VOL 11 / ISSUE 2 / 2011
Experience plays key role
under FR the EE
SU ALLBSCRIP TI PH IN SCARMAON TO OTL CISTS AND
The bad weather at the end of last year threw up many challenges for the business world. In this issue, SCR speaks to Christine Gilmour, Director of Pharmacy for Lanarkshire, to determine how she felt NHS Lanarkshire coped with the difficulties.
CONTENTS 01 SCOTTISH CHEMIST REVIEW
VOL11 ISSUE2 2011
04 INVESTMENT SYNDICATE
New venture for AlbaPharm
Christine Gilmour, Director of Pharmacy for Lanarkshire
05 GETTING INVOLVED
12 UNDER PRESSURE
Public Partnership Forum meeting
11 ALMOST THERE!
Last step to free prescriptions
20 NEW IN-PHARMACY MAGAZINE Lloydspharmacy launch publication for customers
38 THINK FAST
How being aware and can stroke victims
SCOTTISH CHEMIST REVIEW - IN STRATEGIC PARTNERSHIP WITH
Z`ZX visit www.pharmacy-life.co.uk for the latest in pharmacy news u
Focus on hypertension
16 BEAUTY GOES DOWN TO EARTH
Mintel statistics and pharmacists’ responses
23 UPDATE ON DIABETES
What’s happening around Scotland
32 TALE OF ONE CITY Focus on pharmacy in Perth
AD TO COME
SCOTTISH CHEMIST REVIEW
VOL11 ISSUE2 2011
Welcome to the latest issue of Scottish Chemist Review and many thanks for the great feedback that we received to our last issue. As Director of Pharmacy for Lanarkshire, Christine Gilmour is more than aware of the challenges facing pharmacy in Scotland. In this issue Christine tells us how she intends to meet these challenges and reflects on how pharmacy coped with the recent bad weather. The increase in the incidence of diabetes in Scotland remains a major concern for all those involved in healthcare. In this issue, SCR speaks to pharmacist, Lubna Kerr, who is devoted to helping ethnic minorities, whose risk of diabetes is higher than average. We also look at various initiatives and projects, which are currently running across the country. The current economic climate is proving to be something of a challenge for businesses and pharmacy is certainly not immune to the problems. In a new series of features, we take a look at how pharmacies in one Scottish city are coping with the difficulties thrown up by the recession. With skincare and beauty now at the heart of many pharmacies, Mintel’s latest statistics about the trend towards ‘green’ products make for interesting reading. We thought it was only right to let some pharmacists to comment on the findings and how they relate to their own business. Throughout the magazine you’ll find the latest news regarding healthcare in Scotland. Don’t forget that you can also log on to our new website www.pharmacy-life.co.uk to keep abreast of all the latest happenings. As always, SCR is on the lookout for any interesting features that you – the pharmacist – would like to read. So, if there are any budding journalists out there, please don’t hesitate to contact us at any time. Equally, if there are any great stories out there that you think we should know about, just drop us an email at the address below. We look forward to hearing from you.
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04 NEWS SCOTTISH CHEMIST REVIEW
COMMENT GEORGE ROMANES
Good luck with the pilot! Very shortly, a number of Scottish pharmacies and surgeries will begin the Chronic Medication Service early adopter pilots. On the face of it, another pilot scheme might not be an exciting prospect, but the final piece in the jigsaw of Scotland’s pharmacy contract is about to be dragged into place. It is vitally important that we succeed in bringing pharmaceutical care to the forefront in Scotland. The scary thing about all this is that, despite all the checklists, the planning and fine words talked over many years, it will boil down to good working relationships between the professionals to deliver the vision properly. So far, the plans look robust and the leaflets are the clearest yet, but the challenge lies in getting this as correct as we can the first time round, and being able to address the problems that come out of this work. I always blame the lack of time, the IT or whatever, but the crux of this will be a good systems approach and good old face-to-face interaction with your patients. Basically, the time for talking is over. It’s now time to walk the walk. Scotland has delivered services such as the minor ailment service really well and it is already the envy of many a nation. It would be great if the Chronic Medication Service was both equally well used and thought of as the minor ailment service. The only “fly in the ointment” is that it comes along too far behind the new general medical services contract. Perhaps, however, that only means it’s a greater challenge, so good luck to all who participate in the pilot! Scottish pharmacy is depending on you!
New venture for AlbaPharm
P H A R M
AlbaPharm Limited, the leading support group for independent community pharmacy in Scotland, Northern Ireland and the North of England, has announced a new venture, the AlbaPharm Pharmacy Investment Syndicate.
The Syndicate provides an opportunity for suitably qualified individuals and corporate investors to invest in the retail pharmaceutical sector and in doing so, provide funding to allow ambitious young pharmacists to acquire their own practice over a period, for example from a retiring pharmacist. The Syndicate will acquire a number of carefully selected retail pharmaceutical practices and will introduce a hand-picked young pharmacist to run each of them. For these ambitious young pharmacists, the Syndicate
will provide an opportunity to acquire their own business over a period of time. The incoming pharmacist will benefit from AlbaPharm’s involvement in assessing the businesses to be acquired and will have access to a full range of benefits from AlbaPharm. Individual mentoring and ongoing support will also be provided. “We are delighted to be
involved in this new initiative,” said AlbaPharm Chief Executive, David Currie, “in the sector, which will provide funding, introduce capable and ambitious young pharmacists and give them full access to the support available from AlbaPharm. “It has become increasingly difficult for young pharmacists to buy their own business and this will provide a great opportunity for those selected to do so. The retail pharmaceutical sector is poised for significant changes and these will provide many opportunities for those willing to embrace change.” AlbaPharm is being advised in relation to the Syndicate by HM Corporate Solutions, the corporate finance arm of Glasgow–based lawyers Harper Macleod, and by Accountants Campbell Dallas. The AlbaPharm Fund will comprise approximately £5 million of equity and has further support available from banks.
Reduce medicine waste ucampaign
A campaign aimed at reducing an estimated £44 million wasted on medicines across Scotland every year has been launched by four Local Health Boards in the North of Scotland, including NHS Western Isles.
The campaign aims to raise awareness about correctly ordering repeat prescriptions and helping people get the best from their medicines. The potential money wasted on medicines across Scotland every year could pay for: • 1,724 more community nurses • 2,904 more drug treatment courses for breast cancer • 44,000 more drug treatment courses for Alzheimers Now, GPs and pharmacists in NHS Western Isles, Grampian, Orkney, and Shetland have joined together in a bid to educate patients about their treatment and to help patients understand more about their medicines and the options they have. “Everyone involved in prescribing, dispensing
or reviewing medicines needs to make sure that patients are involved in making decisions about their treatment and that more medicines are taken as recommended,” said NHS Western Isles Medical Director, Dr James Ward. “Unwanted drugs in the home may mean that patients are not getting the benefit they could be from their medicines. It also represents a large amount of waste. We want patients on repeat prescriptions to think about what they are ordering and only ask for what they need and are running out of. Any other medicines can be dispensed when needed at a later date, as once medicines have been dispensed, they cannot be recycled.” Further information may also be found on a new national website www. medicinewastescotland.com
NEWS 05 SCOTTISH CHEMIST REVIEW
Catch-up programme NHS Ayrshire & Arran has put out a call to girls and young women born between 1 September 1990 and 31 August 1993, who have not yet been immunised with the Human Papilloma Virus (HPV) vaccine.
uPUBLIC PARTNERSHIP FORUMS
(L-R) Jack Ferguson, Elvin Bailey, Irene Miller, Stephen Kerr and Felix Mulholland
Getting involved “GETTING engaged” in your local health services was the aim of an event held recently by the North and South Lanarkshire Public Partnership Forums (PPFs). PPFs are made up of volunteer representatives and are involved in monitoring NHS performance and in key issues such as raising public awareness of health issues, cleanliness of hospitals and the quality of patients’ food. The event was an opportunity for those attending to hear firsthand from existing PPF members, and to discuss how to become
more involved, either as an active member within the PPF, or on an occasional basis. Seventy-one year-old Elvin Bailey, who has been involved in the PPF for more than three years, was one of those who attended. “People are never stuck for an opinion on health services,” said Elvin (pictured second from left above), “but unless the health board hear these opinions there’s not much they can do about them. It’s extremely important we hear the opinions from all sections of the community especially younger people, those aged 30 to 50 and all parents, so we can hear what they want to see from their health
service. “What are the health board doing right? Could it do something better? How could services be improved? These are the types of questions that everyone has an opinion on and by getting involved in the PPF we can ensure these views are heard by the health board and that they have the opportunity to take action where appropriate.”
