Family Health Services Authority Research Articles

Joseph Edward Gordon

Joseph Edward Gordon (“Joe”) was prominent in the medical political scene in north Tyneside for a quarter of a century, during which time he was chairman of North Tyneside local...

Transient neurological symptoms in the older population: report of a prospective cohort study—the Medical Research Council Cognitive Function and Ageing Study (CFAS)

ObjectiveTransient ischaemic attack (TIA) is a recognised risk factor for stroke in the older population requiring timely assessment and treatment by a specialist. The need for such TIA services is...

Family health services authorities and community pharmacists at the purchaser-provider interface

Abstract The views of both purchasers (family health services authorities [FHSAs]) and providers (community pharmacists) were sought on the development of community pharmaceutical services in the light of the 1992 pharmaceutical care report. Questionnaires were posted to the 480 pharmacists in charge of all community pharmacies in Wessex and to the 98 general managers of FHSAs in England and Wales. The questionnaires focused on reactions to those recommendations of the pharmaceutical care report which, if implemented, would have significant implications for the community pharmacist's workload. Both the FHSAs and community pharmacists indicated that, in their view, the skills of the community pharmacist are currently underutilised. Both groups expressed enthusiasm for the pharmaceutical care report recommendations that the following services should be provided: domiciliary services, disposal of unwanted medicines, supply of aids for disabled people, supply of compliance aids and adverse drug reaction reporting. Neither group was enthusiastic about pharmacists providing a therapeutic drug monitoring service from community pharmacies. On other areas, pharmacists were more enthusiastic about the provision of health advice, diagnostic/screening services and treatment protocols, while FHSAs favoured distribution of welfare foods, needle exchange, instalment dispensing and referral forms. Overall, both the FHSAs and community pharmacists were receptive to the principle of the development of the role of the community pharmacist within the primary health care team but expressed concerns regarding the training and workload implications.

Complaints to family health services authorities about pharmacy services

Abstract The public in Britain is being encouraged to expect health care of a high standard. A consequence of this may be that people are more prepared to make complaints. Pharmacists will know that channels exist through which clients can complain about their services. However, few will have experience of these procedures, or be aware of the frequency with which clients resort to this action, for what reasons and with what outcomes. The objective of the study was to investigate the complaints made to family health services authorities (FHSAs) about pharmacy services. The study involved all complaints made in a three and a half year period to six FHSAs in one health region. The number, nature and outcomes of these cases are presented. A total of 113 complaints was made. These included a wide range of different issues, 92 per cent of which related to dispensing activities. Forty-one per cent of complaints did not constitute a breach of contract by the practitioner. The formal procedure, for investigating complaints, resulting in a hearing was pursued in 25 per cent of cases. There was considerable variation in the outcome of complaints that included an allegation of breach of contract. The diversity in the nature of complaints indicates that clients' perceptions and expectations of pharmacy services extend beyond the supply of the correct medication.

UK postal survey of pharmacists working with general practices on prescribing issues: characteristics, roles and working arrangements

Abstract Pharmacists are increasingly undertaking more non-dispensing work within the general practice setting. A postal survey of 414 United Kingdom pharmacists working with general practitioners (GPs), resulting in 174 responses (42 per cent), indicated that the pharmacists were working with 200 surgeries. The practices with which they worked were more likely to be fundholding (P<0.001), vocational training (P<0.001), and multipartner (P<0.01) practices, when compared with national statistics. Pharmacists funded by family health services authorities (FHSAs), commissioning agencies or health boards worked fewer hours in general practice (P=0.002) than those funded by a practice. The commonest roles, each reported by more than 50 per cent of pharmacists, were PACT (prescribing analysis and cost data) analysis, challenging doctors' prescribing, formulary development, guideline and protocol development, drug information resource, and liaison with pharmaceutical advisers. Thirty-two pharmacists ran in-house clinics. This study was limited by the low response rate. However, the findings suggest that pharmacists working with GPs undertake a range of roles, some of which involve direct patient care and responsibility for practice policy.

