Opioid replacement programmes benefit society overall

listen to ‘Methadone policy in Scotland’ on Audioboo

"Image courtesy of Fireflyphoto / FreeDigitalPhotos.net"

The Scottish Drugs Strategy Delivery Commission has set out it's recommendations and vision for methadone policy in the future north of the border. Sir Harry Burns, the Chief Medical Officer for Scotland, has acknowledged the effectiveness of opioid replacement therapy and the use of methadone in reducing the spread of diseases such as AIDS and hepatitis.

A community pharmacist myself in Scotland, I am, unapologetically, a strong supporter of the methadone programme and opioid replacement therapy in Scotland. It benefits patients and the public. Patients benefit from it because they receive therapy through a legal source. In nearly all cases, patients receive their therapy from a community pharmacy where pharmacists can supply the medicine in accordance with a legally valid prescription signed by a legally appropriate prescriber. It benefits the public because such programmes have been shown to bring a reduction in crime, as demonstrated in the tablet on page 24 of the report. Those who say that such programmes should never exist need to imagine what the serious consequences of abolishing those programmes would bring to society. On this issue, you've got to be careful for what you wish for.

But despite my support for opioid replacement therapy, I can totally understand some of the criticism that is made of such programmes. There has always been a common assertion from many that patients are left "parked" on methadone. There is no denying that in such cases that patients have been enormously let down and questions will have to be raised as to why this is happening in some parts of the country. The report released today certainly suggests, under 'recommendations 1-2' on page 107, that there should be a focus on increasing the cohesion the different approaches in order to reduce drug misuse. I agree. I have to admit that all of us in healthcare should be doing more to work together in tackling the ongoing issue. Success of those programmes should always be based on how many patients we can get drug free rather than just how many people we can get on it in the first place.

The report mentioned the word "enmity" on page 106. None of use can afford to engulf ourselves in any form of enmity with regard to opioid replacement therapy. Doing this is dangerous and benefits absolutely nobody. And it will certainly hinder any future progress that is needed in order to improve the quality of services that are provided to patients who need all the support necessary in order to help improve their lives.

All patients who use opioid replacement therapy are human beings after all and should never be snubbed by society. Rehabilitating those people who are suffering with substance misuse brings economic benefit, reduces crime and makes our country a much safer place to live.

Scottish pharmacy - moving on up

listen to ‘Wilson Review’ on Audioboo

The Wilson Review's recommendations, published yesterday, into the provision of pharmaceutical services in Scotland are encouraging. I personally give the thumbs up to the report released yesterday and believe that the report yesterday paves the way for pharmacy to move onto the next stage in it's evolution of providing excellent, quality healthcare for patients in Scotland.

There are four areas I want to specifically focus on in this blog post with regard to pharmacy in Scotland and this specific review from Dr Hamish Wilson and Professor Nick Barber.

1. Public relations

This is an area which is growing in importance and needs to be given high priority. In recent times, we, as a profession, have faced some very unfavourable headlines/press stories, whether it's the Which? survey findings or the highly controversial and infamous 'Methadone Millionaires' story.  In point 19 of the report, the image of the community pharmacy being seen as 'commerical' is mentioned and concerns were raised about staff changes and lack of continuity in terms of patient-pharmacist interaction when it comes to specifically communicating with the same pharmacist on a regular basis.

There is no doubt that community pharmacies have to be financially healthy in order to continue provision of the services they have to offer. They are not directly part of the NHS, but do provide NHS services which they are reimbursed for. Operating at a loss is no viable option. Community pharmacy contractors need to become profitable in order to survive. And I would go even further - the NHS can look to community pharmacy at a time like now when financial resources are becoming more finite than ever before. Community pharmacy provides excellent public health services to the public whilst at the same time maintaining a successful business model. Community pharmacy has nothing to be ashamed of when it comes to being branded as 'commercial', as long as it maintains it's professional and ethical commitments to healthcare and pharmacy service provision and remains within legal and ethical boundaries.

However, we pharmacists overall need to do a lot more when it comes to promoting a positive image of what we do and of ourselves. Operating within a new system which allows us to provide a consistent and high standard of quality, as suggested in point 19, is a very worthwhile suggestion and should be looked at further. The idea of a pre-booked appointment with a pharmacist within a system that fully supports this mechanism is understandable and I can see the logic behind this.

I would also suggest more of us should become media trained or develop an increased awareness of how to engage with the local and national media. Journalists will not just dismiss us hastily just because we happen to be pharmacists. They will listen if we have something worthwhile to offer them in terms of an enlightening story or development about what we can offer the public in terms of providing healthcare services.