For more information about the PPFs visit www.nhslanarkshire. org.uk/involved/ppf
Healthcare professionals working in stroke care and research are invited to attend the sixth annual UK Stroke Forum Conference from 29 November to 1 December 2011 at the Scottish Exhibition and Conference Centre, Glasgow, Scotland. The Call for Abstracts is open from 18 April until 17 June and applications are welcomed from all areas of stroke research and service delivery. Registration also opens on 18 April and Early Bird rates, offering fifteen per cent discount, are available until 15 August. Hosted by The Stroke Association, The UK Stroke Forum Conference is the largest UK multidisciplinary stroke conference of the year, attracting leading stroke researchers from around the world and featuring plenary and parallel sessions, interactive workshops, poster tours and an exhibition of over fifty stands. To receive UK Stroke Forum news, register for our free monthly ebulletins at www.ukstrokeforum.org.
The girls are being advised to protect themselves against the virus before the catch up programme ends in August this year. From 1 September 2011, HPV immunisation will only be offered routinely to girls up until their eighteenth birthday. “There are more than 300 cases of cervical cancer diagnosed every year in Scotland,” said Dr Carol Davidson, Director of Public Health, “and by offering girls and young women in Ayrshire and Arran this vaccine, we will help to protect them against cervical cancer. I would encourage all young women who have so far not taken up the offer of the vaccine to arrange to be immunised and protect themselves against developing cervical cancer in later life. “This vaccine complements Scotland’s very successful cervical screening programme that has reduced the death rate from cervical cancer by more than 40 per cent in this country.” Around 100 women die from cervical cancer each year in Scotland.
For more information visit www.nhsayrshireandarran.com
06 PROFILE SCOTTISH CHEMIST REVIEW
Experience plays key role The bad weather at the end of last year threw up many challenges for the business world. In this issue, SCR speaks to Christine Gilmour, Director of Pharmacy for Lanarkshire, to determine how she felt NHS Lanarkshire coped with the difficulties.
he horrendous weather conditions at the end of last year brought hardship and difficulties to businesses across the UK. Pharmacists in Lanarkshire, as with their colleagues across the country, faced a trying time.
“December proved to be an unprecedented challenge in terms of adverse weather,” says Christine Gilmour, Director of Pharmacy for Lanarkshire. “The community pharmacy service, just like every other service, was under significant pressure. The response of community pharmacists to the challenge is, however, to be complimented. There were good examples of collaboration. On the occasions when both the Out of Hours medical services and community pharmacy services had to retract from their normal provision, community pharmacy, NHS Lanarkshire management and the Out of Hours Service came together to agree on which late-night opening pharmacies services should be consolidated. “Medicine supply systems proved to be a major issue. Supplies to pharmacies were running several
days late and took a significant time to recover and the fragility of the Direct to Pharmacy schemes was particularly evident. Throughout this time NHS Lanarkshire maintained a regular dialogue with local contractor SGHD about these issues and their implications throughout the crises. “The supply of antivirals posed a challenge immediately before Christmas and, over the Christmas/New Year holiday period, local systems had to be put in place to make stocks available for community pharmacies as the antiviral was not available via the usual supply routes. This required close working with contractors during the very busy festive season and the systems put in place were a bit unwieldy. With goodwill, however, we were able to sustain this until the normal supply systems kicked in.” A quick glance at Christine Gilmour’s CV shows how well she is suited to all aspects of the remit of her job. In her career, which began after graduation from The Robert Gordon University, Aberdeen in 1984, Christine initially undertook her pre-reg in hospital in Glasgow, before working in community pharmacy for four years. She then returned managed service
â€œ...I work to ensure that we are maximising the potential within Lanarkshire for the community pharmacy contract to deliver improved patient care and better access to care...â€?
08 PROFILE SCOTTISH CHEMIST REVIEW
as a prescribing advisor, being appointed Trust Chief Pharmacist at Hairmyres & Stonehouse Hospitals NHS Trust, Lanarkshire in 1993. From 2000, Christine held the position of Acute Trust Chief Pharmacist for NHS Lanarkshire Acute Hospitals, becoming Chief Pharmacist for NHS Lanarkshire in 2006. As Director of Pharmacy for Lanarkshire, the main focus of Christine’s job is providing strategic leadership for pharmacy services across NHS Lanarkshire. “The strategic leadership part of my job is tantamount to the provision of leadership for the planning, coordination, development and delivery of pharmacy services in Lanarkshire. A significant part of that is working to ensure the NHS Board recognises the potential pharmacy has to provide a wider range of front-line services to the patients and the public. The Scottish First Minister recently recognised the role that community pharmacy has in providing direct patient care to drug misusers and was quoted in the press as such. I firmly believe that this type of national coverage and government support is very helpful. “Through my job I work to ensure that we are maximising the potential within Lanarkshire for the community pharmacy contract to deliver improved patient care and better access to care. The remit of a Chief Pharmacist/Director of Pharmacy is broad and I do not think any one person could claim to have expertise in all the areas covered by the role, therefore a level of self-awareness is required to be able to identify blind spots and the support of a strong senior team is essential. I am fortunate in Lanarkshire in that I have a great senior team with a breadth of knowledge and clinical expertise. Part of my job is steering them in one direction.” Christine is in no doubt as to the key areas affecting pharmacy at the moment. “The key areas are patient safety, public confidence in the NHS, funding within the NHS - in particular expenditure on medicines and service modernisation/ redesign. Ensuring value for money from the drugs bill and influencing prescribing is part of normal business for pharmacy. Pharmacy’s role in helping to manage medicines expenditure must, however, also be focused on supporting patients to get the maximum benefit from their medicines and to improve patient safety. Improvements have been made in the quality of prescribing, and robust arrangements are in place across Scotland to manage the introduction of new medicines into clinical care. “In 2008, NHS Scotland became the first health service in the world to adopt a national approach to improving patient safety. This programme was initially focused on the acute hospital service and all acute hospitals across the country became involved in a dedicated drive to ensure that patients receive even safer care. The hospital pharmacy service was involved in this from the start and has lead on a number of pieces of work relating to the programme. “The Healthcare Quality Strategy for NHS Scotland, which was published in 2010, aims to put quality right at the heart of NHS Scotland. The Quality Strategy
recognises that patients’ experience of the NHS is about more than speedy treatment - it is the quality of care they get that matters most to them. The Quality Strategy moves the patient safety agenda forward. Pharmacy must engage in the delivery of this strategy and understand how the services we provide improved care for patients.” As regards the future, Christine has no doubts as to the importance of community pharmacy. “Community pharmacists are increasingly important front-line healthcare providers in the NHS. They have an increasing role as health educators, as primary care health campaigners, and are the best-qualified experts in medicines. To that end, I think there are a number of areas where pharmacy could become involved. Community pharmacists are, however, very busy people and we must be sure that any service we establish is appropriate and sustainable. “Community pharmacy’s strength lies in its accessibility, but this needs to be valued and used wisely. “There are areas of healthcare where pharmacy should take responsibility for leadership, developing standards and informing/auditing what is required. Others, however, may be more appropriate to deliver the service within an agreed overarching framework. “I see community pharmacy becoming more fully integrated with other healthcare professions with increased visibility as an NHS healthcare provider. This will be achieved by increasing the numbers of pharmacist independent prescribers and by working to removing real or perceived barriers that discourages pharmacists from undertaking this role. “In general, pharmacists should have more appreciation and recognition of the authority that they hold as experts in medicines and not being afraid to exercise it. In addition, they should be aware of the changes in the NHS and seek the opportunities that will arise.”
