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Case Study One

Level 1 prescription reviews by community pharmacists in Coventry PCT

As part of a review of medicines management, Coventry PCT set out to improve care for patients and make better use of the skills and knowledge of its community pharmacists to support GPs. Joining the National Collaborative Medicines Management Services Programme (MMS) enabled them to extend the role of the community pharmacists in medication review. A pilot Prescription Review and Intervention Scheme with Education (PRISE) was introduced in February 2002.
The PRISE scheme formalises and enhances existing community pharmacist activity, creating better relationships between prescribers and local pharmacists and improved services for patients. It also provides a consistent agreed process for reviewing prescriptions and managing medicines across the Coventry PCT area.
In consultation with the Local Pharmaceutical Committee (LPC) and interested GP practices, the pharmaceutical adviser arranged for community pharmacists to review prescriptions presented for dispensing without access to the patient's notes. Pharmacists and surgeries involved in the pilot were trained on a range of agreed interventions by the pharmacist, use of standard forms to document interventions and refer problems and proposed changes to the GP. Pharmacists are paid 2 for each intervention and provide a detailed monthly report to the pharmaceutical adviser to claim the fees due.
During the first three months of operation, over 1000 interventions were made and an estimated 85% of changes referred to the patient's GP were actioned immediately. Most interventions related to the quantity of medicine prescribed or to problems with the drug details on the prescription. A small number of reviews revealed significant problems with treatment and led to more in-depth clinical reviews by the GP. Coventry PCT estimates that for an investment of 5000 on fees and administration, approximately 150,000 of potential savings will be made during the first year of operation.
The scheme is now being rolled-out to include more pharmacies and general practices and the range of interventions is being developed and enhanced.
The PCT believes that the scheme has:
  • Enhanced patient care
  • Improved relationships between community pharmacists and GP surgeries
  • Identified and resolved problems in repeat prescribing systems
  • Generated significant savings through more efficient systems and processes.
This relatively simple, low cost scheme provides a way of quickly resolving problems with prescriptions and identifying patients who need clinical medication review. It could potentially be developed by increasing the emphasis on asking patients about their experience with their medicines and checking their understanding of their condition and treatment.
Mark Galloway, MMS Project Facilitator, Coventry PCT