Personally, as a presenter of a weekly radio show on Victoria Radio Network, I ran a regular feature up until July called 'Healthy Matters' where I enlightened listeners of the station in hospital, across Kirkcaldy and online about popular topics surrounding health such as healthy eating/living/exercise, smoking cessation and how to deal with the hot weather. Creativity goes a long way in any area of life and pharmacy is not exempt.

There are many ways for us to promote positive health and we pharmacists are blessed with the knowledge and ability to enlighten the public in a positive and helpful manner. And it will improve their perception of us as a profession.

2. Education/development

Pharmacists and pharmacy technicians have a professional obligation to commit to continuing professional development. NHS Education for Scotland, in my personal opinion, provide many excellent learning opportunities for pharmacists and after my pre-registration placement was completed south of the border, I benefited enormously from the seminars they had on offer towards the end of 2012 and in the early stages of 2013. I have no doubt that I will not be the only pharmacist who forms such an opinion or a similar assertion. Their support is vital and I am confident that it shall continue for a long time to come.

But the biggest challenge and worry for me is the lack of inter-professional networking. There is frankly next to none of it and sadly very little window for opportunity to enhance such opportunities to engage with other kinds of healthcare professionals. I recall at university taking part in inter-professional networking events which I found welcoming because it gave me the opportunity to talk to other healthcare professionals and share thoughts and ideas. But it isn't just the lack of inter-professional networking that worries me. I feel I'm not getting to know my other fellow pharmacy professionals in areas that I work in. And that's a shame because loneliness isn't exactly a comfortable feeling to experience. I like talking to new people and engaging with other people and that motivates and re-invigorates me. One of the benefits of the seminars provided by NES was that you got to communicate with other pharmacists and pharmacy professionals/employees.

The recommendation in bold on point 51 of the report is one of the most important - local networks, organised by local NHS boards, is an excellent idea. It will bring professionals and employees together, create new links and is especially important, because we have to remember that not every pharmacist or person involved in pharmacy is necessarily a member of the recently formed Royal Pharmaceutical Society. The fact that not everyone needs to sign up to the professional body means, inevitably, networking opportunities can only go so far. A recognition of the necessity for closer integration of pharmacy professionals can only be welcomed and seen as positive step forward, if the recommendation in point 51 is implemented.

3. Challenges for the profession

Point 60 highlights the need for pharmacists to be inter-connected with other healthcare professionals when it comes to accessing relevant information about a patient's medicines and care. The biggest drawback for pharmacists in community is a lack of access to doctor's notes and records for patients which limits our ability to make fully rounded and sound decisions in the dispensary. I haven't personally had much experience in hospital pharmacy but I can only imagine that they are more integrated into the healthcare team in hospital and that they are able to readily access patient notes, enabling them to make more substantiated decisions about a patient's pharmaceutical care.

There is no doubt that the Chronic Medication Service is an enabling platform for pharmacists to develop care plans and work more closely with GP's and provide long term care for patients who are taking specific medicines in the long term. But in reality, the service hasn't really taken off nationally and many issues remain and need to be resolved if CMS is to take off and become an overall success. It can still be an overall success but many issues need to be discussed and resolved in order to enable the service to flourish.

One of the other big issues that we face is tackling non-adherence to medicines. It is in the interest of the whole NHS that medicines prescribed and dispensed are used to it's full clinical effects in order to enhance clinical outcomes for patients and deliver value for money for our health service. Point 9 in the report states up to just over 15% of hospital admissions are a result of non-adherence to medicines and monitoring issues. Again we need to constantly remind ourselves in pharmacy that our role is not to be underestimated. We are the medicine experts after all.

4. The future

Despite the ongoing challenges and issues we face in pharmacy and healthcare in Scotland, I am very reassured by this honest, insightful and enlightening report. The duty for all of us in pharmacy is to constantly engage with stakeholders and our political representatives to push pharmacy up the political agenda and constantly reassure our colleagues across healthcare and society that we have a role in the nation that is worthwhile.

But we can be very proud of the health of the pharmacy profession in Scotland. Quite frankly, we are blessed north of the border with one of the finest contracts for community pharmacy that has ever been devised and implemented anywhere in the world. And I say that with no apology whatsoever. Smoking cessation, the minor ailment service and the provision of urgent supply - just a selection of some of the unique services we offer in Scotland that have benefited patients in the Scottish National Health Service.