AD TO COME
10 comment/NEWS WELSH CHEMIST REVIEW
Improving customer service ucomment / MARK JAMES, AAH
Every year it is the same: the snow arrives, traffic grinds to a halt and we spend months talking about why the country never appears to be properly prepared. Then it all happens again the following year.
We faced quite a few snow-related problems at AAH, but overall, unlike some others, we managed to maintain high levels of service despite the adverse weather. How Mark James did we achieve that? Because we anticipated that the weather might be bad and we invested several hundred thousand pounds to equip our vans with snow tyres. Of course, some situations were out of our control such as police closures of roads, but that investment meant we could sleep at night knowing we had done everything we reasonably could in order to maintain a service to our customers. The fundamental point is not about weather conditions or snow tyres. Rather it is that, in order to maintain an acceptable level of service to ensure patients get the medicines they need when they need them, there is a cost associated with that. My concern is that, as the supply chain changes, some wholesalers, but not AAH, are beginning to lose sight of that and are adopting an attitude where only commercial interests count and relentless cost cutting becomes the focus to the detriment of levels of service. That is not an outcome I think serves the interests of the sector or patients. AAH is investing in its network at a time when others are cutting back on theirs. For example, in addition to the snow tyres example, AAH is investing significant sums to install the latest heating, ventilation and air-conditioning equipment in its branches which provides us with complete temperature control. We are investing in expanding the floor space of our regional distribution centres which, along with some other planned changes, will allow us to extend order cut-off times and thereby improve customer service. In addition, we are continuing to work with manufacturers on an emergency delivery service for products, which pharmacists order direct, because they cannot obtain them from their wholesaler. It is crazy and costly for all concerned that manufacturers use couriers when there is a highly efficient pharmaceutical distribution infrastructure already in existence: so why not use it? In conclusion, I remain convinced that investing in improving customer service and driving up standards is the path which wholesale should take otherwise we end up with a fragile supply chain which ultimately fails patients at their time of need.
Guiding donation for breast cancer
The breast cancer care team at Crosshouse Hospital has received a generous donation from the 2nd Kilmarnock Guides, where three of the guides are working towards their Baden Powell award. One of the girls involved, Emma Haggarty, had the idea to arrange a sponsored fitness night to raise funds for the Breast Cancer Care Team, her charity of choice. The event raised a fantastic ÂŁ301.
Just FYI... NHS Board
No. of No. of Pharmacies Pharmacies 2009 2010
Scotland Greater Glasgow & Clyde Lothian Grampian Lanarkshire Ayrshire&Arran Tayside Fife Highland Forth Valley Dumfries & Galloway Borders Shetland Orkney Western Isles
312 180 128 117 92 89 78 73 70
312 180 128 119 93 90 79 74 70
2 1 1 1 1 -
33 26 3 3 3
34 27 3 3 3
1 1 -
Source: Prescribing Information System, ISD Scotland
NEWS 11 SCOTTISH CHEMIST REVIEW
GP scoops prestigious award
Robbie McGregor, Nicola Sturgeon, Claire Muir, Yvonne Williams, Alex Salmond, Caroline Barnes and Gloria Lawrie
Last step to free prescriptions uANNOUNCEMENT
The First Minister Alex Salmond and the Deputy First Minister Nicola Sturgeon have marked the Health Committee’s passage of the legislation which will result in prescriptions for all patients in Scotland being free from April 1 with a visit to an Edinburgh city centre pharmacy. “This is a momentous day marking the culmination of four years’ work in gradually reducing the burden on Scots paying for prescriptions,” said Mr Salmond. “The abolition of these charges from April 1 recognises the fact that during these difficult economic times, no person should see cost as a barrier to access to prescription medication. “We have gradually reduced the cost of prescriptions since 2007 and, in doing so, have helped large numbers of patients, particularly those with long-term conditions and who require a number of prescription items. “At times of economic
difficulty, the last people we should be penalising are the sick. We want to move towards restoring the NHS to its founding principles: healthcare that’s free at the point of delivery and based on clinical need, not the ability to pay.” “Hundreds of thousands of Scots are already better off thanks to our decision to phase out prescription charges,” said Ms Sturgeon, “and they will benefit even further now that full abolition is to be introduced. “It is my firm belief that healthcare should be free at the point of access for everyone and I am proud to have overseen the removal of prescription charging which was nothing more than a tax on ill health that Scotland’s poorest families could ill afford. “There have been attempts to stop our plans with some suggesting that the current financial climate is the wrong time to bring forward this abolition. “On behalf of the 600,000 adults living in families in Scotland with an annual income of less than £16,000, who until now, have not been entitled to
free prescriptions I completely disagree. When times are tight, the last people who should be paying are the sick. “Community pharmacists are behind this change as it will increase the time we are able to spend dealing with the clinical needs of our patients by reducing administration and a requirement for us to act as revenue gatherers for Government,” said Robbie McGregor, Managing Director of Lindsay & Gilmour Pharmacy (pictured above left), in which the announcement was made. “In addition, the new arrangements are considerably fairer. Community Pharmacy Scotland, which acts on behalf of community pharmacy owners, felt the previous arrangements contained many anomalies and were unfair, illogical and not fit for purpose. For example, someone with diabetes would be exempt, while someone suffering from asthma or cancer, would not. “We believe the phased approach towards complete abolition of prescription charges this year has been constructive.”
Dr Ken Lawton and Dr Monica Canning
Dr Monica Canning from Hunter Health Centre in East Kilbride has been crowned GP of the Year for 2010. The Lanarkshire GP scooped the award at a prestigious Royal College of General Practitioners Scotland (RCGP) ceremony in Edinburgh. “I was really shocked to win the award,” said Monica. “I was actually on holiday when I got the call telling me I’d won and to say it was a surprise was an understatement, as I didn’t even know I’d been nominated. It’s a real privilege to win this award and I’d like to thank my patient, Margaret Gardyne, who nominated me.” “All the nominations we had this year were touching, thoughtprovoking and demonstrate the true value of general practice from the perspective of those it is designed to care for,” said Dr Ken Lawton, creator of the awards and chair of RCGP Scotland. “General practice in Scotland is something to be proud of, with over 90,000 consultations held every day in more than 1000 practices across the country, from inner city areas to the Highlands and Islands. The Gala Awards Event is a wonderful celebration of the efforts of staff on the frontline of healthcare.”
12 FEATURE SCOTTISH CHEMIST REVIEW
Through the roof! uHYPERTENSION
Despite numerous campaigns to raise awareness of the damaging effects of hypertension, the incidence of high blood pressure is still on the increase. Hypertension continues to be a major worry for Scottish healthcare providers. Despite intensive media coverage, the latest ISD statistics have revealed that the national rate for hypertension (high blood pressure) has risen from 11.5 per cent in 2005 to 13.9 per cent. This increase may be due, at least in part, to improved case ascertainment by practices over time, but it is also reflects a real increase in the occurrence of hypertension in Scotland, a country with a rising proportion of older people. The data, which was posted on the NHS Scotland Information and Statistics Division website, showed that hypertension affected 143 of every 1,000 people in the country. Hypertension was the most common reason why men
visited their general practitioner between the ages of 45 and 64 and the third most common reason for women of all ages. Between the ages of 65 and 84, hypertension was recorded as the most common reason for going to the doctor irrespective of gender. Even more worrying is the fact that, according to recent Lloydspharmacy research, one in three young adults in Scotland now has high blood pressure! The study found that more than half (58 per cent) of Scots tested showed signs of high blood pressure. Experts said it was particularly worrying that onethird of people under the age of 34 also had raised levels. Only one-quarter of Scots tested in the study of 8586 people over the age of 16 had ideal or normal blood
pressure and the average blood pressure reading in Scotland was 141/86. Various studies have shown that, when pharmacists work side by side with doctors, the number of patients, who reach the recommended blood pressure levels actually increase from about half to three-quarters. In one American study last year, 179 patients with high blood pressure were enrolled at five different primary care clinics in Iowa City. For some 100 of those patients - all randomly chosen pharmacists worked with doctors to find the best drug treatment, while the rest of the patients received standard physician care. After nine months, the patients, who had been treated by the physician-pharmacist team, saw an
average drop of 29 points in their systolic blood pressure readings, from 153 to 124. For those, who hadnâ€™t been seen by a pharmacist, the drop was only about 17 points, leaving them with an average systolic pressure of 133.