Threatening and violent incidents in community pharmacies: (1) An investigation of the frequency of serious and minor incidents

Abstract The incidence of threatening and violent behaviour in community pharmacy is of concern to pharmacists and their staff, who, if they have not experienced events themselves, will be aware of anecdotal reports and will have their own perceptions about their vulnerability and risks. The frequency of serious and more minor incidents, when and where they occur, is unknown. The concerns of pharmacists may have wide-ranging implications for pharmacy practice and the services pharmacists are prepared to offer. This study was conducted in two stages: a postal survey of all community pharmacies in six family health services authorities in and around London, followed by semi-structured interviews with pharmacists who had reported a threat and/or an assault while at work. This first paper reports an investigation of the frequency and nature of events, pharmacists' perceptions of crime and of their own safety, and the association of these findings with demographic and other variables. The second paper addresses the implications for pharmacists and community pharmacy services. Fifty-one per cent of respondents reported that they or their staff had at some time been threatened with violence and 31 per cent had been assaulted. Incidents involving knives or firearms comprised about one-fifth of all cases. Approximately one-third of events related to robbery of drugs, supply of prescriptions or non-dispensing pharmacy services and would thus be peculiar to community pharmacy. Therefore the possession of drugs on the premises and other aspects of the professional role of pharmacists places them at increased risk over other retail businesses. Significant minorities of pharmacists did not feel safe in the pharmacy on their own, or undertaking certain everyday activities. Events and concerns were more common in areas with a high Jarman score. Only weak associations were found between whether or not pharmacists reported incidents and personal and other business characteristics.

Location of community pharmacies: A rational approach using geographic information systems

Abstract The role played by community pharmacies in primary and community care and the extent to which they meet patient and customer needs has come under close scrutiny in Great Britain recently following publication of reports from the National Audit Office and House of Commons Public Accounts Committee.1,2 Spatial variations in the provision of pharmaceutical services and their physical accessibility to different sections of the community are issues at the forefront of the current debate. This paper reports on recent research, being undertaken in the North West region, to develop a systematic approach to the analysis of community pharmacy location drawing on the fields of geodemographics (ie, neighbourhood classifications) and geographical information systems (GIS). Comprehensive information is being assembled about individual pharmacies, the services they provide, the types of residential neighbourhood in which they are located, their advice-giving role, and their proximity to general practitioners, other health care outlets and residential homes. Data sources include the pharmaceutical register, the family health services authorities (FHSAs) and surveys of pharmacists and health care professionals. This is being augmented with digitised boundary information including the road network and small area statistics on demographic structure, social conditions and deprivation. These data are being utilised within a computerised system to identify how well the current distribution of pharmacies accords with expectations and alternative resource deployment scenarios. Particular attention is being paid to the identification of gaps in provision and areas of over-provision.

Late responders and non-responders to a postal survey questionnaire: analysis of potential further response and non-response bias

Abstract The purpose of this study was to evaluate the effect of further mailshots on response rates to a postal survey, and to determine the extent of non-responder bias. A questionnaire on services to drug misusers was mailed to a random sample of one in four community pharmacies in England and Wales (2,654), stratified by family health services authority, followed by three further mailshots to non-responders. The remaining non-responders were contacted by telephone and asked to participate in a brief telephone interview. The addition of the fourth mailshot increased the response rate by only 4.8 per cent overall. Responses to key variables (demographics, participation in service provision) were not significantly different when comparing response to mailshots 1–3 with the fourth mailshot. Responses to the telephone survey succeeded in increasing the overall response rate to 98.4 per cent. These postal non-responders (ie, those responding to the telephone survey) were significantly different from those who responded to the postal survey in the extent of their service involvement, with postal responders being more involved in dispensing Controlled Drugs than telephone responders (50.1 per cent and 39.2 per cent, respectively) and provision of needle exchange (18.9 per cent and 9.6 per cent, respectively). The use of additional mailshots to improve response rate may not be useful in increasing the generalisability of findings. However, persistent non-responders to postal mailshots were found to differ significantly from responders. If extrapolation to the whole population is deemed valuable, telephone follow-up of non-responders allows for the detection of any non-responder bias, and allows subsequent corrections to be made to postal survey responses.

