From left to right:
Jasmeen Islam, Deputy Chief Pharmacist; Rebecca Hellier, Clinical Pharmacist/Teacher Practitioner; Gill Heron, Clozapine Clinic Team Member; Bethan Thorpe, Senior Clinical Pharmacist; Alice Williams, Clinical Pharmacist; Colin Lewis-Conde, Clinical Pharmacy Technician
As the NHS Long Term Plan makes clear, people with mental health problems are at risk of dying on average 15 to 20 years earlier than the general population. For example, schizophrenia is associated with double the risk of heart disease. This is partly due to concurrent physical health conditions. People with mental illness are also less likely to be given health checks (such as blood pressure testing) and support with improving their health (e.g. smoking cessation).
People who are hospitalised for mental health conditions have support to stabilise their mental health, but it may not be appropriate at that time to start reviewing medicines or giving advice to improve concurrent physical health conditions.
Community pharmacies are ideally placed to help support people with mental illness with their overall health. They use Medicines Usage Reviews (MURs) to help people understand their medicines, improve adherence and advise on lifestyle choices that can impact health. They receive funding for 400 each year, and so target them towards people who will benefit most. Pharmacists, as experts in medicine, are in a good position to identify whether a MUR would be helpful to someone with mental health problems.
The Cheshire & Wirral Partnership Mental Health Trust has worked with their Local Professional Network to develop a system so that patients identified as requiring additional support when in hospital are referred to their local community pharmacy.
The mental health professional identifies that there is a requirement for further support and obtains consent from the patient. The professional then sends referral information to the community pharmacy, who use the information to complete a targeted MUR or add relevant information to the pharmacy records.
This has now extended to include referrals from community mental health teams and clozapine clinics. Clozapine is an antipsychotic medicine that is only prescribed in secondary services. It is associated with serious side effects, such as neutropenia, agranulocytosis, seizures, myocarditis and cardiomyopathy.
Communication about medication
Communication between all health providers is important to ensure patient safety. This includes primary care, secondary care and mental health trusts. There is a risk when patients are being treated by different prescribers that the risk of a medicine-related error because all their information is not available in one place. Medicines prescribed and dispensed in secondary care does not appear on the Summary Care Record, or the community pharmacy medication record, without additional input.
The medication record is used to check medicine interactions when new medicines are dispensed against a prescription or recommended by a community pharmacy, or to determine whether symptoms are due to a minor health condition, more serious illness or side-effects of current medication.
The Cheshire & Wirral Partnership Mental Health Trust has worked with their Local Professional Network to develop a system to let community pharmacies know when clozapine is prescribed and dispensed in secondary care, so that the pharmacy can be alert to potentially harmful interactions or where symptoms that may otherwise be identified as minor health conditions can be treated appropriately. In particular, a sore throat, cold/flu symptoms or constipation need to be treated differently if the patient is taking clozapine. The platform used is one that is familiar to the community pharmacy and uses existing commissioning to try and improve outcomes for patients
The approach taken by the Trust has allowed us to help tackle a long-standing health inequality. Better information sharing and integrated working means that whether someone has an appointment with a psychiatrist or is picking a prescription, they will benefit from a joined-up service. In taking this approach, we are also helping to deliver the community-based offer for mental health that is set out in the NHS Long Term Plan.
Deputy Chief Pharmacist
Cheshire & Wirral Partnership NHS Foundation Trust