Project The PATHWAY study is based in eight UK centres including Dundee, Edinburgh and Glasgow. The study recruits in a primary care setting from eight or more GP surgeries around the Edinburgh area. Each practice puts forward twenty-five or so patients. Patients with essential hypertension from the following treatment groups are of particular interest: untreated, suboptimal monotherapy, suboptimal dual therapy (ACE inhibitor + calcium channel blocker) and resistant hypertension (ACE inhibitor + calcium channel blocker + diuretic). For more information email: email@example.com.
FEATURE 13 SCOTTISH CHEMIST REVIEW
COMMENT “The clinic initially began as part of an initiative with one of the local GP practices. At that time supplementary prescribing had started and the GP acted as my mentor. Once independent prescribing came in, I was able to run the hypertension clinic in its current form. “As a company, Lloydspharmacy already provide blood pressure checks, which are available to anyone who wants to make use of the service. My hypertension clinic, which runs from 9am-12pm on a Thursday, is an extension to this service and is run in conjunction with one of the GP practices in Drumchapel Health Centre. Drumchapel is an area, which has high unemployment, and the blood pressure levels are generally high. Although there are six GP practices, I’m only running this clinic in conjunction with one practice, although I also run
a smoking cessation clinic for Varenicline with another practice. At the outset, one of the main drivers for the clinic was the fact that both the GPs and I felt that the demand was there. We felt that a hypertension clinic would help ease the GPs’ workload and would also help us to see those patients who weren’t coming back for regular checks. Initially the nurses in the GP practice weren’t qualified as independent prescribers, so a lot of the GPs’ time was taken up with seeing patients with high blood pressure. Both nurses are now qualified, so, again, this has freed up a lot of the GPs’ time. “The GP refers patients to myself and I usually see them for two or three monthly appointments to build up an overall picture of their condition. If a patient’s BP is very high, then I would see them more regularly – perhaps once every two weeks. If their BP is raised, then I will do further tests, such as those for glucose and cholesterol, and will then perhaps refer them to hospital for an ECG. Once all of the results are back I can assess the cardiovascular risk and gauge if they need medication, using the current guidelines. At the moment I am seeing around six to eight patients per week.”
EDUCATION The Evidence-Based Management of People with Hypertension
COMMENT “Dealing with hypertension in the pharmacy is an ideal area for us to be pro-active in our patients’ care. In addition to the advice given to each patient regarding their medication such as warning about potential postural hypotension, and the dangers of stopping medication abruptly, we also offer advice on dealing with stress, the importance of limiting alcohol and caffeine intake, and the value of a healthy balanced diet. Dietary advice is something we aim to expand upon, with the introduction of a weight management service in the near future. The patient is also counselled on the importance of regular exercise, and, if appropriate, we would also encourage the hypertensive patient to enrol on our smoking cessation programme. “In an aim to reduce the effects of ‘white coat hypertension’, we also offer all our patients a free blood pressure check.”
Hypertension management is the most frequent cause for consulting with a general practitioner in the UK in males over 55 years and females over 65 years. Prevalence of the condition is increasing due to improved diagnosis, an increasing elderly population and rising levels of obesity. This new pack, produced by ICPPE, gives a comprehensive overview of the diagnosis, monitoring and management of hypertension and will guide pharmacists delivering pharmaceutical care for this patient group. Topics include: • Tips for measuring blood pressure • Diagnostic criteria for hypertension and target blood pressure levels required • Ten-year cardiovascular risk assessment and management • Rationale for choice of antihypertensive agents, in particular patient groups and the monitoring requirements for these • Guidance for combining antihypertensive agents and information on significant drug interactions • Treatment of hypertension in special populations, eg, diabetes • Compliance and concordance issues in patients with hypertension This pack includes case studies and MCQs for completion.
The graph above shows the estimated number of patients in Scotland (per 1,000 patients registered with a practice) who consulted either a GP or practice-employed nurse for hypertension (high blood pressure) at least once in the year ending 31 March 2010, by gender and age group.
14 NEWS SCOTTISH CHEMIST REVIEW
New organisation launched upharmacy representation
The three largest community pharmacy associations have created a new organisation, which they hope will create a stronger, unified voice for their members.
Pharmacy Voice sees The National Pharmacy Association (NPA), the Company Chemists’ Association (CCA) and the Association of Independent Multiple Pharmacies (AIMp) coming together to simplify and strengthen the way the three organisations represent their members. “As the NHS enters a time of unprecedented change, it is particularly critical for Pharmacy Voice to strongly influence the policy and commissioning agenda now, on behalf of all our members,” said Rob Darracott, Chief Executive of Pharmacy Voice at the launch. The formation of the new organisation has been widely welcomed. “The proposed changes to the NHS in England will have profound implications for community pharmacy,” said Mark James, group managing director of AAH Pharmaceuticals Ltd. ‘It is therefore vital that ministers and officials who are making policy decisions and deciding the future structure of commissioning understand and appreciate the enhanced role, which community pharmacy should play in providing patient services.” “The Co-operative Pharmacy welcomes the launch of Pharmacy Voice,” said John Nuttall, Managing Director of The Cooperative Pharmacy, “We have championed this and anticipated the official launch for a long time and, now that we have a cohesive body, we have an excellent opportunity to focus our efforts on ensuring that pharmacies get
the recognition they deserve. “We look forward to playing a supporting role in helping to drive change to deliver positive outcomes for the sector and continuing to improve the health of communities throughout the UK.”
(l-r): NHS Lanarkshire director of the South Community Health Partnership, Alan Lawrie; NHS Lanarkshire South East Unit general manager, Marilyn Aitken; Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon MSP, NHS Lanarkshire chairman Ken Corsar.
uNEW HEALTH CENTRE
Fit-for-purpose premises The new £13.6 million Carluke Community Health Centre has been opened by the Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon MSP. Built over three levels, the new state-of-the-art centre provides a wide range of GP-led services such as diabetes, electrocardiogram (ECG) and chronic disease management clinics, as well as clinics covering coronary heart disease, asthma, stroke and blood pressure. The development of the brand new, fit-for-purpose premises in the town’s Chapel Street replaced the old health centre in Market Place.
“I am delighted to officially open the new Carluke Community Health Centre,” said Nicola Sturgeon. “This facility will provide excellent services to the local community. Throughout Scotland, we want to see accessible, modern facilities that deliver the services that patients need and provide good working conditions for our dedicated primary care teams. Even in the challenging times we now face, investment in primary care to ensure patients can access services as close to home as possible remains a priority.” “Once complete, it will amount to over £90 million underlining our commitment to primary and community care services which we see as a clear priority.”
If you require any support, please advise your preferred option (1 – 5) to the email address: GPICT@wales.nhs.uk. If you have any IT access issues relating to the online toolkit, please contact the Primary Care Service desk on 08450 267 297.
