by Mary Ann Sant Fournier BPharm MPhil
President, Malta Chamber of Pharmacists
Professional centre, Sliema Road, Gzira
Website: www.synapse.net.mt/mcp/
Email: spizjar@waldonet.net.mt

Change and Innovation in Community Pharmacy – Phased National Implementation of the POYC scheme and Educational Opportunities

The national implementation of the POYC continues to roll-out with patient registration being extended in a further 10 localities (Pieta, Lija, Balzan, Fleur-de-Lys, B’Kara, Floriana, Valletta, Iklin, Siggiewi and Qormi during the period of 17 March till May 2008). To date, more than 22,500 patients have registered for the scheme in 29 localities.

Patients in Rabat were able to accede to the POYC service at the end of April. This brings the number of patients being served by the pharmacists in the pharmacy of their choice to 2390.

The service was extended gradually during May to Swieqi, St Andrews, Ta’ Giorni (which forms part of St Julians), Pembroke, Paceville, Dingli, Bahrija, Mtarfa, Ta’ Xbiex and Msida. In June, the rest of the pharmacies in St. Julian’s, together with those in Attard, San Gwann and Gzira are expected to start serving registered patients.

During April, several POYC meetings were held. The Standing Advisory Committee met on 10th April with the main item on the agenda being the pressing need to enhance the human resources at the central processing unit.

Two meetings were held at the Professional Centre, Gzira, for pharmacists practicing in the pharmacies, and owners. These consisted of a ’brainstorming’ session (10th April), and an information meeting for those pharmacists and owners in localities which were at patient registration or implementation stages of the national roll-out, as explained above (29th April).

With the conclusion of the pilot stage and the introduction of the phased roll-out of the national implementation, several lessons are being learnt, particularly from the pharmacists themselves who have and are experiencing the registration and implementation stages.

Discussions have focused on specific emerging issues, such as the information which should be given by the Department of Health to patients about changes to their entitlement, where there is a perceived clinically unjustifiable usage. This would be an effective supportive tool to the pharmacists’ interventions.  In this regard, a structured educational campaign using all the communications media possible and targeting the public on the registration and service delivery phases is also envisaged. It is recommended that such a campaign should be designed and implemented on the successful model of the recent Malta Euro Changeover campaign.

Educational initiatives at community pharmacists are in the pipeline. These shall have a strong information communication technology component and will range from the upgrading of computer skills to full e-learning initiatives. Indeed the Chamber is expecting the outcome of a recent application1 for a grant to the UNESCO Participation Programme 2008-9 for the implementation of a project on “Pharmacy e-Learning”.

EU Leonardo Project supported training visit to independent pharmacies which are NHS Contractors in the UK

Meanwhile, 6 community pharmacists and a pharmacy owner have already had the unique opportunity to participate in a training visit to independent pharmacies which are NHS contractors in the UK.  The visit (15-21 November 2007) was partly supported by the EU Leonardo Projects and was organized by the Malta Chamber of Pharmacists (MCOP) in collaboration with the Pharmacy Section of the Chamber for Small and Medium Enterprises, and with the then Parliamentary Secretary for Small and Medium Enterprises in the Ministry for Competitiveness and Communications.

The visit included a one day training seminar with representatives of the UK National Pharmaceutical Association (NPA) and the Pharmaceutical Services Negotiating Committee (PSNC), with which the MCOP has longstanding professional relations. This was followed by structured visits to independent pharmacies which are NHS contractors in the UK.

npa

The Chamber was supported in the coordination of the visit by Colette McCreedy, Director of Pharmacy Practice, NPA. The NPA training seminar consisted of an intensive meeting with McCreedy, who was accompanied by Raj Patel (the NPAs new EU representative), a member of the NPA Board of Management, and a key member of the PSNCs Negotiating Committee. The PSNC represents  community pharmacy on NHS matters. 

The Chamber delegation presented and explained the principles and provisions of the Memorandum of Understanding (2007) and the new Pharmacy regulations and the POYC scheme, giving a picture of the realities and vision for community pharmacy in Malta. The delegates had the opportunity to participate proactively.

McCreedy gave a presentation2 on community pharmacy in the UK, which essentially addressed the pharmaceutical demographic and regulatory background, together with the new NHS contract (2005).

The local management of the NHS in the UK is undertaken by 10 Strategic Health Authorities and 152 Primary Care Trusts (PCTs), with each PCT serving on average 350,000 people (approximately Malta’s total population) though the geographical size varies considerably. There is an average of 70 pharmacies within each PCT area. The higher accessibility of patients to pharmacists’ services in Malta is immediately evident when the demographic ratios are compared (Malta – 400,000 population: 209 pharmacies i.e., approx 1914:1). There are an average 40 GP clinics within each PCT area.

The new NHS pharmacy contract was introduced in 2005. It was expected to bring about a fundamental change in community pharmacy practice with more focus on quality and less focus on prescription volume. The new contract framework is represented by Essential, Advanced (which include medicines use review (MUR)), and Enhanced services.

The NPA considers the following as challenges faced by pharmacists in the UK: the uncertainty about pharmacy opening legislation; the difficulty to achieve the MUR targets; and NHS reforms are making it difficult for local health economies to commission enhanced services.

New opportunities include the increasing recognition by the Government of the value of the community pharmacy services and the emerging roles for pharmacists in prescribing, public health and as special interest practitioners. And there is a high level of public confidence in the community pharmacy service.

On-site experience of the implementation of the above was later possible for the Maltese delegation through the visits to several pharmacies, chosen for logistical reasons in or close to London. A visit to a large single-owner pharmacy, incidentally managed by a Maltese colleague, situated in central London offered the right ‘control’ in that its practice and financing does not depend on NHS prescriptions; in fact, this does not reflect the rest of UK, where in the majority, 80% of practice and pharmacy financing is NHS centred. The other independent pharmacies which were visited were single-owner and situated in South-West and West London, in Hertfordshire and Bedfordshire respectively. The delegation could thus see the different levels of development of services to patients and of IT applications.

Importantly, the Maltese contract was considered by our UK counterparts as “unique and forward-looking” in that service payment is patient based and not related to the number of items dispensed or prescription volume. The immediate computerization of the scheme introducing patient mediation records at pilot stage was also commended.

This was a unique opportunity to gain an insight, observe and learn from and exchange views with community pharmacists delivering an NHS service in the UK. Other opportunities in other EU countries will be announced shortly.

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  1. ‘Pharmacy e-Learning – The setting up, implementation, evaluation and accreditation of an On-Line Continuing Professional Development Programme for Pharmacists’ Grant Application to the UNESCO Participation Programme 2008-9. Archives of the Malta Chamber of Pharmacists. 2008.

McCreedy Colette. Community Pharmacy in the UK. Presentation to the Malta Chamber of Pharmacists and the Chamber for Small and Medium Enterprises. National Pharmaceutical Association, United Kingdom. Archives of the Malta Chamber of Pharmacists. 2007.