Community pharmacists, injecting drug misusers and the reduction of HIV transmission

Abstract The role of 268 community pharmacists in reducing human immunodeficiency virus (HIV) transmission by providing advice and injecting equipment to drug addicts was investigated. Postal questionnaires were issued to proprietors or managers of all (362) community pharmacies in two family health services authorities within the North West Thames regional health authority to determine their current activities concerning the reduction of HIV transmission between injecting drug misusers (IDMs). More than half of the pharmacists supplied injecting equipment to IDMs, most frequently as 1ml disposable insulin syringes. Eleven per cent of those pharmacies from which equipment was sold provided disposal facilities. More than half of those without disposal facilities failed to provide information regarding safe disposal when supplying injecting equipment. Virtually all the pharmacists surveyed did not supply accompanying health education literature when they sold injecting equipment

Comparison of attitudes of general medical practitioners and community pharmacists to prescribing matters

Abstract In order to compare the attitudes of general medical practitioners (GPs) and community pharmacists to a broad range of issues concerning prescribing, a questionnaire was mailed in April, 1994, to all GPs and community pharmacists in contract with a local family health services authority (St Helens and Knowsley), an area covering 350,000 people. Replies were received from 60 per cent of the GPs and 84 per cent of the pharmacists. There was general agreement between the doctors and the pharmacists in their attitudes towards prescribing, and agreement that the quality of prescribing was a legitimate subject of concern for local health authorities. The role of community pharmacists was the main area of disagreement, with the GPs generally being more conservative while the pharmacists favoured a wider role. The professions shared a concern to improve the quality of prescribing, and about one third believed that a substantial amount of prescribing was of poor quality. A substantial minority of each profession had little contact with the opposite numbers from the other profession: 43 per cent of doctors had met a pharmacist fewer than four times in 1993. We present evidence of general agreement between the professions on a wide range of issues concerning the quality of prescribing in the community. However, if UK pharmacists are to achieve the wider role they and the government desire, the concerns of GPs need to be addressed.

Health promotion by community pharmacists: consumers' views

Abstract As part of the evaluation of the Barnet family health services authority high street health scheme (HSHS), 592 consumers were interviewed in six pharmacies. The objectives were to investigate whether the consumers came to the pharmacies for advice on general health matters, saw pharmacists as a reliable source of advice about staying healthy, read health promotion leaflets and had heard of HSHS. The general medical practitioner's (GP's) surgery was felt to be the most convenient place to get advice about staying healthy, and the GP the best person from whom to get it. The pharmacist was rated second in each case, above the media, although only 90 (15 per cent) of respondents had ever asked the pharmacist for general health advice. Only 237 (40 per cent) thought that it was the “usual” job of the pharmacist to give advice about general health, 112 (19 per cent) thought that it was not, and 243 (41 per cent) did not know. Those who had taken away leaflets to read (178, 30 per cent) were significantly more likely to be frequent visitors to the pharmacy, to have chronic illnesses, to think the media was the most convenient place to get advice, to have previously asked the pharmacist for advice about staying healthy and to think it was usual job of the pharmacist to give advice about staying healthy. Only 65 (11 per cent) had heard of the HSHS. Many consumers do not currently perceive that there is a role for community pharmacists in health promotion, and the profession needs to think again about some of the presumptions that have been made in the past.

Identification and costs of prescriber-defined repeat prescribing

Abstract The use of different definitions of repeat prescribing has, understandably, resulted in different published values of both numbers of prescriptions and their costs. One possible way of determining the number of repeat prescriptions would be to allow prescribers to self-identify prescriptions at source. However, the cost of repeat prescription items only becomes a tangible cost if, and when, the patient has the prescription dispensed. The aim of this work was to allow prescribers from six general practices in one family health services authority to self-identify repeat prescriptions. Only those prescriptions presented for dispensing were analysed and costed. Out of a total of nearly 54,000 prescription items, 29.4 per cent were identified as repeats; they accounted for 32.2 per cent of the total cost of the prescriptions. Overall, the average cost of repeat prescription items was higher than that for new prescription items. The approach used in this work is a novel method of identifying, quantifying and determining the extent and costs of repeat prescribing in a study population. The limitations of the method are discussed.