(l-r): Students from Carluke High school with Marilyn Aitken, Nicola Sturgeon and the artist who helped the pupils design their artwork (on left hand wall) Elspeth Lamb (right)
AD TO COME
16 FEATURE SCOTTISH CHEMIST REVIEW
Beauty goes ‘down to Earth’ in 2011 uskincare
It would seem sometimes that the remit of today’s pharmacist is neverending. The traditional role of medicine dispenser has now been expanded to include testing for various medical conditions and the provision of advice. Now, with an increasing number of pharmacies incorporating skincare and beauty ranges into their retail remit, the pharmacist is to take on yet another role; that of skincare expert! SCR, in association with Mintel International, takes a look at what the coming year has on offer in the world of beauty. According to new statistics just released by Mintel Beauty Innovation, 2011 will see beauty companies placing increased importance on the environment. This not only means focusing on sustainable sourcing with attention to maintaining biodiversity, but also creates a renewed emphasis on repackaging to minimise waste. From a marketing perspective, simplifying text and “stripping back” to tell straightforward, direct stories of plant-based ingredients will be key for both manufacturers and retailers. Closely linked with sustainability, the ‘down to Earth’ trend addresses the practicalities of
making and marketing ‘green’ beauty. Factors pertinent to the manufacturers include managing price pressure due to varying supply and demand of natural and organic raw materials, and learning to master the challenges of green chemistry, such as the use of sustainable surfactants, ‘green’ solvents and alternatives to parabens. Free-from formulas - a key trend in 2010 - continue to evolve in an effort to avoid petrochemically-derived ingredients. In 2010, thirteen per cent of new skincare, hair care and cosmetics made the paraben-free claim (a figure that was up five per cent on 2008 figures). Also in 2010, almost nine per cent of new skincare, hair care and cosmetics made the organic claim (twice as many as in 2007); the all-natural claim was found in fewer than
three per cent of launches in 2010. In all studies, the main culprits in terms of skincare and beauty products are parabens and phthalates. Parabens are a chemical preservative and common ingredient found in shampoo and many other personal care products. The most common ones which regularly appear in ingredients are butylparaben, ethylparaben, methylparaben, isobutylparaben and propylparaben, and these are found in everything from make-up remover and shampoo, to shaving cream and toothpaste. Basically chemicals act as preservatives, extending a product’s shelf life by inhibiting bacterial growth. The reason why parabens are so harmful is because their chemical structure is strikingly similar to the hormone oestrogen.
When paraben-laced products are applied to the skin, they are absorbed into the body and may be mistaken for oestrogen, which can disrupt the endocrine system. Too much oestrogen – or oestrogen mimickers – can cause big problems, including weight gain, fluid retention, depression, and possibly even cancer. In addition to the health risks, parabens also pose environmental risks. Washed off in the shower or in the bath, they can accumulate in pipes and waterways, and can disrupt the hormones in animals. Scientists have documented hundreds of animals with genetic defects, such as frogs with extra legs, which they say could be the result of paraben pollution. “Paraben-free claims actually outpaced organic and all-natural claims in new skincare, hair care and cosmetics’ launches in 2010,”
FEATURE 17 SCOTTISH CHEMIST REVIEW
said Nica Lewis, Head Consultant at Mintel Beauty Innovation, “backing up Mintel’s Nu Natural trend that predicted that brands would emphasise results and free-from claims over certification. 2011 will see beauty companies placing increased importance on the environment, focusing on sustainable sourcing with attention to maintaining biodiversity. A renewed emphasis on repackaging to minimise waste will also be a factor.” Developments in the global beauty industry over the past year have been closely monitored by Mintel’s Beauty Innovation team and, while skincare launches dipped slightly in Europe and the US in 2010, China saw dynamic growth with a 40 per cent jump in new skincare products. Around the world, anti-aging claims are still vital, with more than one in four launches making this claim (up five per cent on 2009). New skincare products with environmentally-friendly packaging were also up five per cent on the previous year, showing manufacturers’ commitment to recycling and eco-friendly materials - a trend Mintel expects to have real impact in 2011. “2010 was a year for rebuilding with new skincare product launch activity almost matching pre-
recessionary levels,” said Vivienne Rudd, senior beauty analyst at Mintel. “The past year saw M&A activity resumed too as credit markets eased, with consolidation amongst ingredient suppliers and Unilever, Shiseido, L’Oreal, Estee Lauder and Coty all inking deals. This development will influence brands in the year ahead from a marketing perspective linked to the ‘down to Earth’ trend too. Simplifying text and ‘stripping back’ to tell straightforward, direct stories of plant-based ingredients will be key and manufacturers who treat consumers as educated shoppers instead of novices stand to benefit.”
Parabens: the controversy Are parabens bad? Well, it really depends on whom you ask! Scientists seem to say that they probably are and would like more testing carried out. Experts seem to agree that they can have an effect on breast tissue, but further research is needed to get a better idea of whether they can definitely cause breast cancer. For many years, parabens were considered safe, both in the UK and overseas, due to their non-toxicity. An allergic reaction or sensitivity to parabens is extremely rare - especially considering how widely used they are. However, several studies in recent years have suggested that parabens might be more harmful than we think, although many results are inconclusive. A study published in 2004 (Darbre, in the Journal of Applied Toxicology) detected parabens in breast tumors. In 2007, however, the US Food and Drug Administration concluded that “at the present time there is no reason for consumers to be concerned about the use of cosmetics containing parabens.” Not surprisingly, big manufacturers, who use them, say that they are absolutely safe. These companies say they have to use some form of parabens to prevent bacterial and fungal contamination. Many don’t consider it harmful and have no qualms about adding it to their ingredient label. Cosmetics sold on a retail basis to consumers are required by law to declare ingredients on the label. This is important information for consumers who want to determine whether a product contains an ingredient they wish to avoid. Parabens are usually easy to identify by name, such as methylparaben, propylparaben, butylparaben, or benzylparaben. The danger is that parabens are being “swept under the rug” by big companies.
18 COMMENT SCOTTISH CHEMIST REVIEW
What the professionals say... uresponse
Mintel’s statistics make for interesting reading. SCR asked five pharmacists to assess the findings: Ian Will
Although I am not antigreen, I feel that this is a marketing ploy companies cannot afford to miss! Call me Victor Meldrew if you like, but using organic “stuff” is just an excuse for price increases! I am not convinced about the damage that parabens and other chemicals have caused. These products have been used over the years, and no evidence - other than anecdotal – of the damage they have caused has ever been provided! As far as pharmacies and skin care are concerned, the secret is well-trained staff and intervention by the pharmacist only when required.
eco-friendly, environmentally aware society. There are certainly many more people coming into the pharmacy looking for nonallergenic skincare products. If I’m noticing this in our quiet rural area, then I would imagine that the same is true on a larger scale in cities. The Simple range of skincare products has always done well for us but I’ve now brought in a hypoallergenic range – you simply have to move with the times. We’ve always had a lot of patients with skincare issues such as dermatitis or reactions to products. The girls, who work in the pharmacy, tend to look after the beauty and skincare issues as they’ve received relevant training in this regard. Overall I would say that, with regard to parabens, Mintel’s figures are overstating the issue and the statistics. I do believe that parabens are an issue, but I think that this feature has blown it out of proportion.
George Romanes GLM ROMANES LTD
Whether Mintel’s findings are right or wrong, I’ve definitely noticed a backlash against anything with too many ingredients. The findings are very much would you would expect in today’s
Laura McGregor A & I CRAWFORD
We cater for quite a range of skincare needs. We stock a vast range of the cheaper ranges, such as Olay, L’Oréal, Ponds and Neutrogena, as
well as some of the more expensive ones, such as Clarins and Clinique. Recently, we have definitely noticed more people looking for the more expensive ranges, so, for that reason, I contacted Chanel with a view to putting in a dedicated Chanel counter in the shop. Unfortunately, there’s a territory type of issue with Chanel and another pharmacy had already put it in, so we weren’t able to get the concession. I find women’s reactions to skincare very bizarre sometimes. Some people want to spend a fortune, while others don’t want to spend a penny! We do have a lot of customers who have allergies, so they tend to go for the Simple range. As regards Mintel’s findings, I would have to say that I haven’t had anyone looking for environmentallyfriendly or paraben-free products. I’m firmly of the opinion that, when it comes to skincare, women will pay anything to make themselves look younger and I do believe that a lot of hype around issues like these are a marketing ploy. In terms of the damage caused by parabens, I’ve never really looked into it – but I certainly will now!
Skincare isn’t a big part of our market. Of our three pharmacies, two of them are in less affluent areas where top-end skincare and beauty products would rarely be sold. The third one is in Cullen, which is a more affluent area, and one or two customers would be aware of parabens. I reckon the subject of ingredients in products would be a much bigger issue in city centre stores.