I take my hat off to all past and current Scottish Governments for recognising our value in healthcare and continue to urge them to engage and listen to what we have to say for the future of pharmacy healthcare provision in Scotland. Many countries, worldwide, are taking a look to Scotland with interest and, dare I say it, envy and will no doubt be inspired by how far pharmacy has advanced in Scotland.

Exploring chronic pain in pharmacy

Last night pharmacists across the Kingdom of Fife and beyond congregated at Victoria Hospital in Kirkcaldy for a special seminar on chronic pain management. The event consisted of talks from specialists and a series of workshops where pharmacists and other personnel discussed issues ranging from the effectiveness of over the counter medicines for pain relief to more complicated treatments through exploring a series of pre-set case studies.

What was so striking about last night was the diverse range of opinion and personal learning experiences that participants shared, particularly during the workshop sessions. It became clear to me personally that pain relief is not just some sort of an irrelevant issue that can be brushed aside in pharmaceutical care. There's much more to it.

For instance, one of the consistent highlighted issues that kept coming up was attitudes towards over the counter treatments. It became apparent to me that many perceive simple and basic treatments, such as paracetamol over the counter (or even in a GSL pack) as ineffective and simply because they were being sold without a prescription.

A former British Prime Minister once used an infamous catchphrase, "back to basics". And as far as pain relief is concerned, maybe it is time to head back to basics. Even us pharmacists should become more aware of the opportunity that may arise through speaking with our patients about their medicines, in the fact that all our patients may require is just a chance to put their concerns and thoughts forward about what they are taking and how happy or unhappy they are with the medicines they have been prescribed to achieve the desired therapeutic outcome.

Its amazing how much one can learn from even an event like this. None of us have seen it all and there is always an opportunity to learn something new. It was a terrific night and was especially fun talking with fellow pharmacists about their experiences as well.

Would an independent Scotland benefit pharmacy?

Today the Scottish Government agreed with the Electoral Commission's findings over the proposed wording of next year's question in the forthcoming Scottish independence referendum, due to be held in the autumn of 2014. Pharmacy in Scotland isn't exactly immune from the effects of the recession with pharmacies having to take on the effects of category M cutbacks and pharmacists, particularly newly qualified ones, struggling desperately trying to get their foot on the pharmacy employment ladder.

Would an independent Scotland pave the way for a creative new way to deal with the current issues that are overshadowing the pharmacy profession north of the border?

None of us know what an independent Scotland will really look like. But nobody can also doubt either the opportunity it may bring as well.

Frankly, nobody has the right to assert that Scotland is incapable of running its own affairs effectively. To suggest so would be petulant. Many newly formed independent nations have managed just fine since embracing their own independence and nobody can really deny that whether they support the union or independence.

But the choice next year will be really down to what is in Scotland's best interests. Whether Scotland is better staying together with the rest of the United Kingdom, hoping that the coalition's austerity measures will result in future economic prosperity. Or whether Scotland's position in the union is untenable and therefore being independent is the only way forward.

Scotland already runs its health service very differently from England, Wales and Northern Ireland. The major difference can be seen between the coalition government's proposal to radically reform the way the NHS is administered by allowing GP's more of a say in the way services are commissioned in England. Scotland, under the Scottish National Party run government at Holyrood, has ruled out the private sector from running any aspect of the National Health Service.

A lot of the arguments for independence are based on the way the economy should be run. Many people north of the border do not approve of the austerity measures being brought about by Westminster and want to go down an alternative route by administering their own affairs and economic decisions.

As pharmacy are concerned, I can imagine nearly every contractor up and down Scotland do not necessarily welcome the category M cuts with glee. Although health policy is different in Scotland, could general economic policy from Westminster be holding the profession back?

Or could even a lack of creative thinking be holding back the profession? Some people argue that we already have enough powers north of the border to take an alternative route when it comes to administering and satisfying the needs of the pharmacy profession, pharmacy contractors and pharmacists.

But some others argue that because the Scottish Government has to resort to only a grant from Westminster for funding of public services in Scotland, it doesn't hold enough power to raise the necessary capital to adopt a different economic policy, despite the fact that the Scottish Parliament has the power to vary income tax by three percent over or under the current levels of income tax.

I would quite like to see some sort of a national debate set up and run, for example by the Royal Pharmaceutical Society in Scotland, to see what everyone in the pharmacy profession in Scotland thinks about what Scottish independence could mean for the future of pharmacy in Scotland.

