Chronic Medication Service: are you ready? Print E-mail
Written by Sally Arnison   
There should be few surprises for Scottish pharmacists when the Chronic Medication Service (CMS) begins early in 2007. However, like any change in practice, integrating a new service into everyday practice requires energy, commitment and effort. This article looks at some of the challenges CMS will present and how you can prepare to make the most from this new service for your business and your patients.

Evolution

The CMS was first outlined in 20031. It can be seen as bringing together the mechanics of serial dispensing of prescriptions with the clinical component of pharmaceutical care model schemes so that patients with long-term conditions can have their medication supplied, monitored and reviewed by their community pharmacist over a 12-month period.

Serial dispensing has been piloted in three sites across Scotland. Every community pharmacist has had the opportunity to undertake the pharmaceutical care model schemes in clinical areas including asthma, epilepsy, coronary heart disease and hypertension. The outcome of this evolutionary process is CMS, which will be rolled out as the final core service in the new Scottish pharmacy contract.

Because CMS is a core service, it is important that patients are able to access the same level of service from every pharmacy in Scotland. You need to be able to provide the best possible care for your patients so that they remain registered with you.

Funding


The Scottish Pharmaceutical General Council (SPGC) and the Scottish Executive Health Department (SEHD) should be commended for their vision in negotiating the remuneration package for the new pharmaceutical care services contract2. They have taken a bold step away from volume-based payments for pharmacists, and CMS will be based on a capitation payment.

Although at the time of writing (autumn 2006) it had yet to be decided exactly what figures will apply to the CMS component of the new contract, the funding will come from the global sum. This means there can be no cap on funding for essential services.

Remember that until CMS comes online you are being paid a participation fee for model schemes. SPGC has recommended that “all contractors should be taking part in at least one of the model schemes as such activity will be helpful when we move on to the next stage of the new contract.”

In some areas health boards have offered further financial incentives to contractors to continue to offer model schemes and hone their clinical skills ahead of CMS.

Preparation


You will already have successfully managed one enormous change to your practice with the introduction of the minor ailments service (eMAS) and the public health services (PHS) in summer 2006. There are probably a lot of learning points you can take from these services and apply to your preparation for CMS. How ready do you feel for CMS? Have you considered how you are going to make it part of your core business on top of everything else you already do in a jam-packed day?

The NPA highlighted six steps to successful implementation of the new pharmacy contract in England3. These included:

  • Developing the whole of your pharmacy team;
  • Training and CPD for you and your staff;
  • Developing your premises;
  • IT requirements;
  • Operational changes;
  • Relationship building.

It is important to address each of these issues as you prepare for CMS in Scotland.

Developing the whole team


Firstly it is crucial that your staff are informed about CMS. They will be your advocates who will sell the service to your patients. Think about how you can best keep them informed of new contract issues. Consider using role-play to help your staff feel comfortable talking to patients about CMS.

Secondly, do you have the right amount of staff at the right times? Saturdays always used to be quieter days when we could catch up on jobs from the rest of the week. Is this still the case? Have you seen changing patterns since GP surgeries have closed for weekends? Have you reflected this in your staffing levels?

Training and CPD


Do you feel the need to undertake further study before you feel competent to deliver CMS? NHS Education Scotland (NES) has produced training packs for the clinical areas covered by pharmaceutical care model schemes over the last few years. These would be a good place to start. Remember to record all your CPD.

What about staff training needs? Remember your registered technicians are now obliged to record their CPD as well. Are you providing them with opportunities to develop their skills? Have you considered the need for an accuracy checking technician? Would this free up more of your time to be involved in CMS?

Developing your premises


The Scottish Executive has been investing in pharmacy premises for a number of years. It would be a good time to re-evaluate whether your premises will allow you to deliver what you want to with CMS and the other components of the new contract. Does your consulting room have all the equipment you require? What happens if a customer requires a discreet consultation and the consultation room is in use?

IT requirements


CMS will require you to use your patient medication records (PMR) system rather like a GP uses patient notes. You need to be able to track and record interventions so that any user can see what is happening at any given time. Does your current system allow this to happen?

Much work was done around IT up to implementation of eMAS in June 2006, and this has laid the foundations for future ePharmacy developments. You may want to consider IT as wider than just your pharmacy system. For example, have you considered investing in electronic point of sale (EPOS)? Would this help you with stock management? What else would you like to be able to use your PC for? Some forward-looking pharmacists are already in conversation with their local GPs to investigate wireless connectivity to the GP prescribing systems.

Operational changes


Perhaps it is time to stop what you are doing right now, take a step back from the dispensing bench and just observe what is going on around you. Ask yourself whether you have to be involved in everything you are currently doing. Could your staff do some things better, or differently, in order to streamline your workflow?

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Table 1. Checklist for CMS
How CMS will operate in each pharmacy will be as individual as you are. However you need to consider the following points:

  • How will you identify patients who would be suitable for CMS?
  • Where and how will you store prescription forms?
  • How will you ensure patients are seen when they collect each instalment?
  • Will you run an appointment system for medication reviews?
  • How will you communicate your findings to GPs?
  • How will you ensure the service runs smoothly when you are not present personally?

Relationship building


CMS – and arguably the whole of the new pharmacy contract – will only achieve its full potential if we truly engage with other healthcare professionals. Building relationships with others will be a key aspect of making this happen. It is not just GPs with whom we need to link but a whole range of people including the practice manager, reception staff, nurses, dentists, health visitors, social services team etc.

We also need to work hard at building relationships within pharmacy, so that we are all giving consistent messages. Your local pharmacy champion and your pharmacy locality group (PLG) should be key to this.

These six steps are only a starting point to get you thinking about how you will implement CMS in your practice. You may wish to start drawing up an action plan. Table 1 gives you a checklist of activities to help prepare yourself and your pharmacy team for CMS. You could use this to start your action plan but there may of course be additional points you want to add.

Getting help


Extensive resources are out there to help you prepare for CMS. Make sure you access all that are available, including community pharmacy websites. Find out who is your local pharmacy champion. They will be able to help you with all matters relating to the new contract.

NES will be producing training packages for specific clinical areas. Their workshops are well worth attending. The NPA will be able to help you, as will wholesalers and other pharmacy bodies who will undoubtedly be producing a wide range of support materials.

The process of change is never easy. Making big changes does not happen overnight, but can be done as a series of small changes. Why don’t you start with just one tiny change and see where it takes you?

References

1. Scottish Executive Health Department, New Community Pharmacy Contract, 2003 (www.show.scot.nhs.uk/sehd/publications/
DC20030731CommPharm.pdf ).
2. Scottish Pharmaceutical General Council, Financial framework for the new pharmaceutical care services contract, SPGC, April 2006.
3. NPA, New Directions. The complete NPA guide to the new pharmacy contract, 2005.

 
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