Wes Mountain/The Pharmaceutical Journal
Community pharmacy teams play a significant role in providing care and support to people using substance misuse services. However, there has been little change in how pharmacies provide dispensing and supervised consumption services for individuals on medication-assisted treatment (MAT) for several years. In response, Change, Grow, Live — a charity that provides treatment to around 30% of people receiving opioid MAT in England — has developed a brand-new holistic ‘Core MAT Service’ that recognises the skills of the entire pharmacy team.
Why was the Core MAT Service developed?
The supervised consumption service only benefits the small percentage of people who require supervised consumption, which introduces variation in the level of care that people in treatment receive. The organisation wanted to ensure consistent levels of support, no matter what stage individuals are at in their treatment and recovery journey. Very often, pharmacy teams already deliver many elements of this support to service users, and we believe that pharmacies should be recognised and renumerated for the work they undertake.
Community pharmacies have many demands on their resources, along with facing funding pressures, medicines supply issues and workforce shortages. Recognising these problems and acknowledging the valuable input that community pharmacy teams have in the care of people accessing our services, we launched the Core MAT Service in conjunction with local pharmaceutical committees (LPCs) and public health commissioners in April 2023 across Cambridgeshire, Peterborough, East Sussex, West Sussex, West Kent and Norfolk. The service covers nearly 5,000 prescribed service users.
What is the Core MAT Service?
The Core MAT Service moves from a transactional supervised consumption service to a more quality-based commissioned service, introducing a standardised approach, which contractually supports all individuals receiving a MAT prescription after being dependent on opiates.
The service consists of four vital components:
- Wellbeing support to all MAT-prescribed individuals through harm minimisation advice, signposting to other services and healthy living advice;
- Reporting missed and late doses of MAT using a simple process that allows the prescribing team to utilise live data sent from the pharmacy to actively support service users to keep them in treatment and minimise the risk of disengagement and illicit drug use;
- Supervised consumption where required is provided by any suitably trained member of the pharmacy team; and
- An annual pharmacist review that contributes to the service users’ treatment plan and recovery through reviewing MAT adherence, dose optimisation of MAT, reviewing other medicines use, medicines safe storage and overdose prevention.
Pharmacies receive a monthly fee of £7.50 per person to whom they dispense MAT. An additional £30 is paid upon completion of each annual pharmacist review.
Outcomes from the pilot
The Core MAT Service was introduced across six pilot sites, which overall represent 5% of all people prescribed MAT in England. The new service was agreed upon with four different LPCs who contributed to the final service-level agreement and supported the creation of templates on the PharmOutcomes website.
Following the six-month pilot, an evaluation of the outcomes showed that pharmacies were receiving an average of 66% more income compared with previous payments from supervised consumption services; 3,500 more service users were supported with this service compared with the previous supervised consumption service; and there was a 5% growth in pharmacies delivering the service at a time when pharmacies are closing and streamlining which services they provide.
With ever-increasing demands on time, efficiencies in processes are essential
With ever-increasing demands on time, efficiencies in processes are essential. The pilot showed 87% more pharmacies were reporting missed and late doses, with some areas reporting an 800% increase in the number of reported missed and late doses. This can be attributed to improvements in the reporting process that halved the time taken to report and action missed and late doses.
During the pilot, shorter quarterly pharmacist reviews were undertaken, with more than 1,000 pharmacist reviews conducted, resulting in our service users being signposted to other services, receiving naloxone training and concerns around suboptimal MAT doses being highlighted to the prescribing team. Learning from the pilot, and with direct input from contractors and LPCs, these regular quarterly reviews have been replaced with a more comprehensive annual review.
How patients have benefited
Feedback of patient experience with the Core MAT Service has been positive, with the pharmacist reviews being specifically mentioned as supportive, beneficial in supporting dose optimisation and contributing to our service users accessing additional services. The reviews allow the patient to benefit from one-to-one support with a healthcare professional who is independent of the prescribing service and to utilise the pharmacist’s unique clinical expertise.
Interoperability between the Change, Grow, Live electronic patient record system and PharmOutcomes allows for data reported by the pharmacy team to integrate directly into the service users’ clinical records. Real-time notification of late and missed doses supports patient safety and retention in treatment as our teams can promptly contact the patient to offer support, while pharmacist review information can be accessed by prescribers and recovery workers to inform future treatment plans.
Expansion to other areas
Positive feedback from people who received this service during the pilot, our staff, community pharmacies and LPCs has meant that the Core MAT Service has continued to run in the six pilot areas and has been introduced to four new areas: East Lancashire, North and Central Lancashire, Hertfordshire and Reading. Our hope is now that the value of the Core MAT Service will be recognised and adopted more widely, allowing all people who are prescribed MAT in England to benefit from this novel approach.
