Pharmacy teams to support care homes with ‘clinical review’ of patients amid COVID-19 response

Pharmacy teams will be expected to “support the clinical review” of patients in care homes as part of the NHS’s COVID-19 response.

An operational model, published by the Specialist Pharmacy Service on 19 May 2020, details four ways in which pharmacy teams will be expected to offer support, including working with multidisciplinary teams to prioritise care for patients; facilitating medication supply; advising care homes on medication use; and delivering structured medication reviews (SMRs).

It adds that local pharmacy leaders will draw up a “local workforce strategy and action plan” to “support the mobilisation and deployment of clinical pharmacy teams to support care homes”, as well as potentially set up a COVID-19 ‘Pharmacy and Medicines Care Home Task Force’ to deliver this work.

The model was published after NHS England and Improvement requested the provision of pharmacy and medication support to care homes in a letter on 1 May 2020, as part of a wider response to the outbreak of COVID-19 in care homes, which was described as posing a “significant challenge” to the sector.

As a result, the model states that “clinical, general practice, care homes and clinical commissioning group (CCG) pharmacists and pharmacy technicians, supported by specialist hospital pharmacists, and community pharmacy, are being asked to rapidly mobilise and join multidisciplinary primary and community care teams to support care homes, and implement this model”.

If teams do not have the capacity to support all care homes in their local area, it suggests the local taskforce “have urgent discussions, supported by the pharmacy leadership group and [Health Education England] pharmacy deans, with local organisations to identify additional staff”.

In addition to providing pharmacy staff, the sector will also support care homes through access to their expertise and clinical information.

“Community pharmacists and their teams can actively work with care homes pharmacists and pharmacy technicians in all aspects of medicines supply, including facilitating medication supply to care homes (especially end of life medication),” the model says, adding that ”a single point of contact for care homes for rapid advice on medicines and their use” should also be set up.

Pharmacists will also be expected to undertake SMRs with patients “via video or telephone consultation”.

The model adds that while “it is desirable” for these pharmacists to have independent prescribing training, “the current priority during the COVID-19 emergency demands a flexibility to provide urgent support for care home residents”.

Graham Stretch, chief pharmacist at the Argyle Health Group — which manages care for 1,000 nursing home residents in west London — was on the short-life working group tasked with developing the model, which he described as “a good, positive start”, adding that “we hope to be able to provide much more proactive, and less reactive, support”.

“The job now is to delegate this to regional and local levels,” he said. ”What we hope is that pharmacists and pharmacy technicians from any organisation — be it a CCG, a GP surgery, or a primary care network — come together with a mechanism based around a single access point.”

Prime minister Boris Johnson said in Parliament on 13 May 2020 that there had been a “terrible epidemic” of COVID-19 cases in care homes.

Commenting on this, Stretch said: “We need to try our best to put it right. Care homes have been challenged by the level and volume of work. It’s important that we put in practical, proactive support around medicines — and we don’t need to reinvent the wheel, we can use existing structures.”