Stuart Dunn Hughes Chemist
In the pharmacy we do very little skin care products and no high end ones. As for the findings, I think it is a lot of hyped-up environmental/ marketing clap trap. Women want something that makes their skin feel and look better and they don’t care what’s in it.
AD TO COME
20 NEWS SCOTTISH CHEMIST REVIEW
Silver celebration Femstrual training
Pharmacists preparing to stock Femstrual, Manx Healthcare’s tranexamic acid 500mg in March can benefit from training material available now. Accessible to every single pharmacy in the UK, the Manx Healthcare brand of this POM to P reclassification has a recommended retail price of £7.95 and a trade price of £4.60. To help some of the one in three women in the UK who are currently living with heavy menstrual bleeding, Femstrual is the only P medicine tranexamic acid widely available through pharmacies in the UK. It is suitable for women aged between 18 and 45 with a heavy menstrual flow over several cycles and a regular cycle of between 21 and 35 days. The widespread availability of the product has been welcomed by the profession since news of its launch broke on February 1. The product launch will be supported by both a trade and consumer advertising campaign throughout 2011.
Sarah Purdie of New Deer Pharmacy in Aberdeenshire recently celebrated her silver anniversary in independent pharmacy. Sarah is pictured with colleague, Norma Anderson, who started working alongside her exactly 25 years ago. Sarah was awarded a bunch of flowers and bottle of champagne for her fantastic achievement by her Phoenix BDM, Linda Sim.
New in-pharmacy customer magazine ulaunch
Lloydspharmacy, the healthcare company with 1,650 pharmacies across the UK, is launching a customer magazine, All of You, in March. Published in collaboration with Axon Publishing, the magazine will provide Lloydspharmacy with a new channel to communicate to customers about healthcare and lifestyle choices. All of You will be free of charge and comprise three different sections; healthcare, beauty and lifestyle. Aimed primarily at women, each edition will include topical features and expert advice
along with service and product information to support the health and wellbeing needs of all the family. Building on the company’s ethos to provide healthcare for life, each edition of the Lloydspharmacy customer magazine will include an Ask the Expert column where customers can submit their own health questions. There will also be regular beauty product pages, recipes to support healthy eating and customer competitions “Lloydspharmacy has continually evolved to meet the changing needs of our customers,” said Steve Gray, Trading Director at Lloydspharmacy, “New and
even regular customers may not be familiar with the wide range of affordable products and healthcare services we now offer. Our All of You magazine will help us become closer to our customers and to inform them of the new ways in which we can help.” All of You will be available for free in all Lloydspharmacy branches throughout the UK from next month. Further editions will follow in May and September with it becoming a quarterly publication from January 2012.
NEWS 21 SCOTTISH CHEMIST REVIEW
New school programme uhealthy diet
Today’s community pharmacists are only too aware of how big a problem obesity is becoming across the country. Now, NHS Fife has launched a new programme, which offers advice and support to youngsters who are an unhealthy weight and their families. The BEST (Be active, Eat well, Stay healthy, Together, in Fife) programme’s BEST @ School project is currently being rolled out to Primary 4 pupils in fourteen schools across Fife, comprising four one-hour sessions where youngsters will learn about the importance of healthy eating and physical activity. Supporting the Curriculum for Excellence, each session focuses on a different topic, with youngsters taking part in a range of activities including sports taster sessions, interactive games, workshops, discussions and healthy tuck-shop planning. “This new pilot expands on the work of BEST,” said
Back row (l-r): Dr Grant McHattie, Associate Medical Director, NHS Ayrshire & Arran; Brian Reid, Manager, Ayr Utd; Irene Campbell, Project Manager, NHS Ayrshire & Arran; Paul Ardin, Director of Primary Care Development, NHS Ayrshire & Arran. Front row (l-r) Ryan McCann and Jonathan Tiffoney from Ayr Utd. Fiona Todd
Fiona Todd, NHS Fife Child Healthy Weight Practitioner, “delivering a key message to pupils, staff, parents and the wider community about the importance of maintaining a healthy weight through good eating and physical activity choices.”
For more information on the BEST programme contact the team on 01383 565338 or visit www.nhsfife.scot.nhs.uk
Just FYI... Drug Name
Examples of use in MAS1
No of items
Paracetamol Ibuprofen Simple Linctus2 Emollients Dimeticone Chloramphenicol Clotrimazole Chlorphenamine maleate Compound Alginic Cetirizine
Pain, fever Pain, fever, inflammation Cough Dry scaly skin Scabies, head lice Eye infections Vaginal thrush, athlete’s foot
Indigestion/ Acid Preparations heartburn Hay fever, other allergic reactions
Top 10 MAS items dispensed in Scotland, April 2009 to March 2010
99,587 75,933 53,485 51,023 48,730 45,076
Know who to turn to campaign NHS Ayrshire & Arran has teamed up with players from Ayr United FC to help tell young, 17-35 year old males from across Ayrshire and Arran, how they could make better use of their NHS services. The public education campaign called ‘When you’re ill, know who to turn to’ aims to help people make informed decisions about their health care and the services they may require. As part of the public education campaign, anyone attending Accident and Emergency inappropriately is given one of the new “When you’re ill, know who to turn to” leaflets. The leaflet clearly states the eight options available to people who need assistance from their health service alongside a list of symptoms that could be appropriately dealt with by each option. These include: • Self care – for minor illness or injury you can deal with yourself, such as hangover, grazed knee, sore throat, coughs and colds • Pharmacist – for expert advice or information on medicines and
healthcare including the Minor Ailment Service. Examples of minor ailments include coughs and colds, indigestion, constipation, aches and pains • Dentist – for regular check ups, routine treatment and emergency care • Optometry – for any eye problems including blurred vision, difficulty seeing well or discomfort – red eyes, irritated eyes • Family doctor – when your illness or injury just won’t go away make an appointment to see your GP who can provide advice and information about conditions such as vomiting, ear pain, sore belly, backache • NHS out-of-hours service – Turn to your NHS out of hours service when you are too ill to wait until your GP or dental surgery is open.
Other campaign materials include posters, display stands, advertising, drinks mats, health quizzes, on-line information and direct contact out and about in communities. For further information on the ‘When you’re ill know who to turn to’ campaign contact 0800 169 1441.
22 NEWS SCOTTISH CHEMIST REVIEW
Project wins national award
A project, which explored the most effective ways for communities in rural Scotland to get involved in planning their future health services has won a national award and attracted international interest. The Remote Service Futures Project was a joint Knowledge Transfer Partnership (KTP) initiative between the Centre for Christina West Rural Health, part of the new University of the Highlands and Islands and NHS Highland, and looked at the challenges of providing services in remote and rural areas, including staff recruitment and travelling times and costs for patients, families, carers and health professionals. The two-year scheme, which has now been completed, has received one of two awards for the best Scottish partnership project in the Knowledge Transfer Partnership (KTP) Scotland Awards, which were presented by Angela Constance, minister for skills and lifelong learning, at a ceremony in Dunblane. “This is a real accolade for the NHS Highland and UHI Centre for Rural Health partnership,” said Christina West, Argyll and Bute Community Health Partnership’s clinical services manager, “and for the first time an NHS partnership has achieved this award, recognising that, by organisations working together, we can identify new and innovative solutions.”
Pictured at the Charity of the Year launch at The Co-operative Group’s Manchester head office are Alan Halsall, Mike Holmes – Executive Director of Campaigns and Marketing for ENABLE Scotland, Chris Brooker, Business Development Director at The Co-operative Pharmacy, Mark Goldring – Mencap’s Chief Executive, and Natalie Cassidy.
The Co-operative Pharmacy’s Business Development Director, Chris Brooker, was joined by soap stars Natalie Cassidy and Alan Halsall to kick-start a year of fundraising for the new Charity of the Year partner Mencap and sister charity, ENABLE Scotland. Both Natalie and Alan pledged their support as The Co-operative embarks on a year-long programme of fundraising to help the charity to transform the lives of 20,000 young people in the UK with a learning disability.
