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Cynulliad Cenedlaethol Cymru |
National Assembly for Wales |
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Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon |
Health, Social Care and Sport Committee |
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Ymchwiliad i Hepatitis C |
Inquiry into Hepatitis C |
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HSCS(5) H01 |
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Ymateb gan Fferylliaeth Gymunedol Cymru |
Evidence from Community Pharmacy Wales |
Community Pharmacy Wales (CPW) represents community pharmacy on NHS matters and seeks to ensure that the best possible services, provided by pharmacy contractors in Wales, are available through NHS Wales. It is the body recognised by the Welsh Assembly Government in accordance with Sections 83 and 85 National Health Service (Wales) Act 2006 as ‘representative of persons providing pharmaceutical services’.
Community Pharmacy Wales is the only organisation that represents every community pharmacy in Wales. It works with Government and its agencies, such as local Health Boards, to protect and develop high quality community pharmacy based NHS services and to shape the community pharmacy contract and its associated regulations, in order to achieve the highest standards of public health and the best possible patient outcomes. CPW represents all 716 community pharmacies in Wales. Pharmacies are located in high streets, town centres and villages across Wales as well as in the major metropolitan centres and edge of town retail parks.
In addition to the dispensing of prescriptions, Welsh community pharmacies provide a broad range of patient services on behalf of NHS Wales. These face to face NHS Wales services, available from qualified pharmacists 6 and sometimes 7 days a week, include, Medicine Use Reviews, Emergency Contraception, Discharge Medicines Reviews, Smoking Cessation, Influenza Vaccination, Palliative Care Medicines Supply, Emergency Supply, Substance Misuse and the Common Ailments services.
CPW is pleased to have the opportunity to respond to this request for a written submission to inform the One-day Inquiry into Hepatitis C to be undertaken by the Health, Social Care and Sport Committee.
The request for information from the Health, Social care and Sport Committee relates to the action being taken to meet the requirements of the Welsh Health Circular WHC/2017/048 Attaining the WHO targets for eliminating hepatitis (B and C) as a significant threat to Public Health.
On a number of occasions in the past, CPW has signalled to Welsh Government and its Health Boards, a desire to move away from the simple supply and supervision services, that are currently commissioned, to more comprehensive services designed to better meet the needs of drug users.
In line with the principles of Prudent Healthcare and the stated direction of travel for NHS services in Wales, CPW would wish to see a ‘once for Wales’ approach to the design and commissioning of community pharmacy drug user services that better utilise the accessibility of the community pharmacy network and the skills of the pharmacy team.
Those members of the population that are drug users are notoriously poor at engaging with NHS and Social Care providers and CPW therefore strongly suggest that it is important to ‘make every contact count’ and therefore a comprehensive support service should be made available at every location where there is contact with this vulnerable group and this includes community pharmacy.
Community pharmacies that currently provide services to drug users have developed a degree of rapport and trust with these individuals and the foundation is therefore in place to deliver further support through hepatitis testing and treatment. The CMO’s letter of October 2017 fully recognises that ‘tests for these individuals and treatment provision should be delivered in settings and environments that they are familiar and comfortable with, and are likely to attend and accept treatment from.
Persuading those at risk of hepatitis infection to undertake a test is not easy and often require a number of conversations over a period of time with a trusted healthcare professional before the client is comfortable with undertaking a test. It is for this reason that any hepatitis service should be designed around client care and not commissioned on a transactional ‘item of service’ basis. It is important that Welsh Government and its Health Boards recognise the challenge associated with driving engagement and expectations are tailored accordingly.
The development of new, directly acting anti-viral medications has revolutionised the treatment of hepatitis C and therefore there are no barriers, other than those put in place by commissioners, for treatment not to take place in a community pharmacy following a positive test result.
CPW would wish to ensure that a national, flexible and fully comprehensive Community Pharmacy Hepatitis Service is put in place that allows the healthcare professional to engage in coproduction and provide the type of service that best meets the needs of the client.
For example a client should be able to be tested in a pharmacy, take their own test in a pharmacy, take away a test for return later or take away other test kits for partners, family members and friends that they believe may have been at risk of exposure to hepatitis. Any person who has a positive test result should have the choice as to whether they wish to be treated in the pharmacy or to be referred to their GP/local sexual health clinic.
While CPW would be supportive of hepatitis services initially being available from all pharmacies providing sterile injecting equipment and/or a supervised administration service it is essential that promotion of these services is not limited to current service users. Those currently not actively engaged with services such as the homeless and sex workers should be made aware that their community pharmacy provides a walk-in advice, test and treatment service. It is important that all care workers are also aware that they can refer at risk individuals to a community pharmacy for support.
CPW would also wish to see arrangements put in place to encourage local blood borne virus nurses to work in partnership with nominated community pharmacies so that they can operate collaboratively to meet the needs of their local population. CPW would therefore recommend that the current Community Pharmacy Collaborative Working Scheme is extended to include local blood borne virus nurses.
CPW also recognises the significant growth in injection of drugs amongst groups of people who do so to improve image or performance (IPEDs). This is a major group that should be more heavily targeted if WHO targets are to be reached in Wales. CPW would recommend that there should be a range of posters put up in all gymnasiums, sports clubs and tanning salons to raise awareness of the risk of contacting hepatitis, the fact that modern treatments are effective and simple to use and also to promote the walk in advice, test and treat service available at a nearby pharmacy.
CPW is pleased that there has been some engagement with two leading health boards on the design of a community pharmacy support service. We would however wish the pace of introduction to be stepped up and the service designed to be a broader more comprehensive service supported by local marketing. The service that is planned for trial is a test and advice only service with treatment held up by operational barriers that need to be overcome as a matter of urgency, if the capacity of the community pharmacy network is to be utilised to meet WHO targets.
CPW believe that the effective engagement of the community pharmacy network to provide a local, easily accessible, flexible and comprehensive Community Pharmacy Hepatitis, Advice, Test and Treat Service, will help Welsh Government achieve WHO targets for the elimination of hepatitis as a significant threat to public health.
CPW remain committed to working with Welsh Government and its Health Boards to put these arrangements in place.