General medical practitioners' attitudes towards the use of patient medication records

Abstract A survey was conducted to ascertain general medical practitioners' (GPs') attitudes to community pharmacists' use of patient medication records (PMRs) and to assess whether GPs envisage a role for family health service authorities (FHSAs) in maintaining records of patients' data. The survey questionnaire was sent by post to all 1,257 GPs in contract with Avon and Devon FHSAs. A total of 811 questionnaires was returned, an overall response rate of 64.5 per cent. A majority (59 per cent) of GPs considered that community pharmacists should keep patient medication records and there was strong support for pharmacists holding PMRs for the elderly and confused, and also for patients with diabetes, asthma, epilepsy, and those patients who had experienced major adverse drug reactions or allergies. Some GPs, however, remained unconvinced of the usefulness of a pharmacy PMR. Seventy four per cent of respondents considered that patients should keep their own medication records. In contrast, only 4 per cent were in agreement with patient medication data being stored by FHSAs. The community pharmacist's role in maintaining PMRs received less support from doctors in dispensing practices than from their non-dispensing counterparts. Some 80 per cent of respondents were in favour of pharmacists providing PMR system-generated patient information leaflets with dispensed medicines. Most GPs considered that such leaflets had a positive effect on patient compliance. Recently registered GPs were found to be more supportive than their older colleagues of community pharmacists recording patients' clinical conditions and providing information leaflets.

Application of a formal prescription monitoring service to community pharmacy

Abstract A three-month study in a suburban health centre pharmacy investigated whether a clinical pharmacy service could be carried out in the community setting. Each week, all the prescriptions from the three general practitioners in one of the health centre's six practices were monitored. After referral to the patients' medical notes, the pharmacist identified the prescriptions that required discussion with the prescriber. The outcome of these prescription interventions was recorded. A one-month follow up study was carried out after the initial study period. Level 3 PACT data were consulted to establish changes in prescribing patterns and cost savings. During the three-month study period, 5,162 items were monitored. A total of 354 interventions were made, of which 216 (61 per cent) were accepted by the doctors and resulted in the prescription being changed. During the follow-up study, 2,462 items were monitored and 82 interventions made. The most important outcomes of the study were that the service encouraged discussion between the pharmacist and GPs about clinical problems, and that it provided an opportunity for pharmaceutical skills positively to influence patient care. All three GPs said they would like to see the clinical service provided on a long term basis and thought it should be funded by the local family health services authority. There was also a fall in costs, although this was not analysed statistically; the practice's prescribing costs were 9 per cent below the local FHSA average for the study period and 8 per cent below the FHSA average the following quarter. Prior to the study they had been 2 per cent above the local FHSA average.

That was then, this is now….

That was then, this is now….

Community-level socio-economic status and cognitive and functional impairment in the older population

This study aimed to determine if people living in communities with higher socio-economic deprivation are at an increased risk of cognitive and functional impairment even after controlling for the effects of individual socio-economic status. We analysed cross-sectional data from the Medical Research Council Cognitive Function and Ageing Study which consists of a community-based sample of Cambridgeshire, Gwynedd, Newcastle, Nottingham and Oxford. The study included 13 004 men and women aged 65 years and over who were randomly selected from Family Health Services Authority computerized records after being stratified to ensure equal numbers of those aged 75 years and over and those under 75 years. The outcome measures were cognitive impairment (Mini-Mental State Exam 0-21) and functional impairment (Instrumental Activities of Daily Living and/or Activities of Daily Living disability). Individuals living in more deprived areas, as measured by the Townsend deprivation score, were found to have a higher prevalence of cognitive impairment [odds ratio (OR) (most deprived versus least deprived quintile) = 2.3; 95% confidence interval (CI)1.8-3.0; P < 0.001] and functional impairment [OR (most deprived versus least) = 1.6; 95% CI 1.4-1.9; P < 0.001] after controlling for age, sex, centre effects, education and social class. There is a significantly higher prevalence of cognitive impairment and functional impairment in elderly individuals living in socio-economically deprived areas regardless of their own socio-economic status. This evidence is of relevance for informing public health policy and those allocating resources for the long-term care of the elderly.

