"Information sharing with pharmacists leads to safer care"

This month we have spoken to Stephen Goundrey-Smith, The Royal Pharmaceutical Society (RPS) informatics advisor and PRSB advisory board member, about the challenges of information sharing in pharmacy.

What challenges does the pharmacy profession face?

At present, there are around 11-12,000 community pharmacies in England, and some 54,000 pharmacists in England, Scotland and Wales. While a large number of these professionals work in community pharmacy, around 15-20% work in hospitals, and a small number also work in other areas such as primary care, industry or within GP practices. Hospital and community pharmacies do excellent work. As well as providing medications, they also offer clinical support to help people get the most out of their medications. However, pharmacists, particularly those working in the community, have been marginalised from the rest of the health and care services and information sharing has been lacking.

How is the role of pharmacy changing?

Over the past 20-30 years, pharmacists have taken on a greater range of clinical services. This includes medicines use reviews (MURs), to help patients understand and get the most from their medications and, more recently, the New Medicine Service, which educates patients on their latest medication to help them understand how it works and why it’s important to keep taking it. Pharmacists are also branching out to offer additional services such as help to quit smoking, disease screenings and flu jabs. This means that information sharing is more important than ever as pharmacists seek to gain more clinical data about the patients they’re helping to treat, and also record the interventions that they are making. Several systems are now in place to help hospital pharmacists communicate with community pharmacists concerning patients discharged from hospitals to ensure continuity of care. The summary care record has also been important for pharmacists, as it gives them access to the GP’s prescribing record out of hours. However, while there has been some work to improve communication, we have a lot more work to do and pharmacists require more detailed records to enable them to provide extensive clinical services.

What areas would benefit from improved information flows?

As the remit of pharmacy increases, we are faced with other challenges. For example, people who aren’t entitled to a flu vaccine on the NHS are able to have one in a pharmacy. But we are still looking for a standard solution for sending information on vaccines given back to the GP so that they have a record of their patients receiving the jab.

As well as poor information flows, there is variation in different areas in terms of how services are commissioned. I believe that better record formats and the widespread adoption of standardised information will put us in a better position to justify the provision of national service specifications. In addition, better records will lead to more consistency in care processes, which will enhance quality of care. A growing number of pharmacists are working in GP practices. Better records can also help to support information sharing between them and community pharmacies, which will be of benefit to the whole primary care sector.

In addition to communicating with GPs and hospitals, it is also important that we are able to share records with, and access records from, care homes, as many elderly patients have a set of complex needs and medications, which are regularly updated. At the moment, information flows are still limited and we would like to see this improve through the adoption of standardised records.

The PRSB is working hard to deliver standards for clinical records, which is essential for facilitating this information sharing. We have been keen to support the organisation from the outset and see its work as integral for the facilitation of good care across the whole health and social care sector.

Read more news
Read more blogs

Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.