Although ES7 was not included in the contract, community pharmacists still have legal obligations under the DDA and these apply throughout the UK.

In England and Wales, it was agreed that funding to help meet the costs of complying with the DDA should be provided to all contractors and distributed on the basis of number of prescription items dispensed. When the contract was introduced in April 2005 this funding was equivalent to 5.5p per prescription item.

The act

There are almost nine million people (17 per cent of the adult population) in the UK with a disability covered by the DDA. Of these, 2.75 million have a significant hearing problem and two million have a significant visual impairment. The DDA is UK-wide and covers England, Scotland, Wales and Northern Ireland. The parts with which community pharmacists must comply are Part 2 Employment Rights and Part 3 Access to Goods and Services. In this article I will concentrate on the supply of medicines in community pharmacies.

The DDA defines a disabled person as someone with a “physical or mental impairment, which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities”. An impairment is regarded as “affecting normal day-to-day activities” if it affects any of the following:

• Mobility;
• Manual dexterity;
• Physical co-ordination;
• Continence;
• Ability to lift, carry or otherwise move heavy objects;
• Speech, hearing or eyesight;
• Memory or ability to concentrate, learn or understand;
• Perception of the risk of personal danger.

People with sensory impairments such as those affecting sight, hearing or speech are included within this definition. An impairment that is corrected by medication, special aids or prostheses remains an impairment under the Act. The Act covers people with progressive conditions such as multiple sclerosis, muscular dystrophy or HIV infection from the point of diagnosis. It also covers those who have previously been disabled and have recovered.

Certain conditions are specifically excluded, for example, dependency on alcohol, nicotine and other substances, seasonal allergies and kleptomania. There was an amendment to the DDA in December 2005, which removed the requirement for a mental impairment to be a clinically recognised condition. This means that even being confused or forgetful, as long as this is long-term and affects people’s daily activities, could be considered a mental impairment under the DDA.

Examples of people who could be defined as disabled under the DDA include people with:

• Arthritis who cannot open their medicine containers or use an inhaler correctly;
• A visual impairment who cannot read dispensing labels or measure their dose of a liquid medicine;
• A mental impairment that means they cannot remember to take their medicines.

Table 1. Practical ways to help patients.

What pharmacists must do

Since 1999, pharmacists have been required under the DDA to:

• Take “reasonable steps” to change practices, policies or procedures that make it impossible or unreasonably difficult for a disabled person to use a service;
• Provide an auxiliary aid or service if it would enable disabled people to use the service.

It is still unclear what is “reasonable” and this has not been defined legally. It could be argued that this will vary between pharmacies because of factors such as space, staffing levels and volume of dispensing business.

Pharmacists must assess patients who request assistance with taking their medicines to decide whether the patient is disabled under the definition of DDA and, if so, what adjustments to their service are required. Various assessment forms are available, but any form has limitations and may not always correctly identify if a patient is disabled or not.

One technique is the use of trigger questions such as discussing with the patient whether they have problems:

• Removing medicines from packaging (containers, blisters etc.);
• Swallowing, applying or inhaling medicines;
• Measuring doses;
• Reading dispensing labels;
• Understanding dispensing labels;
• Remembering to take their medicines.
• is important to consider each patient individually. Pharmacists should record their assessment and the adjustments they make to their service. Often it may be appropriate to carry out such an assessment as part of a medicines use review (MUR).

Auxiliary aids and services

After deciding that the patient is eligible for support under the DDA, the pharmacist must decide which type of support or auxiliary aid will be most appropriate. There are many different ways in which pharmacists can help someone who is having difficulty in using their medicines (Table 1) and a monitored dosage system (MDS) may not always be the most appropriate method.

If patients continue to have problems despite the provision of an appropriate aid, it may be appropriate for the pharmacist to refer them to the GP, the primary care organisation or social services, as they may need further assistance.

Pharmacists frequently receive requests for assistance from carers, often on behalf of patients who are ineligible for support under the DDA. Charts and reminder sheets may be useful to help carers who administer medicines to patients. Pharmacists may need to reassure carers that they are able to administer medicines to patients from dispensing containers as long as they follow the instructions on the dispensing label carefully.

Pharmacists are also frequently asked to provide auxiliary aids, in particular MDS, to patients who are not eligible under DDA. This could be provided as an enhanced service or other locally funded service. Alternatively the pharmacy could offer the service to ineligible patients for an appropriate charge.

I hope that this article has dispelled some of the misconceptions surrounding DDA and community pharmacy. DDA often simply means making small practical adjustments in order to help patients make the best use of their medicines. This is something that community pharmacists have already been doing for many years.

Further information

Information leaflets and further resources on DDA are available on the NPA website.