Pharmacists are well positioned to promote awareness campaigns, like National Eye Health Week, with patients and ensure that they are aware of the services available to them in their local pharmacy.
Satyan Kotetcha, local professional network (LPN) chair for Birmingham and Jeff Blankley, local pharmaceutical committee (LPC) chair for both Wolverhampton and Birmingham, talk to Julia Robinson about the eye care services they provide in the West Midlands and how important awareness campaigns are in highlighting to patients what services they can access.
What eye care services are provided by pharmacies in Wolverhampton and Birmingham? How do these compare to other services available in Great Britain and what are the key challenges?
JB: Wolverhampton CCG commissions a Minor Eye Conditions Service (MECS) through community pharmacy, which aims to facilitate the patient journey. The service evolved from the Primary Eye care Assessment and Referral Service (PEARS) commissioned by NHS England, as a local bolt-on to a minor ailment scheme. MECS is a fantastic example of primary care working collaboratively to find the best treatment option for a patient with an eye condition, as well as being convenient for the patient. The optometry and pharmacy professions are working together to provide the best available care and reduce visits to GPs and even A&Es.
Patients present and the optometrist treats or refers the patient to pharmacy, GP or A&E depending on the diagnosis. Serious and urgent conditions are referred to hospital and acute minor eye conditions, such as dry eye, itchy eye or infected eye, are referred to the community pharmacy.
The referral is a written paper making the diagnosis clear and prescribing the appropriate eye drops from an agreed formulary indicated on the form. Non-formulary/non-standard strengths and sizes are excluded but preservative-free preparations are allowed.
The patient then takes the form to the pharmacy and receives the eye-drops. The fee and cost of drops is reimbursed by the clinical commissioning group (CCG). The service receives around 100 activities per month and it clearly saves consequential time with GPs and hospitals as well as providing the remedy immediately. PharmOutcomes provides the platform to report activity and all other back office functions.
Wolverhampton CCG has been judged as outstanding for the past three years. In Wolverhampton, the lead profession is optometry and this has the support and collaboration of the pharmacy and medical professions. Other CCGs are now exploring the service.
SK: The pharmacists here [in Birmingham] have a commissioned service where opticians will assess patients with minor eye conditions. If appropriate the optician will refer the patient to a participating community pharmacy where the pharmacist will supply appropriate drops as recommended by the optician, ranging from preparations for dry eye to steroids and antibiotics. Not only does this reduce burden on the eye clinic at the hospital, it utilises the skills and supply chain in primary care and also forges better relationships between the professions.
It was a challenge getting buy-in from commissioners who were concerned that the service would create demand rather than shift activity; however, the evidence has meant that the service has been recommissioned. We are also hoping for other areas in the West Midlands to adopt the service as this would allow better referral from NHS 111 and delivery at scale. We have had some success with a West Midlands wide approach to minor ailments covering all but a few CCG areas.
Building on this we have had a series of events in Birmingham and Wolverhampton to upskill pharmacists, dentists and opticians around each other’s roles in caring for patients with diabetes leading to referrals for medicines use reviews (MURs), dental checks and regional screening. I believe these services are quite unique and trail blazing and don’t know if other areas have adopted them yet.
What are the benefits for the public, the pharmacist and pharmacy when it comes to being involved in awareness campaigns?
SK: Pharmacies have such a great footfall, and to leverage this in making every contact count makes such sense. Awareness campaigns raise the profile of pharmacies in public health amongst the general public and show that our role goes beyond just dispensing prescriptions.
There is also job satisfaction for counter staff as it gives them an opportunity to develop their role leading into provision of services such as blood pressure and diabetes screening.
JB: MECS are supported by leaflets and posters across all the GP surgeries and pharmacy facilities.
Pharmacy activity is tracked through PharmOutcomes, so, inactive practices can be identified and supported. A similar process covers the optometry practices across the city. Normal activity data is extracted and shared periodically.
