Wales is made up of seven local health boards (LHBs) responsible for providing health services in their geographical area. This differs to the system in England where the decisions lay with the CCGs.
- Abertawe Bro Morgannwg University Health Board
- Aneurin Bevan Health Board
- Betsi Cadwaladr Health Board
- Cardiff and Vale Health Board
- Cwm Taf Health Board
- Hywel Dda Health Board
- Powys Teaching Health Board
I am a community pharmacist and I have recently worked in three of these health boards. I believe there is no significant difference between them in terms of services or funding. I feel however there are slight variances between LHBs. For example in Cardiff and Vale, there is strong emphasis on deprescribing but I feel there is greater leniency towards GPs to prescribe anything. On the other hand, in Aneurin Bevan, I noticed lack of pharmacy involvement in the community setting. Communication was poor with hospitals particularly regarding discharged patients and I did not find any GP pharmacists welcomed.
Prescriptions, prescriptions and more prescriptions.
Prescriptions in Wales are largely paper-based and mostly carry a 2D barcode. There is growing interests for hub and spoke dispensing where the barcode is scanned through a computer system linked to a hub. These prescriptions are then dispensed, checked and packaged to be sent to the respective pharmacies.
Residents of Wales benefit from free prescriptions of course however I feel this is doing more harm than good. Many patients especially within Cardiff and Vale, request prescriptions for OTC pain killers/ products including paracetamol (as pack of 32), Sudocrem (original), Vaseline (original), paracetamol/ ibuprofen liquid, ibuprofen gels, and the list goes on.
Free prescriptions for all individuals in Wales was approved in April 2007 with emphasis that the:
“…policy aims to provide medication for free that is only available with a prescription. Where patients already buy non-prescription medication over the counter they should continue to do so in the normal way.”
– Said: Dr Brian Gibbons, Health Minister.
It is also important to note that prescriptions are only free for people registered at a Welsh GP or Welsh patients with an entitlement card if their GP is based in England.
In my opinion, the introduction of free prescriptions in Wales has rightly resolved health inequalities and ensured medicine cost is not a hinderance. In England, where the cost per item is £8.60, it is no surprise that NHS England is suffering due to the long-term implications of patients avoiding treatment.
The discharge medication review (DMR) service is specific to Wales and aims to improve medicines management and patient outcomes post-discharge. The scarcity of DMRs performed across health boards has introduced question as to the need for this service. Pharmacist backlash against scrapping DMRs has consequently encouraged better links between primary and secondary care and promoted openness to improve and enhance current pharmacy services. In Cardiff and Vale for example, about 72 wards have electronic discharge notifications sent from the hospital to the patient’s nominated pharmacy.
MURs in Wales vary slightly compared to in England as follows:
- National target groups differ
- All MURs in Wales are claimed electronically using the National Electronic Claim and
Audit Form (NECAF)
- There is no requirement for patient to receive services from a pharmacy in Wales for three months prior
A maximum of 400 MURs can be reimbursed per pharmacy in any 12 month period. Following a DMR, an MUR can be performed after 6 months.
There are five national target groups in Wales:
- Patients taking antihypertensive medication;
- Patients taking medicines for respiratory disease;
- Patients taking high risk medicines (MXT; Li; NSAIDs; Diuretics)
- Patients prescribed a medicine no longer required
- People aged 85 or over who take six or more medicines
For patients to fall in the antihypertensive category, the patient should be taking two or more medicine not four or more which is the case in England.
Choose pharmacy is a recent web-based application rolled out to ultimately enable pharmacists to supply necessary OTC treatment free of charge. This is through the common ailment service (CAS) scheme available only for a defined list of 26 common ailments. This application is also used to support electronic DMRs through access of an electronic discharge advice letter.
Accreditation in Wales follows different procedures than in England. Pharmacists providing MURs in Wales must be registered to do so and added to the MUR listings form. Once registered, pharmacists can perform MURs across all health boards in Wales.
From April 2018, accreditation for enhanced services including EHC and smoking cessations will change. There will no longer be a requirement for face to face training and fees for assessments will be scrapped. The pilot phase has just been completed and introduced the new process via a WCPPE online package. It is hoped that pharmacists will be better trained following assessments using virtual patients and video consultations.
Written by Ayah
Cpwales.org.uk. (2018). Home – Community Pharmacy Wales. [online] Available at: http://www.cpwales.org.uk/ [Accessed 26 Mar. 2018].
Nhsdirect.wales.nhs.uk. (2018). NHS Direct Wales. [online] Available at: http://www.nhsdirect.wales.nhs.uk/ [Accessed 26 Mar. 2018].
Wales.nhs.uk. (2018). Health in Wales | Free Prescriptions for Wales Approved. [online] Available at: http://www.wales.nhs.uk/news/6081 [Accessed 26 Mar. 2018].
Wales.nhs.uk. (2018). Health in Wales | Structure. [online] Available at: http://www.wales.nhs.uk/nhswalesaboutus/structure [Accessed 26 Mar. 2018].