Organ donation app for iphone utechnology
NHS Lothian has become the first health board in Scotland to create an iphone application (app). Designed as part of NHS Lothian’s organ donation campaign, the “Sign up to Save a Life” app makes it easy for potential donors to join the national register while on the go, and to find out more about organ donation and transplantation in Lothian. The app is available to download free of charge from iTunes App Store and is suitable for all ages. The health board
has already teamed up with staff, scores of big businesses and organisations, as well as patients to run the campaign, which encourages people living in Lothian to join the national organ and tissue register. The app includes general information, quick facts and a direct link to the national organ and tissue donors’ registers either via web browser or text.
For more information on organ donation and transplantation in Lothian visit www.nhslothian.scot. nhs.uk/signuptosavealife
WORDS: DEBBIE ORME
More than 200,000 people in Scotland are known to have diabetes: an alarming four per cent of the population. Thousands are also believed to have the condition but have not yet been diagnosed.
24 DIABETES SCOTTISH CHEMIST REVIEW
Challenging diabetes during pregnancy uself-management
For women with Type 1 diabetes, self-management is particularly challenging during pregnancy due to physiological and hormonal challenges. Hormonal changes during pregnancy, coupled with diabetes, mark regulating sugar levels difficult, which can have damaging consequences. These high blood glucose levels increase the risk of congenital malformation, stillbirth, neonatal death, preterm delivery, macrosomia (oversized babies) and neonatal admission. New hope has arrived in the form of research funded by Diabetes UK, which has for the first time successfully demonstrated the potential of an artificial pancreas in pregnant women with Type 1 diabetes. It is hoped that the development could drastically reduce cases of stillbirth and mortality rates among pregnant women with the condition. Pregnancy poses additional risks for women with diabetes as hormonal changes make it very difficult to keep blood glucose levels within a safe range, especially at night. As a result of high blood glucose levels, babies of women with diabetes are five times as likely to be stillborn, three times as likely to die in their first months of life and twice as likely to have a major deformity. Hypoglycaemia (low blood glucose) in pregnancy is a major cause of maternal mortality. Two in three mothers with pre-existing diabetes have Type 1 diabetes. Published in the February 2011 issue of ‘Diabetes Care’ and led by Dr Helen Murphy of Cambridge University, the study evaluated the performance of an artificial pancreas or ‘closedloop insulin delivery system’ in ten pregnant women with Type
1 diabetes. The researchers found the device was able to Dr Helen Murphy
automatically provide the right amount of insulin at the right time, maintain near normal blood glucose levels and, in turn, prevent nocturnal hypoglycaemia in both early and late pregnancy. First use of an artificial pancreas in pregnancy The artificial pancreas was created by combining a continuous glucose monitor (CGM) with an insulin pump, both of which are already used separately by many people with Type 1 diabetes. Previous studies have shown improved blood glucose control and reduced
hypoglycaemia with overnight use of an artificial pancreas in children with Type 1 diabetes but this is the first time it has been successfully used in pregnant women with the condition. “For women with Type 1 diabetes, self-management is particularly challenging during pregnancy due to physiological and hormonal changes. Previous studies indicate that pregnant women with the condition spend an average of ten hours a day with glucose levels outside the recommended target,” said Dr Murphy. “These high blood glucose levels increase the risk of congenital malformation, stillbirth, neonatal death, preterm delivery, macrosomia [oversized babies] and neonatal admission.” she added.
Case study Debi Harris, 26, from Airdrie near Glasgow was diagnosed with Type 1 diabetes in 1993. In 2009, Debi’s first child, Jacob, was delivered Debi Harris by emergency caesarean section after 37 weeks when doctors discovered her placenta had stopped working. Debi had also been experiencing regular sudden and serious hypos (hypoglycaemia) which made her collapse unconscious on several occasions. Despite the difficulties, Jacob was born healthy. Debi is currently 20 weeks pregnant and is now learning to combat the effects of the hypos while looking after a boisterous 19-month-old toddler. “This pregnancy has been much better,” Debi told SCR. “With my first pregnancy, I had got to the stage where I needed assistance. I was vomiting a lot and, as a result, the insulin wasn’t getting a chance to work properly. With this pregnancy I haven’t really been sick, so I think that’s why I’ve been able to manage better. “I think one of the main things about diabetes and pregnancy is that it’s important to let others around you know the signs when you have a hypo. In my case, for example, I become pale. While some people don’t like others to know, I think it’s important that others recognise when you are dipping, especially now when it’s not just about me, but about looking after Jacob as well. “Although Jacob is only 19 months old, we have already taught him to go to the cupboard to fetch me a carton of juice or Dextrol. To date, I have always been able to do this myself, but it’s important that he can do this in the event of me being unable to reach these things.”
DIABETES 25 SCOTTISH CHEMIST REVIEW
Diabetes drug could reduce cancer risk uresearch
New funding available uprevention
The publication of the Scottish Diabetes Action Plan last year set out a course of action over the next three years, which is intended to support prevention and detection of diabetes and subsequently help improve NHS care throughout Scotland. Those involved in healthcare in Scotland warmly welcomed the news of the £675,000 funding by Diabetes UK and the Chief Scientist Office (CSO) of the Scottish Government for research into Type 1 diabetes. The Scottish Diabetes Research Network (SDRN) Type 1 Diabetes Bioresource will see the development of an invaluable data source for researchers and will lay down the foundation for many future diabetes studies worldwide. At the end of last year patients began being invited to take part in the research during their usual clinic visits. A network of diabetes specialists across Scotland asked patients of sixteen and over with Type 1 diabetes to donate a sample of
blood and urine. By combining samples with information on the patient’s diabetes history, the bioresource will enable future research into the causes and consequences of Type 1 diabetes, which could lead to new avenues of research into prevention and improved treatments. The study will initially take place at clinics in Aberdeen, Dundee, Dunfermline, Edinburgh, Glasgow, Kirkcaldy and Livingston and aims to include up to 10,000 patients. It is anticipated that other centres will join as the study progresses. The project will also be supported by dedicated Diabetes Research Nurses provided by the Scottish Diabetes Research Network.
Diabetes UK is aiming to address the increased risk people with Type 2 diabetes have of developing cancer by funding new research to determine whether a popular diabetes drug can prevent one out of three cases of cancer in people with the condition. Research has shown that people with Type 2 diabetes could have up to a 27 per cent increased risk of developing cancer, particularly breast, colorectal, endometrial, liver and pancreatic cancer. Common risk factors associated with Type 2 diabetes, such as obesity and diet, could help to explain this increased risk. However it has also been suggested that increased blood glucose levels could also have an effect. Previous studies have suggested that metformin (taken by people with Type 2 diabetes as a first line medicinal treatment, after diet and exercise, to lower blood glucose), lowers the increased risk of cancer for people with Type 2 diabetes by 30 per cent, but these studies are not definitive. Diabetes UK has awarded funding to researchers at Oxford University to collate information from the largest and best clinical trials of metformin in the hope that a way to tackle this increased cancer risk can be found. “We know that good diabetes management can help to
prevent the serious complications diabetes can lead to,” said Dr Iain Frame, Dr Iain Frame Director of Research at Diabetes UK, “such as heart disease, stroke, kidney disease, blindness and amputation. However, while there are various approaches to minimise the effects diabetes can have on specific organs, little is known about what preventative measures can reduce the risk people with diabetes face of developing some forms of cancer. “If it is found that metformin can help to reduce the risk people with Type 2 diabetes have of developing cancer then this will be a big step forward in terms of how we can help people manage the condition and hopefully allow us to develop a means to tackle the increased risk for all people with diabetes. It will also be important to understand the effects of metformin on its own and in combination with insulin and other treatments.”