Healthy Living Pharmacies (HLPs), in some locations, have been used to promote MECS and posters added to the HLP Healthy Zone.
Why did Wolverhampton and Birmingham LPCs ask local pharmacies to participate in National Eye Health Week?
SK: Sight is very important but we often take it for granted. Lots of people attend pharmacy when there is something wrong – they may have difficulties with vision, medicines that cause dry eyes or blurred vision so promoting eye health fits really well with pharmacy. We are not competing with opticians but signposting and supporting patients.
The local professional network (LPN) and local pharmaceutical committees (LPCs) have supported roll out of HLPs across the West Midlands with funded training from Health Education England (HEE). Health promotion campaigns are a great way to demonstrate return on investment and to raise the profile of HLPs.
I am the LPN chair for pharmacy and a colleague of mine who is the chair for eye health approached me to ask if pharmacy would support this work.
We had already decided our mandated campaigns so approached the LPCs to ask if they would volunteer for just 200 pharmacies to participate, the response from the nine West Midlands LPCs was unanimous.
We targeted Birmingham and Wolverhampton due to previous engagement with eye health but ranthe campaign in other areas of the West Midlands. A regional independent wholesaler distributed all of the packs for us free of charge. They did the same for an earlier diabetes campaign as they could see the benefit, beyond just delivering medicines.
JB: Eye Health week was in the calendar for Health Champions for a while. There are a lot of these campaign weeks which some pharmacies support, particularly where there is a local need identified.
What advice would you give to pharmacists and pharmacy teams interested in promoting awareness days, weeks or months?
SK: Communication is key. Plan all of your campaigns in advance and try to link with awareness days and national initiatives where there is already lots of media noise. Use different channels, particularly social media feeds.
JB: To ensure that pharmacies and optometrists work together to help manage minor eye conditions and provide a joined-up message around eye health it is important to have joint working and meetings to coordinate and have sponsored events to increase attendees.
Both my LPCs communicate directly with contractors generally as a one-topic email.
In Wolverhampton, this is supported by the city council public health department and a quarterly HLP newsletter is circulated with the Public Health England (PHE) calendar of events, which is shared annually with the new campaigns highlighted at each publication. Local activities are incorporated into the “news” each quarter.
Birmingham LPC is embarking on a similar model, but at the LPC’s expense, as CCGs and the city council are yet to see the prevention and self-care opportunities in community pharmacy and HLPs.
Getting meetings arranged helps, although only a proportion of contractors attend. There are networks of HLPs in Wolverhampton driven by a keen public health specialist in the council. There is also support from both officers and elected representatives in Wolverhampton city council.
How can you market awareness campaigns effectively? What resources are available?
SK: We are very lucky in the West Midlands as we have great links to charities and PHE —- they have ordered all the national materials for our current mandated campaign ‘Stay well this winter’ (with emphasis on flu vaccination). We are also in the process of producing a short video clip in a pharmacy on how to set up a campaign — making it real and setting expectations.
JB: We now use PHE websites to link to collateral available. Distribution is a challenge and can be just wallpaper without sufficient engagement.
How do you measure the success of awareness campaigns?
SK: Last year we launched a Diabetes Awareness campaign, in collaboration with Diabetes UK and the Academic Health Science Network, distributing 100,000 leaflets to pharmacies highlighting the care patients should expect from pharmacies. An astounding 47,000 leaflets were confirmed to have been stapled to patient bags with audited responses from 12,000 patients. This was so successful that Diabetes UK is rolling it out in other areas and we are now doing the same for the British Lung Foundation and chronic obstructive pulmonary disorder (COPD) next year!
JB: The LPN really successfully marketed the diabetes campaign through community pharmacy. Evidence from the surveys showed that 25–35% of diabetics had not had their eyes tested or feet inspected or did not know what the right results for glucose, cholesterol and blood pressure were.
SK: But don’t rely on just sending packs out with a letter also use a platform such as PharmOutcomes to measure impact and participation.
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