Over the past few weeks, our personal and professional lives have been disrupted like never before. As we approach four months since the first confirmed case, the outbreak of Covid-19, is now rapidly approaching almost 500,000 cases and 20,000 deaths. The virus has gone from the subject of water cooler chat to a global crisis on an unprecedented scale, with over 19 countries now in full lockdown.
For those of us who work in General Practice, our days are rarely straightforward. General Practice is a highly pressurised, under resourced and often overwhelmed environment. As the advice from the government has changed, and the severity of the situation has become apparent, our team of Pharmacists here at Ashburton, have had to adapt rapidly to the changing face of healthcare services, amidst this global crisis.
Ashburton Prescribing was started in 2013, by Pharmacists Sue Read and Lynne Garforth. Ashburton provides bespoke Pharmacist services to General Practices, across the North West of England. To date we have a team of 26 Pharmacists, working in over 40 GP Practices, assisting with Prescription Queries and signing, Medication Reviews, Medicines Reconciliation and a host of other tasks designed to support GPs with their ever growing workload.
As a small organisation, we have always been keen to prioritise innovation and agility in our working practices and now more so than ever. At present, around a quarter of our team are working remotely from home, either through self-isolation, or taking precautionary measures. They are able to do so by using remote access laptops that allow them to access EmisWeb (Clinical Patient System) either purchased externally, or borrowed from the practices. As the weeks go by, we are acquiring as many devices as possible, in order to allow our Pharmacists to work from home to reduce the risk to themselves, their families, patients and their colleagues.
All face to face medication review appointments are being done over the phone, and workflows are being prioritised to allow pharmacists to concentrate on ensuring the most vulnerable and high risk patients receive the medication they require.
Since Ashburton began working in GP Practices, we have encouraged our staff to do as much with patients as possible over the phone. We have found that a significant amount of patient contact can be done in this manner, which keeps face to face appointments free for patients who really need them. One of the positive things to come out of this crisis, may be that it adjusts the way people interact with their healthcare providers, hopefully for the better. There is no doubt that even before Covid-19, we were in crisis in General Practice. In some parts of the country, we have already seen the numbers of people presenting at A+E reduced significantly since the outbreak.
As many clinicians across the country move to working remotely, there have been obvious pressures added to IT systems and personnel. We have encountered delays to accessing the systems, issues with overburdened servers, and backed up IT support lines. IT staff are often quickly scapegoated, but they too are working around the clock to ensure that clinicians can continue to provide health care services to patients. When recognising those involved on the front line, it’s important not to forget those in the background enabling the wheels to keep turning.
Clinically, measures are having to be taken to reduce the burden on the NHS. For example, many of the GP Practices we work with have relaxed their protocols for requesting less urgent blood samples for patients. We are having regular conversations with practices about which medicines can have extended routine testing, whilst remaining vigilant in ensuring that those taking high risk medicines like Methotrexate and Warfarin for example, are still being closely monitored.
One of the services we offer to practices is a pharmacist led Anticoagulation clinic,where we manage patients prescribed warfarin or Doacs (Direct Oral Anticoagulants). The vast majority of our patients are elderly, and have comorbidities, which means they are all currently being advised to self-isolate. This has adjusted the way in which we treat those patients, moving to home visits, ensuring that the appropriate precautions are being taken when entering and leaving the patients’ homes.
Furthermore, some practices are increasing their use of electronic prescribing and electronic Repeat Dispensing(eRD). Repeat dispensing offers many extra benefits. eRD allows the prescriber to authorise and issue a batch of repeatable prescriptions for up to 12 months with just one digital signature. eRD stores all issues of the eRD prescriptions securely on the NHS Spine and automatically downloads them to the patient's nominated community pharmacy at intervals set by the prescriber. Patients are required to give their consent for repeat dispensing. This can be verbal, formal written consent is not required. It is important to remember that not all patients are suitable for eRD, and the decision to put it in place for anyone is a joint decision between patient and prescriber.
More information about eRD can be found here: https://digital.nhs.uk/services/electronic-prescription-service/electronic-repeat-dispensing-for-prescribers
Finally, there has been a significant rise in the amount of patients over ordering, or ordering unnecessary items. We are seeing examples of patients ordering upwards of 3 months worth of medication at a time, and trying to stockpile medicines, which means that the supply chain then runs out and other patients are unable to get hold of any medicines. This is causing other health problems For example, if an Asthma patient is unable to get their inhaler then they are at an increased risk of an asthma attack which could be fatal.
We are appealing to all patients, continue to order your medications as you have previously done. The multidisciplinary teams in General Practice, Doctors, Nurses, Pharmacists, Paramedics, Physician Associates, HCA’s, Physio’s, are working around the clock to ensure that patients continue to receive the treatment they require. The more you panic order and put pressure on healthcare services, the greater risk you put on other patients and clinicians.
This is without any shadow of a doubt, the biggest crisis our country and health care service has faced in living memory.
We are going to have to work together to get through it.
Listen to the advice of your Health Care Professionals, think of others, continue to wash your hands and follow the guidance to isolate.