How does community pharmacy reduce the GPS workload by helping patients living with diabetes?
Authors: Micallef R , Mujeeb S 
Published: November 2022

Abstract

Introduction
Diabetes mellitus is a metabolic disorder that affects more than 220 million people worldwide.1 The prevalence of type 2 diabetes is on the rise, leading to higher levels of morbidity, workload, and cost for the National Health Service (NHS).2 In addition, the long-term complications of diabetes can also contribute to higher levels of morbidity and workload for General Practice. Community pharmacists have clinical knowledge which is being utilised to provide a range of services to patients living with long term conditions.3 These include the New Medicines Service (NMS) and the Community Pharmacist Consultation Service (CPCS) that can both support those living with diabetes by helping patients to understand their condition and use their medication correctly, reducing the need for a General Practitioner (GP) appointment. The role of the pharmacist in community pharmacy diabetes management currently has limited research.

Aim
The aim of the study was to explore the role of community pharmacy in helping diabetic patients and thereby decrease the workload of the GP.

Methods
This study targeted community pharmacies in Croydon (n=77) and Kingston Upon Thames (n=34) in greater London, aiming for one response per pharmacy. A survey consisting of 29 questions was crated with a mixture of tick box and free text questions. Community pharmacies were visited in both boroughs, and surveys were distributed and collected. After data collection, quantitative analysis was completed through SPSS and qualitative analysis was using thematic analysis. Ethical approval was granted by Kingston University.

Results
In total, 65 responses were received (59% response rate). Diabetes was found to be the long-term condition that had the greatest number of referrals to the GP (n=30/65; 46%). Referrals were mainly in response to recurrent infections and over the counter sales linked to eyes and feet. Community pharmacies provided an average of 3 advanced services, including NMS (n=63/65; 97%), CPCS (n=61/65; 94%), flu vaccinations (n=59/65; 91%) and hypertension screening (n=24/65; 37%). Some of the key themes when participants were asked about the most common issues identified in an NMS consultation with a diabetic patient, was adherence issues to their medication, lack of knowledge about diabetes and about lifestyle changes, leading to opportunities for community pharmacy-based interventions, and limiting a referral to a GP. Pharmacists felt confident in having intervention conversations and felt knowledgeable about diabetes.

Discussion/Conclusion
Community pharmacies are an essential part of a patient’s diabetic journey, supporting person centred care. This study outlines and establishes a clear role of how community pharmacies can carry out different services for diabetic patients, be able to identify any diabetic complications in the community setting. NMS and CPCS were found to be beneficial services for diabetic patients unlocking the full potential of a community pharmacist. Although a small study in a limited geography, this study highlights that community pharmacists support diabetic patients to manage their condition, thus reducing referrals to GPs and therefore the GP workload. Future studies can be carried out over a larger area to extrapolate findings.

References
1. Ali, M., Schifano, F, Robinson, P, Phillips, G et al. Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study. Diabet Med, 2012;29(9):326-333.
2. Hindi, A, Schafheutle, E, Jacobs, S. Community pharmacy integration within the primary care pathway for people with long-term conditions: a focus group study of patients’, pharmacists’ and GPs’ experiences and expectations. BMC Fam Pract, 2019;20(1):1-15.
3. Gummerson, I. The new community pharmacy contract: an overview of services in relation to diabetes care. Pract Diabetes, 2005;22(7):250-252.