Sharing data is nothing new, of course, but the pioneering work that has happened across east London demonstrates the breadth of connectivity with huge potential and has already proven highly impactful. Relevant personal health and care information is now able to be contextually accessed by community pharmacy services.
The traditional role of the community pharmacist as the healthcare professional who dispenses prescriptions written by doctors has evolved, developing additional clinical responsibilities and services to better support citizens as well as improved integration with the rest of the NHS.
“I believe that all community pharmacies should have access to their local patient record – this supports with the daily work of making safe supply provision of medicines, at the click of a button. I call it ‘right access at the right time to provide the right care at the right place’.”
- Vikesh Patel, community pharmacist, Newham
This expansion of the east London Patient Record (eLPR) has involved a huge collaborative effort from partners across the patch, all working together to promote interoperability and data availability to support patient care and decision making. The team credits their ongoing success to a number of factors, such as ensuring joint working from the outset with the multiple providers (Homerton University Hospital NHS Foundation Trust, Barts Health NHS Trust, North East London GPs, North East London Local Pharmaceutical Committee (LPC) and City & Hackney LPC) and suppliers (Pinnacle and Cerner) throughout the ICS. They also found that advocating an agile and iterative approach – on top of being open and transparent – meant they could make progress quickly.
Having access to a shared care record is beneficial for all care settings, but one key area where there’s been a notable limited focus and availability has been in community pharmacy. Although the summary care record (SCR) has been available for some time, local shared care records offer the next level of comprehensive data. Access to shared care records allows pharmacists to review the bigger picture, enabling even basic interactions to be more meaningful and personal.
On an average day, over 1.6 million people1 will visit a pharmacy in England – many community pharmacies offer longer opening hours and you don’t need to have an appointment to visit and access advice from a healthcare professional. There is huge potential for community pharmacists to act as a conduit for members of the community, providing support and advice.
Figure 1: Shared care record impact on services
Now, community pharmacists across east London are able to access the eLPR directly through their local information system (PharmOutcomes), offering advice, support and safe supply of new and amended prescriptions. These interventions not only replace time-consuming calls with GP surgeries, but often serve to prevent re-attendance to A&E.
Direct results
Community pharmacists have a direct link through PharmOutcomes that enables them to access a patient’s discharge summary, which almost always includes the medications that were prescribed/amended/stopped at discharge. Previously, this would have required them to contact the GP or the hospital to find out the details and even then, it would be verbally reported to them over the phone. Vikesh estimates that this phoning around could take up to 45 minutes to get the right information and it’s now available to them at the click of a button, and visible to them in black and white, so there is less chance for error or delay.
Robbie Gwinnett, software development engineer from Pinnacle (the supplier of PharmOutcomes) credits the success of the workflow integration to the working relationship between the key stakeholders: "This has been one of most successful cross-organisation projects that I've been part of – we had multiple bodies who all had to be on good terms and very understanding of each other to make it a success."
Community pharmacists are required to authenticate if they need to access patient details through the eLPR, providing the reason why. This gives assurance as well as audit capability for the project team, helping to also understand and support the use case for community pharmacy access. All organisations have worked closely with the data protection teams across the integrated care system to ensure that as data is shared across organisations, the right checks and balances are in place to be confident it is only accessed by those providing direct care, in line with patient expectations. The work has been a first-of-type in this part of London for this type of meaningful data connection. It is hoped that this will offer a blueprint to other regions around the country for regional care records connection.
The Discharge Medicines Service (DMS)
DMS became a new essential service within the Community Pharmacy Contractual Framework (CPCF) on 15 February 2021. Now, NHS Trusts are able to refer patients to the DMS at their community pharmacy if they would benefit from extra guidance about newly prescribed medicines. Typically, an email notification is sent to the pharmacy that alerts them to log into the shared care record to view the relevant details and support the patient in the community. Whilst this service is still relatively new, it has already demonstrated to be of huge value, particularly for vulnerable patients or those struggling to access services.
Community pharmacists are spending time helping patients to understand how to take their medication properly, offering advice and support on demand.
Raj Radia, chair of the City & Hackney LPC strongly believes that we should consider the person at the centre of everything and to wrap services around them, highlighting the key role that community pharmacy has to play. He says, “We’re the only health provider easily accessible, yet we’re not being utilised. And I think we’ve got tremendous potential to really grow this.”
Raj is a huge advocate for harnessing the potential of the eLPR for community pharmacists to play a key role in the health and wellbeing of the local population. His advice to community pharmacy colleagues would be:
“You have to get on board as there is such a wealth of information available. If you’re not accessing the eLPR [when interacting with a patient] you are not giving the best care possible for that patient. We are always here to help!”