Make better use of hospital pharmacists in mental health, says second Carter review

Second Carter review outlines how £1bn of efficiency and productivity savings per year can be achieved by 2021, including innovative use of pharmacy staff and increasing numbers of pharmacist prescribers.

Sandra Gidley, chair of the Royal Pharmaceutical Society English Pharmacy Board

Mental health and community trusts should deploy pharmacists in much more “innovative” ways to ensure that they are able to tackle problems such as the use of antipsychotics and polypharmacy, says the second version of the Carter productivity review.

The review, led by Lord Patrick Carter, looks into “unwarranted variation” between trusts and how £1bn of savings can be wrung out of mental health and community services running costs, including on medicines and “pharmacy optimisation”.

It recommends trusts identify “local opportunities for the innovative use of pharmacy staff”, including for child and adolescent mental health services (CAMHS), antipsychotic use, medicines automation and polypharmacy. It adds that increasing the numbers of pharmacist prescribers will “add capacity, expertise and value”, starting with increased numbers in training in 2018.

The 80-page report, published on 24 May 2018, also recommends that NHS England’s specialist pharmacy services and the regional medicines optimisation committees develop a national ‘do once’ system for organisational medicines governance. This could include national standardised medicines policies, patient group directions and other essential organisational governance documents during 2018–2019 — as revealed by The Pharmaceutical Journal in May 2018.

It also advises that trusts provide their own stores and distribution services consolidating medicines stockholding, and aggregating and rationalising deliveries. “This should seek to reduce stockholding days to a maximum of 15 and deliveries to less than 5 per day, and ensure 90% of orders and invoices are sent and processed electronically by 2020–2021,” it said.

Carter said: “I am confident that if the recommendations in this report are implemented, up to £1bn of efficiency and productivity savings per year can be achieved by 2021.”

A spokesperson from the Guild of Healthcare Pharmacists welcomed the proposals in the report, but added that building up the workforce would “require time and additional investment”. 

He added: “The advanced clinical roles pharmacists and pharmacy staff have developed in areas like CAMHS and clozapine clinics have, in isolation, been highly successful and pharmacists are in many areas proving themselves to have a unique and valuable contribution to make in direct care delivery positions rather than as a support to medical and nursing staff.”

Sandra Gidley, chair of the English Pharmacy Board (EPB) at the Royal Pharmaceutical Society (RPS), said she was “delighted that Lord Carter has recognised the roles that pharmacists can play in improving care for those with mental health problems”.

However, she said it was unclear what ‘teeth’ the report would actually have. “The EPB is shortly to launch its campaign on how pharmacists can improve the care of patients with mental health issues and some of our proposals will fit nicely into this agenda,” she said. “It would be helpful if Lord Carter engaged directly with the professional body because the health sector needs to be much more joined up about the care it provides for the most vulnerable in our society.” 

In his first review, Lord Carter recommended that NHS trusts use at least 80% of their pharmacist resource for direct medicines optimisation activities, medicines governance and safety.

Last updated
The Pharmaceutical Journal, PJ, June 2018, Vol 300, No 7914;300(7914):DOI:10.1211/PJ.2018.20204931

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