Treating complex patients in their own homes is possible — we already do it

Two and a half years ago I applied for a fixed-term secondment with the pharmacy homecare team at University Hospitals of Leicester.

A distant relation of hospital outpatient collection, pharmacy homecare services deliver medication to patients’ chosen location in the community, alongside any other support they may need, with their consent.

At first, homecare appeared to me like a bizarre Kafkaesque system with little or no advantage over outpatient dispensing. Surely it is more efficient for patients to collect their medication from the hospital, rather than have a scheme to deliver medication to the patient’s home?

But I have learnt that homecare is much more than just a medicines delivery service.

When I started this new role, I had no previous experience of homecare and within months of starting, my small team all moved on, and with them any hope of being shown what to do by anyone who knew how.

I did all the roles of the out-going team, and learnt everything painfully, with favours and apologies. I learnt the strengths and weaknesses of the whole service from the ground up. Bloodied but not beaten, I trained a new team, a dedicated and innovative group, and together we have built a great service.

Within a year we doubled the number of patients we serve, introduced multiple new therapies, and recovered from long-standing staff shortage; we laid the foundations for a sustainable service.

Each party plays a part: from the prescribers, through pharmacy and the homecare providers, to the nurses who visit the patients — each dedicated to ensuring that every patient gets their medication at the right time, in a way that is convenient to them.

There is little direct face-to-face interaction with patients, but even those you have not met become old friends; their nuances become familiar and you are able to build a service that meets their personal needs, whether they are working, studying away from home or have restricted mobility.

Most homecare medicines are eye-wateringly expensive (biologics, for example), but they often come with some free pharma-sponsored extras, such as nurse visits, Youtube videos, dummy training devices, leaflets and text reminders (the cost of which is perhaps embedded in the price of the drug, rather than at no cost).

The vast majority of homecare therapies are self-managed, placing the onus back on patients to arrange details of their care, such as deliveries, increasingly being organised online. But patients benefit from fewer hospital visits, with all the associated saved costs of time off work, parking fees, and in some cases, prescription charges and exposure to hospital infections.

Of course, not all conditions can be managed by the patients or their carers. In these cases, nurses can visit patients’ homes for the administration of medications and clinical reports are sent back to the trust. Equipment such as pumps, fridges, giving sets and sharps bins can all be delivered to the patient and collected when no longer needed. Thereby, hospital beds and outpatient appointments can be freed up for other patients.

Prescriptions delivered are checked by the trust pharmacists, and purcharse order numbers are created by the pharmacy homecare team, before they are sent to homecare providers, which generates valuable usage data for commissioners and the trust. The pharmacy homecare team ensures the NHS is correctly billed for the services provided by homecare providers and that agreed specifications are met. Regular meetings with providers and good lines of communication ensure fruitful working relationships.

Homecare teams are increasing well-funded and can appear to be the golden goose of pharmacy, growing fast and better resourced, at a time where austerity measures apply elsewhere; investment in homecare teams give significant returns through savings on VAT from high-cost drugs, a fact not overlooked by NHS leaders and commissioners alike. The introduction of biosimliars and uptake via the homecare route gives commissioners wiggle room in their budgets to fund further services. It also fits in with the agenda recently identified in the NHS’ Long Term Plan to treat more patients in the community, rather than in hospital.

Admittedly, homecare cannot be used for every patient, but its future holds great potential. And I have had the privilege to not only witness its evolution, but also to mould it and direct its flow with so many amazing people all the while.