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COVID-19 is changing our lives in ways that we cannot predict, or often imagine, and general practice is no stranger to this. Of course, not all the changes in the health service since the start of the pandemic have been positive, but as practices plot their way to a “new normal”, GP pharmacists are hoping that some of the following temporary changes that have been implemented become permanent.

Greater focus on care homes

In May 2020, NHS England sent a letter to all primary care providers asking them to ramp up the support given to care homes. Part of this included pharmacy and medicines support — where it did not already exist — including facilitating medicines supply, structured medication reviews via telephone or video, supporting reviews of new residents or those recently discharged from hospital, and supporting care homes with medicines queries.

Liz Butterfield, specialist pharmacist at Airedale Telemedicine Hub, believes that history may identify the past few months as a defining moment in the development of pharmacy care home services. “There has been recognition by the whole clinical system that care home residents will benefit from holistic medication reviews and appropriate deprescribing, and that pharmacists are key to delivering this care.” She believes this has led to the genuine inclusion of pharmacy input into the multidisciplinary care of deteriorating patients.

Adding a pharmacist to a care home telemedicine service

Immedicare has provided 24-hour, senior-nurse-led clinical support and video assessment to care homes nationwide for several years. When the coronavirus pandemic struck, doctors in and around Bradford collaborated to add a medical rota to the service, in an attempt to avoid admitting care home residents to hospital. The rota, filled by local consultants and GPs with a special interest in care for older people, was commissioned by Bradford District and Craven CCG to support all local GP surgeries and care homes.

In April 2020, the service began employing a pharmacist, Liz Butterfield, for two days a week — allowing the nurses to call upon her expertise as they see fit. “The nurses might refer to me deteriorating patients, frequent fallers, those who have developed delirium or acute confusion, those with swallowing difficulties or at risk of AKI [acute kidney injury], or anyone else who they deem would benefit from a pharmacist’s input — particularly those for whom polypharmacy is an issue,” explains Butterfield. “I then assess whether any medicines might be contributing to the problem and make recommendations.” She has also joined the daily multidisciplinary meetings that take place via Zoom, providing opportunity for proactive intervention.

Her recommendations are sent to the patient’s GP and practice pharmacist for consideration but, as Butterfield points out, when a recommendation is received from the hub, the GPs realise that the problem has been triaged by a specialist and deemed urgent.

“I’ve really enjoyed the set-up, and it has allowed me to discuss patients informally with GPs and consultants who are working in the hub. Setting up this new service has been a huge challenge, but very rewarding and welcomed by nursing colleagues,” she adds. “While the pharmacist position was initially funded temporarily to respond to COVID, funding has been secured to continue employing a pharmacist in the future.” She believes the service’s model could be replicated regionally.

Immedicare’s response to new challenges

Immedicare have responded proactively to the new challenges that care homes have faced during the pandemic, from a rapid, remote deployment process being created, to the service being enhanced to adapt to the changing needs of care homes, such as the employment of a pharmacist to support the Bradford District and Craven CCG local services.

Furthermore, Immedicare are launching a new portal, which will connect local GP’s, community nursing teams, pharmacists, ambulance services and local hospitals to care homes using the Immedicare telemedicine service, allowing them to deliver vital care services virtually. These are just a few examples of how Immedicare is helping organisations to develop truly integrated and fully coordinated support pathways for care homes.