How pharmacists can bring patient care closer to home

I have worked in community health services for over 10 years. It is a little-known sector but extremely rewarding. Some of the key messages in the Darzi Report centre around health and care needing to be closer to home and to ‘embrace new multidisciplinary models of care that bring together primary, community and mental health services’. Community health services fit perfectly into this vision.

What are community health services? 

Each geography will have a variety of community health services that are managed and organised by different types of organisations, including NHS Trusts, community interest companies, social enterprises, local authorities and independent providers. They cover services that support people from birth to the end of their lives. Services are mainly delivered in people’s homes, including care homes, but also in community hospitals, intermediate care facilities, clinics, and schools.

Where does pharmacy fit in?

Pharmacy professionals have a huge role to play in ensuring patients can safely manage their medicines in their own home. We look after complex patients who want to be at home and work as a multidisciplinary team to enable this to happen. We look at how medicines are obtained, stored and administered in the community so that we can safely manage the patient’s condition. Pharmacy professionals also work in community hospitals or rehabilitation units to support patients and ensure safe discharge onto home or other places.

Challenges of working in the community

We are often working in someone’s home; this is their environment, and we need to respect that.  Whilst some homes are spotless, there are others that are more chaotic, cluttered or unsanitary with obstacles such as pets and environmental factors such as smoking.

There is a large range of services that pharmacy professionals could be working within so there is a requirement to have generalist knowledge and the ability to adapt to different situations. In addition, there are complexities with connectivity in patients’ homes, meaning that access to notes may not be easy and paper-based charts are sometimes used. We also find that medicines legislation and guidelines do not consider the constraints of community services – for example, many of the services are nurse- or AHP-led and not medic-led. 

Opportunities of working in the community

We use our skills to support patients, often when no other sector of healthcare sees them. Walking into a patient’s world is a privilege; you experience how they manage their condition and medication firsthand. Pharmacy professionals can make a huge difference to how patients manage their medication and empower them to self-manage. 

We are often working with complex situations that require a high level of problem solving and options appraisals. I recently looked at how we could administer a complex two-hour intravenous infusion three times a day for a patient, and I outlined ten options for managing this. None of these were perfect, and all had risks or challenges. However, working with the multidisciplinary team, we were able to safely discharge this patient home which was where he and his family wanted him to be. 

I have also provided advice on how we could support a young person who was nearing the end of his life to be at his hostel whilst also being an intravenous drug user. This was extremely complex and needed to involve a range of professionals. We had to ensure that this patient was safe but also had a duty to ensure the safety of others around him. We also needed to treat this patient as an individual and ensure that his views and perspectives were taken into consideration. 

I describe community health services as ‘grey’ as we are often working within complex situations and often outside usual medication guidelines. We work as part of a multiprofessional team to ensure patients are safe within the community. This is such a rewarding sector in which to work, and I would encourage pharmacy professionals to consider this in their career. 

We are currently looking for interested pharmacy professionals to join our UKCPA Community Health Services Committee or to support educational webinars and other pieces of work. Please get in touch if you are interested in being a part of our team in any capacity or to find out more about what we’re doing. I have found a great network of professionals through UKCPA and would encourage anyone interested to get in touch.

Appendix:

Community health services include: (from NHS England)

• Urgent Community Response including 2-hour rapid crisis response services
• District nursing
• Child health services
• Community occupational therapy
• Community paediatric clinics
• Community end of life and palliative care
• Community physiotherapy
• Musculoskeletal therapy
• Pulmonary or cardiac rehabilitation
• Community podiatry
• Community speech and language therapy
• Falls prevention services
• Intermediate care services
• Specialist nurses (for example, diabetes, COPD, heart failure, incontinence, tissue viability)
• Bed-based community rehabilitation
• Wheelchair services
• Health visiting
• School health services
• Sexual health services

• Some community services organisations also include mental health community-based care.
• Some community services organisations include Hospital at Home (virtual wards) although some of this is provided by the acute hospital.

This list is not exhaustive.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.