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

Monday, July 2, 2018: Bundles of Safety

This article was published at Pharmacy in Practice website

A series of simple questions are offering a step change in safe dispensing of non-steroidal anti Inflammatory medicines (NSAIDs).

Building on the Scottish Patient Safety Programme, a communications bundle and toolkit are now being used across Scotland’s network of community pharmacies with the aim of getting every member of the team involved.

The work is being led by Mark Easton, National Clinical Lead Pharmacist for Primary Care at Healthcare Improvement Scotland, who is to lead a session on the programme for pharmacists from across Scotland, Wales and Northern Ireland at the forthcoming Celtic Conference in Edinburgh.

He has been telling Pharmacy in Practice about progress so far.

“There’s so much we can do to both improve safety for patients and improve the quality of care that pharmacists deliver, which are essentially two sides of the same coin. Choosing which high-risk medicines to focus on was a mix of listening to what clinicians were telling us and using the data that we had. For example, we know that there are around 61,000 unscheduled hospital admissions every year in Scotland relating to medicines and NSAIDs come within the top five of the medicines associated with these admissions. We also knew that NSAIDs weren’t just being prescribed; a lot of people taking NSAIDs were buying them over the counter in pharmacies, corner shops and supermarkets. So, we needed to reach a broad group of people and we needed to engage whole teams.

Working across 27 pilot sites within four health boards in Scotland, we developed, tested and validated a care bundle. As it turned out, the first thing we had to recognise was that a lot of people don't know what a care bundle is so, before we were able to roll it out nationally, we spent some time getting the explanation right of what it is and how it works.

The first element has been a communications bundle and then, later this year, we plan to roll out a clinical decision-making support tool for pharmacists.

At the heart of the communications bundle are three very simple questions – yes or no checks – asking patients if they know that they should be taking their NSAID with or after food; whether they understand that they need to tell their pharmacist or GP about any side effects; and making them aware of the ‘medicines sick day rules’ for the circumstances when they have a stomach upset, for instance, risk getting dehydrated and need to temporarily stop taking their NSAID to protect their kidneys. And the beauty of the three questions approach is that it works regardless of the role or experience of the team member delivering the bundle.

So far, the evaluation we've done shows that, by and large, the bundle has been well received within community pharmacy and people have particularly like the whole pharmacy approach. Certainly, in the pilot work we saw some real benefits beyond the actual bundle work. Engaging the whole team in an improvement project had a wider benefit because people, feeling engaged in patient safety, went on to make suggestions about additional improvement work that they could be involved in. And, on top of that, feedback from patients around the use of it has been really positive.


Mark Easton will be leading a session on the National NSAID communication bundle at the Celtic Conference for Pharmacy in Scotland, Wales and Northern Ireland, being held in Edinburgh on Tuesday 26 March.  Registration is free for healthcare professionals at