Variations in practice nursing: implications for family health services authorities

Differences between Family Health Services Authorities (FHSAs) in practice nurse activities are described and interpreted, using the results of postal questionnaires to all practice nurses in England and Wales in late 1992. There were an estimated 15000 practice nurses of whom 12589 (85%) returned a completed questionnaire, which asked about 30 tasks, including domiciliary visits, carried out by practice nurses; employment conditions, professional qualifications, experience, and clinical grading; and practice characteristics. The proportion of nurses undertaking four out of five tasks varied by a factor of two or more across FHSAs. Just over a third (39%) of the variation in nurses' activities could be explained by professional and practice characteristics. The analysis distinguished between FHSAs where nurses were more likely to engage in tasks requiring diagnostic and clinical skills, including assisting with minor surgery, and FHSAs where nurses were more likely to conduct domiciliary visits, help with chronic disease management, and provide advice on welfare benefits, incontinence and health promotion. The former FHSAs were characterized by larger practices with four or more partners employing several nurses, training practices, and practices with a manager. The latter group was characterized by smaller inner city or urban practices, including single-handed partnerships, and practices often employing one nurse. The 1990 general practitioner (GP) contract boosted nurses' involvement in those activities attracting new payments but its impact on their roles and responsibilities was mediated by their professional skills and experience and the type of practice where they worked. The contribution of practice nursing to the delivery of primary and community health care varies considerably. Further research is required to find out whether role diversity reflects uncertainty about the appropriate use of their skills. FHSAs need to develop a variety of strategies to support and promote practice nursing.

Older people, prescribed drug consumption and the general practitioner contract

This paper draws on data obtained in the first year of a longitudinal study designed to monitor the effect of the general practitioner contract and the 1990 NHS and Community Care Act. The study focuses on the care received by people over the age of 75 living in areas covered by four first wave community trusts. One objective of the first year of this study was to examine the impact of the general practitioner (GP) contract particularly with regard to drug consumption and nursing input. Random samples of older people were obtained from family health services authorities in the four trust areas. Health visitors were recruited in each locality and were trained to conduct the interviews. A total of 775 people were interviewed and assessed for functional, physical, mental, emotional and social status. Each person was asked whether they had been given a health check, who had been involved and where this was carried out. They were also asked to show those medicines they had taken in the 24 h before they were interviewed. Multivariate analysis showed that after controlling for physical symptoms, functional ability, pathology, admission to hospital in the previous 12 months, socio-economic class, self-health ratings and consultations with their doctor, those who had been given a health check had consumed fewer drugs. The implications of these findings for the drugs budget are calculated. The results of the study suggest that savings on the drugs budget may offset to a large extent the additional costs of employing practice nurses to undertake health checks but further research is indicated.

Examining and presenting trends of internal migration flows within England and Wales

AbstractThis paper examines trends in internal migration flows within England and Wales. Spatial trends are presented using tables and thematic maps. Temporal trends are presented more efficiently using a contemporary visualisation method, the heat map. Sample data from the National Health Service Central Registrar (NHSCR) are presented and discussed as a case study. The analysis includes in‐, out‐ and net migration, as well as migration flows, for the Newcastle district. It also considers the Family Health Service Authorities (FHSAs) that are net migration losers and gainers. In addition to the methodological contribution of this work, conclusions are drawn on temporal trends, the degree of dispersal in migration linkages, and the continuation of the counterurbanisation phenomenon in the 1990s. Copyright © 2005 John Wiley &amp; Sons, Ltd.

The wisdom lost in knowledge: changes in the face of general practice

The wisdom lost in knowledge: changes in the face of general practice