These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Medicines shortage – a new prescription for an old problem

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 2)

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 1)

Cost of medicines falling

Three Nations Three Practices

Community Pharmacy Eliminating Hepatitis C

Homeless People make Glasgow

Heart Failure – we can get treatment right for everyone

Bundles of Safety

Community Pharmacy’s Leader in Scotland

CPO: On the Road to Achieving Excellence

Pharmacy technicians may become prescribers

Profile: Dr Norman Lannigan OBE

Profile: Jonathan Burton MBE

Profile: Clare Morrison MBE

Deep Dive Pharmacy

Mind the Gap - Diagnostic Skills for Pharamacists

Bundles of Safety

Supporting Excellence - Alison Strath Interview

2018 Pharmacy Forum Agenda Launched

Which Referendum to Choose

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Pharmacy First in Forth Valley One Year On

Initiatives Highlight Potential of Community Pharmacy

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Wednesday, August 1, 2018: Deep Dive Pharmacy

This article was published on Pharmacy in Practice

The Govan SHIP (Social and Health Integration Project) was set up in 2015, centred on four ‘deep dive’ GP practices serving some of the most socio-economically deprived communities in Scotland. The Scottish Government wants SHIP to develop anticipatory and preventative approaches for people with particular health needs to try to reduce unscheduled care and keep them out of a hospital. At the start of this year, Rizwan Din was appointed to work as a clinical pharmacist across all the SHIP practices, as part of a team delivering a very person-centred service to people who often don’t prioritise their own health. He took some time out to tell Pharmacy in Practice about his role.

The SHIP project is about integrating health and social care services to provide seamless patient care. Traditionally the quality of the interface between health and social services was variable and, in some cases, poor. Patients under the care of both are often some of the most vulnerable and complex. They are at risk of deteriorating rapidly when things go wrong, for instance, if there is a lack of communication about changes to medication, leading to GP home visits, referrals to unscheduled care services or hospitals admission 

“By bringing together health and social care teams at monthly multi-disciplinary team (MDT) meetings, we’ve increased communication, which has led to improved patient care. I found that there were various members of the team who, as a pharmacist, I’d never had the opportunity to liaise with previously. This project allows us to work together to improve the patient’s journey and reduce the burden on GP time. 

“The project had been running for a few years without designated pharmacy support beyond our practice prescribing support pharmacists, who are doing a great job! I saw this as an exciting opportunity to work with my line manager to develop a unique service. And, as details of the new GMS contract were revealed, I see this project as something of a pilot for the new pharmacotherapy service. 

“The patients included in the SHIP project are referred by their GP or a member of the MDT. The fact that non-traditional methods were used to identify patients has meant many patients were included who might have been excluded using traditional methods like SPARRA. I have found the benefit of this first hand, doing important polypharmacy interventions with a number of patients who might have been too young or had too few medications to warrant a review normally. There is no typical SHIP patient. My patients range from vulnerable elderly couples, people with mental health issues and even children with safeguarding issues. The majority of patients are housebound, so almost 40% of reviews are carried out on home visits. A further benefit of the home visit is that I was able to see how the patient is managing their medication. Storage of medication is a common issue, with multiple medications stored around the house some of which are out of date. Compliance issues are identified and addressed during these reviews, and I have an opportunity to discuss patients’ symptoms at a time when they are not acutely ill. I also get the opportunity to address wider social issues. In one case, the main cause for concern for one of my patients was a housing issue and I was able to liaise with the appropriate member of the MDT to alleviate it. 

“Patients have found the polypharmacy reviews very helpful and they have commented that it helps them understand what their medication is for, and the review process helps them to take control of their own treatment. One of the main benefits of this review for patients has been the reduction in tablet burden due to de-prescribing. 

“As per the polypharmacy guidelines, if the risk of side effects is higher than the likely benefit of treatment then the conversation to de-prescribe can be initiated. Side effects of medication result in 9% of hospital admissions so I believe acting to lower side effect risk helps to lower hospital admissions. I also found that inhaler technique was particularly poor in the elderly hence a review offers an opportunity to re-visit inhaler technique and ensure the patient is on the most suitable inhaler based on their technique and ability, thereby reducing risks of exacerbations.

“It is early to realise the full impact of this input. However, patients and surgery teams have provided positive feedback about the pharmacy input into the service. I believe this project has re-affirmed that pharmacists are important members of the MDT and I see the pharmacist’s role is further integrated into the primary care team, which will allow the pharmacist to utilise their skill set fully.” 

Rizwan Din is leading a session on ‘Integrating Pharmaceutical Care in a Health and Social Care Integration Project’ at the Pharmacy Management National Forum for Scotland in Dunblane on 30 August. Registration is free for pharmacists here.