly or daily prescription instalments, care homes, multi-compartment compliance aids and prescription delivery services. This will be helpful in managing demand if, at a later stage, the community pharmacy had to close or restrict services due to staff illness. The community pharmacy team may wish to discuss with their local GP practices ways of working, for example, whether issuing patients with a four week supply of multi-compartment compliance aids at a time would be helpful for some patients.
Managing prescription demand
During this phase, community pharmacies may find there is a greater demand for prescription collection and delivery services. Rose Marie Parr has said that she recognises that these services are not a remunerated element of NHS pharmaceutical services. In order to manage demand appropriately, community pharmacy teams should be encouraging family members and neighbours to collect prescriptions on behalf of those who are self-isolating. She has said that Scottish Government will also encourage this in their public messaging.
Community pharmacy contractors will also want to consider any potential risks to delivery drivers and patients and implement proportionate measures on doorstep procedures, such as ringing the doorbell and maintaining distance with no signatures required.
In her letter Rose Marie Parr has acknowledged that community pharmacy contractors may also experience some challenges in terms of staffing levels, depending on the approaches taken to population distancing strategies. A community pharmacy contractor must notify the appropriate primary care service lead in their Health Board if they are not going to be open. Other activities to support this include ensuring all staff know who to contact and keeping a copy of the key contact list out with the pharmacy in case the key holder is not available.
Minor ailments and unscheduled care PGD
In addition, there may also be an increase in the use of services such as the Minor Ailment Service (MAS) with people seeking supportive treatments and the Unscheduled Care Patient Group Direction (PGD) which will allow community pharmacists to provide access to up to one full cycle of a prescription both in and out-of-hours.
Rose Marie Parr has warned that during the mitigate phase, larger numbers of people will be affected, including pharmacy staff, GP practice staff and the supply chain, as well as members of the public and patients. This could see further demands on services such as MAS which will become NHS Pharmacy First Scotland later in April. If GP practices start to experience excessive demands or have reduced staffing to manage demands, it might be that there is an increasing demand for community pharmacists to provide access to repeat prescriptions. Rose Marie has said that the Scottish Government will be proactively encouraging GP practice teams to make greater use of existing serial prescribing and dispensing arrangements over the coming weeks.
Chief Pharmaceutical Officer for Scotland Rose Marie Parr commented:
“I thought it would be helpful to provide you with an update on the emerging COVID-19 situation, our current preparedness plans for managing the outbreak, and more specifically how they relate to community pharmacy. I will also describe some of the developing plans which will be refined over time based on the evolving situation. This will be the first in a series of regular updates I will be issuing in response to the COVID-19 pandemic.
“I very much appreciate that COVID-19 will be placing new and ever-increasing challenges on community pharmacy and GP practice teams and I am grateful for your ongoing efforts and support. I am also aware of the pressures that hospital pharmacy teams will be experiencing and the importance of the whole pharmacy profession working together to deliver pharmaceutical services to patients, including at the points of transition between primary and secondary care.
On the topic of pharmaceutical services Rose Marie commented:
“In the first instance, it will be important to maintain pharmaceutical services and ensure that they are delivered safely. As part of the primary care workforce, community pharmacies will be at the front line in terms of providing advice and access to supportive treatments to members of the public.
“As I stated at the outset, the situation on COVID-19 is evolving, as are our strategies to contain, delay and mitigate. We are engaging with Community Pharmacy Scotland and Directors of Pharmacy to ensure that our plans are fit for purpose at each of the phases of our response. I will continue to keep you updated as and when appropriate. We will, where appropriate, consider with Community Pharmacy Scotland, if there are community pharmacy activities that can be reduced or stood down for a period of time or other areas that need to enhance or expanded.”
In a tweet this afternoon Rose Marie postponed her planned retirement in July:
“Many thanks to Pharmacy teams in Community Hospital and Primary Care working extremely hard in response to COVID-19 pandemic. As the Chief Pharmaceutical Officer for Scotland, I am committed to supporting you through these challenging times and have postponed my planned retirement -for the foreseeable future.”
The above article is a summary of the key points in Rose Marie’s letter which we hope is helpful if you are pushed for time however if you work in community pharmacy in Scotland we suggest you read the letter in its entirety. We have shared it below.
This content is being shared under the Open Government Copywrite licence.