Review of NHS Pharmaceutical Care of Patients in the Community in Scotland

Care at Home

42. Many of the principles which relate to pharmaceutical care in care homes are also applicable to services for patients who require supported care at home. The situation can, however, be even more complex with a wide variety of formal or informal carers of varying capabilities, with the growing implications of Self Directed Support, and the issues arising from the operation of a number of recent pieces of legislation²⁸ . Direct supply of specialist items by homecare companies bypassing the mainstream services causes problems for pharmacists and GPs and the patient information they hold, and we recommend that these arrangements should be reviewed by Scottish Government and NHS Boards. We heard much about the considerable inconsistency both in the level and nature of services provided across Scotland. The multi-agency and multi-disciplinary challenges are precisely those which the current proposals on integration of health and social care are intended to address. As with care homes, the NHS Board in partnership with the local authority should be responsible for co-ordinating the local arrangements for pharmaceutical input.

43. We consider that the following principles should apply:

• nationally agreed service standards
• nationally agreed standards of documentation and recording systems
• clear definition of roles and responsibilities of all involved in giving care
• all care providers having access to current medication details and to the sharing of other information appropriate to their particular responsibilities
• single shared assessment and the use of MDS only where that is assessed as being appropriate for individual needs
• quality assured training, guidance and support for care staff (including informal carers) in medicines, safety issues, administration etc

The aims should be as for those in care homes, but with a particular focus on re-ablement and the active involvement of family and paid carers. The use of such tools as SPARRA²⁹ can assist in identifying those at greatest risk and hence need for more intensive support. There is also the opportunity to use other members of the pharmacy team, as demonstrated in the Reshaping Care for Older People Programme, to contribute to the service provided. Advances in telehealth, including remote monitoring systems and prompts, can also support the input from professional staff.

44. We recognise the challenges for the NHS and its partners as the need for more extensive and specialised care is delivered in the community. This reinforces the need for professionals in the community to work effectively as part of a wider team involving those whose locus has traditionally been more hospital based, and with whom there has to be effective communication and exchange of information. Implementation of all the changes required to meet patient needs will inevitably take time, but we believe there is a widespread desire to move forward. We recommend, therefore, that the practical evidence submitted to our review, together with local examples of good practice (e.g. in Highland) should be used as the basis of developing a national approach to which NHS Boards, Local Authorities, the Care Inspectorate and professional bodies are committed.