Please let me know what you think: anas@officialanashassan.com

Polypharmacy will eliminate pharmacist unemployment

Image courtesy of adamr / FreeDigitalPhotos.net

Polypharmacy is defined as a scenario where a patient is on a high number of different medicines, some of which could be clinically deemed to be unnecessary for use therefore creating a burden on the patient in terms of adhering to compliance with prescribed medicines. And being on a high number of medicines can be clinically dangerous as a result of its continued use (due to drug-drug interactions or adverse drug reactions).

Unncessary polypharmacy isn't an ideal scenario for a patient's long term pharmaceutical care. Nor is it a help for the public purse especially in times of austerity like now where any savings in public spending will undoubtedly be welcome for taxpayers and the UK coalition government.

Last week in Edinburgh, I learned a little bit more about how pharmacists across Scotland are tackling the issue. Already to my understanding, NHS Highland, NHS Lothian and NHS Tayside seem to have made the most progress in starting to find solutions with other NHS health boards following suit. The recent "Polypharmacy Guidance" document, published jointly by NHS Scotland and the Scottish Government recognises the consequences of excessive polypharmacy which could cause patients problems.

The document also illustrates, in section 2.1, a criteria which makes an assessment of factors such as whether a medicine is being prescribed correctly, for instance, for a valid indication, at the appropriate dose, whether its clinically effective and whether a more cost effective treatment is available.

Later on in the document, it has been suggested that for 43,190 patients aged 65 or over with two unnecessary prescription items stopped over six repeat prescriptions in a year would bring annual savings of over £5,662,397. Compare that with an annual Scottish medicine bill of approximately £1.18 billion (ISD Scotland, 2011/12) that may only sound like a small drop in the ocean. The money saved could be utilised to either fund expensive treatments for specific groups of patients, for instance there has been talk of a possible cancer drugs fund for Scotland.

But what does it all mean for unemployed pharmacists? The savings made could be used to invest in employing nearly 222 band 6 pharmacists in Scotland. The facilitator/presenter of last week's seminar gave the impression that pharmacists are currently playing a major role in managing polypharmacy north of the border.

And who said that the pharmacist unemployment crisis wasn't solvable?

The curse of the Norovirus

Image courtesy of Salvatore Vuono / FreeDigitalPhotos.net 

Its nasty. Its unpleasant. It inflicts torture. Its the norovirus.

According to a report in The Independent newspaper this morning, vomiting bug cases have almost doubled since last year, affecting up to nearly a million people. It has disrupted school classes, closed hospital wards and caused problems in other care settings.

And I know what its like. I've been struck by the norovirus. Twice.

The bug is highly contagious and anyone can catch it if they make contact with anything that is contaminated, including any object. It is also very easy to catch from another person and even no contact is required. 

Sadly, there is no cure for it so any infected individual must let the virus run its course. Generally the virus will end its run within one or two days after it begins. However, according to NHS Choices, any individual suffering from the norovirus can make certain measures to minimise its disruption:

- Drink plenty of fluid to avoid dehydration.

- Use paracetamol appropriately to combat any pain, aches or fever.

- Eat foods that are easy to digest if you need to consume food.

- Do not go to your doctor as nothing can be done and the norovirus is contagious.

- If your symptoms last for a few days or if you have a serious illness then contact your GP for advice.

Regarding the fourth point, I would also add don't go to accident and emergency either because again nobody there can do anything for you and the last thing you would want is the virus spreading to another patient in the hospital. When I had the virus second time round, a long time ago, I was in such agony that I insisted on going to hospital. But when the staff at A & E told me it was probably the norovirus then that put everything beyond doubt.

And its also best to stay at home as well in order to minimise the impact of the norovirus. You don't want to infect anyone else after all!

This morning, Ward 2 at Stracathro Hospital has been closed due to the outbreak of the virus there. Anyone planning to visit the hospital ward to see family relatives or friends is advised by the hospital not to head there for 48 hours.

With just less than a week to go until christmas, the last few days will be a little more nervous for everyone. Lets hope this virus is contained and in control well in time for then.

Latest Scottish Pharmacy Review magazine

I am delighted to announce that just a few minutes ago, I discovered that my article regarding why politicians do understand community pharmacy in Scotland has been published in the latest edition of the Scottish Pharmacy Review.

To take a look at it, please visit: http://www.pharmacy-life.co.uk/ and head to the 'Magazines' section.

Please note that only suitable healthcare professionals within the pharmacy sector will be permitted to access this section of the website.

Then make your way to the latest magazine. I feature at the end of the magazine.

Alternatively, if you are expecting a copy at your community pharmacy place of work then you can check me out in the magazine too! Print or online, I'll be there!