NHS Arden & GEM Commissioning Support Unit (CSU) provided pharmaceutical support for Worcestershire County Council in the production of their Patient Group Directions (PGD). Since implementation, over 150 clients have used the PGD and it has also been used as a case study by the National Centre for Smoking Cessation and Training (NCSCT).
The challenge
Worcestershire County Council decided to implement a PGD for the drug varenicline (Champix®). A PGD is a written instruction for the supply or administration of medicines to groups of patients who don’t have to be individually identified before presentation for treatment. Champix® is a drug used as an aid for smoking cessation and has been shown to be very effective, particularly when used alongside individual or group behavioural support.
Currently, in order to access Champix®, clients must take a recommendation letter from the smoking cessation service to their GP, return to their GP to collect a prescription and then go to the pharmacy for this to be dispensed. It was hoped that by removing the need for a GP to be involved, this effective medication would be available to more people. There has been a pharmacy voucher scheme in place in the area for Nicotine Replacement Therapy for ten years that has worked well and it was thought that a Champix® PGD would complement this option.
Our approach
Worcestershire County Council established a project team to oversee the development and implementation of the PGD, which included a senior pharmacist from the CSU who provided pharmaceutical advice. A PGD must be signed by an appropriate doctor, a pharmacist and the appropriate health organisation.
It took approximately five months from the first project group meeting to the launch of the PGD. As part of this process, community pharmacists attended an evening training session in order to be signed up to the PGD and ready to deliver the service.
The outcomes
Over 150 clients have used the Champix® PGD between December 2013 and May 2014 and it has been successful. The PGD has also been used as a case study in a report published by Public Health England and the NCSCT titled ‘Local Stop Smoking Services – service delivery and guidance 2014’. The PGD and supporting information are also available on the NCSCT website for adaption for local use. www.ncsct.co.uk/usr/pub/LSSS_service_delivery_guidance.pdf
Key learning points
- Working collaboratively is crucial to the delivery of the service. Our project group had membership from the Local Pharmaceutical Committee, a local GP as well as NHS Arden & GEM CSU.
- The need for community pharmacists to attend a training session must be identified as part of the project planning.
- Managing the distribution and collation of contracts between Worcestershire County Council and community pharmacists was initially time intensive.
- The PGD needs to be reviewed on an annual basis. The project team need to be aware of any new relevant clinical trial data and safety data for the use of Champix® at this review, and of any issues raised by the clients and community pharmacists with regard to the delivery of the service.
Future support
NHS Arden & GEM CSU medicines and therapeutics team will continue to provide a pharmaceutical view and advice on any new research and safety data.
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