26 DIABETES SCOTTISH CHEMIST REVIEW
Ethnic minority origin living with diabetes ueducation
A culturally sensitive diabetes outpatient education service is being delivered to people of ethnic minority origin living with diabetes in Lothian. Designed by a pharmacist, Lubna Kerr, the initiative began as a research project, but the effectiveness and popularity of the programme resulted in its development and implementation as part of the local diabetes care package and is part of NHS Lothian strategy of accessing the hard-to-reach groups. “Over the last decade it has been proven that there is a greater prevalence of diabetes in South Asian people,” said Lubna. “Current statistics would indicate that people of South Asian origin are up to six times more likely to develop type 2 diabetes than Caucasians. In addition, cultural and language differences may represent barriers for South Asian people with diabetes in accessing appropriate healthcare. “There are several reasons for this. Moving from a warm to a cold climate means that some of the genes will physically ‘switch off’. Also, many South Asians, who move to the UK, work very hard and don’t have time to exercise, so there’s a lifestyle element. The diet is different and they are subject to high stress levels due to a
variety of social and cultural pressures. For this reason, many of those from ethnic minorities who have diabetes will find that their condition improves greatly when they go back to a warm climate.” As a result of the success of setting up the ethnic minority diabetes service in Lothian, Lubna has now set up a social enterprise health charity. The Centre of Health and Wellbeing (CHWB), which is aimed at significantly boosting health and wellbeing of the people of Scotland by encouraging people to take responsibility for their
own health. “The Centre of Health and Wellbeing is also running a bespoke diabetes lifestyle programme in West Lothian, allowing patients to take control of their lifestyle and to enhance their existing healthcare treatments. “Individuals attending the diabetes programme initially have a full clinical health assessment,” said Lubna. “Then a specifically designed programme of wellness education focusing on selfmanagement, motivational guidance, nutrition, complementary therapies and relaxation techniques is delivered. We are now planning our third diabetes programme and so far the participants have all loved it.”
For more information visit www.chwb.org.uk.
DIABETES IN PRACTICE Diabetes is a progressive disease which affects much of the population and is characterised by the body being unable to regulate blood glucose. Pharmaceutical care of the diabetic patient has become increasingly important, just as the national approach to diabetes has become high profile, multidisciplinary in nature and one of the government’s health priorities. This package puts together the evidence base already existing for the pharmaceutical care of patients with diabetes, as described in SIGN Guideline 55, The Scottish Framework for Diabetes and in documents from key centres like the Clinical Standards Board for Scotland. Topics include: • The differences between Type 1 and Type 2 diabetes • The major challenges in screening and detection • The major challenges in control and compliance • Treatment and monitoring of Type 1 and Type 2 • The multidisciplinary team approach to caring for diabetic patients • Complications of diabetes and how to minimise them • Future directions such as transplantation and gene therapy
AD TO COME
28 AWARDS SCOTTISH CHEMIST REVIEW
Scottish Pharmacy Awards 2010
Community Pharmacist of the Year WINNER: Ian Will, Will Chemists, INVERURIE
As he picks up his award for Community Pharmacist of the Year, Ian Will tells SCR how his focus on providing what the customer wants is one of the main reasons for his success. “Receiving the accolade of Pharmacist of the Year was a fantastic honour,” Ian told SCR, “particularly since it is firstly a nomination by a collage, and most importantly, since it is voted for by colleagues, friends and customers alike in recognition of services to the community. “At Will Chemists we are fully aware of the professional challenge of the NHS Scottish
Contract in general, and the Chronic Medication Service in particular, so it is vital that the pharmacist can both spend more time with the patient and can ensure that the patient is confident that the information is accurate and pertinent. Will Chemists is very customer-focused and I have always been concerned about customer perception. I knew that we were providing
Ian Will & John Cochrane Strathclyde Pharmaceuticals
an excellent service (as borne out by a customer satisfaction survey from about two years ago), but my feeling was that our operation was ‘organised chaos’. We therefore decided some time ago to undertake a refit, but, as with everything else that we do, we ensured that our patients and customers were fully involved in the process by showing them how the works were being carried out. “The local twelve-doctor surgery had plans for a Health Living Centre and wanted us to be part of that project. However, the plans became protracted and the costs were rising rapidly, so it became clear that the sensible option for us was to improve our premises rather move to high rental premises. The purpose of the refit was to bring our pharmacy into the twentyfirst century with a significant investment, which would last. “The service requirement for the new pharmacy contract was the overriding influence on the style and the size of investment in our pharmacy. This meant that automation in the dispensing process was paramount and complemented the technician training arrangements already in place. Both of these would release the pharmacist to engage with our patients. “My son, Galen, who is also a pharmacist, and I went to
Holland to check out robotic dispensing systems and, while we were there, we saw the Robopharma system in operation. We decided to go for this system, primarily because of its ability to house nearly 300 of our completed prescriptions, which were crammed on shelves and difficult to locate! “During the refit, which involved major building works, we kept our patients and customers involved in the process by showing them how the works were being carried out. All, without exception, were overwhelmed and excited that their Inverurie pharmacy was at the leading edge of technology use.” “The aim of the project was to produce a professional pharmacy capable of providing safe segregated work areas, automated, and providing an ambience conducive to a quality retail and healthcare environment where medicine advice can be given, accurately and unhurried. There is room for significant expansion in business and it is anticipated that “hub and spoke” dispensing will eventually be developed for our other pharmacy in the town.”
AWARDS 29 SCOTTISH CHEMIST REVIEW
Scottish Pharmacy Awards 2010
Community Pharmacy of the Year WINNER: Rowlands Pharmacy renfrew
There’s no doubt that Rowlands Renfrew is a true jewel in the life of the local community The pharmacy team has a reputation for always ‘going the extra mile’ to support their local community and the GP surgery work and, together as a team, they work very hard to support any patient needs brought to their attention. From the delivery driver, who is known by the elderly population as someone who keeps a close eye on the elderly customers to ensure their safety and well being, to Claire, the pharmacist, who is loved and respected by staff and customers alike, Rowlands’ excellent customer service is exemplary. Claire is actually known to her patients as the ‘Saturday girl’, who worked her way up to being the manager and the staff respect her greatly. This consistency has resulted in excellent customer service and patients are happy to use the pharmacy. Many of the other staff have also been there for a long time and have developed very close relationships with many of the customers, who keep coming back, as they feel welcome and always get what they need with a smile. They all work very hard for every patient in the pharmacy and would go out of their way to make sure the patient received everything they needed. “Rowlands has a strong reputation in the local community of ‘Caring for you and your family,” said Laura Fraser, Area Manager for Rowlands, “This
Rowlands Pharmacy Renfrew with David Currie AlbaPharm and Donna Hoskings, SCR
image is maintained and carried on by dedicated and enthusiastic staff, who are committed to excellent patient are. I am proud of the work being done by the Renfrew team. They use a downto-earth, friendly approach with all the patients and they maintain high standards of patient care.” Rowlands Renfrew underwent a refit in November 2009, utilising a seldom-used space within the existing premises to extend the dispensary area and still maintain the required front shop space for new health awareness initiatives. The dispensary was doubled in size and, as a result, enabled the pharmacy to provide extended services to the customers and
the surgery. This new concept pharmacy supports the work of the Scottish pharmacy contract in allowing staff to spend focussed time engaging with patients to discuss healthcare issues. It also allowed introduction of a retrieval area and consultation room, as well as a health information kiosk. The layout has zoned areas, with consultation points which allow staff to chat informally with customers about health issues. One example – the ‘Keeping well’ section - invites a proactive approach on the part of the customer and staff are well trained to give supportive advice. There is a common complaints cards stand (contains bookmark style card with health advice on a
range of minor ailments topics), which customers can access themselves or staff can talk them through health related issues and give advice. The whole pharmacy is colour-coded to make it easy for the patient to navigate the way round the store and staff are gradually moving away from traditional counter assistant roles to healthcare assistant roles, where they interact with the customers throughout the store advising them on medicines, healthcare needs, public health services available such as smoking cessation.
30 AWARDS SCOTTISH CHEMIST REVIEW
Scottish Pharmacy Awards 2010
Medicines Management through Therapeutic Partnerships of the year WINNER: Claire Cairns & Kerry Steel, Rowlands, Forehill
Claire Cairns & Kerry Steel were absolutely delighted to pick up the award on behalf of Rowlands Pharmacy, Forehill The pharmacy thrives in a local community through outstanding partnerships with local GP surgeries, the two proactive pharmacists (Kerry and Claire), who job share, and a focused and motivated team of staff who dedicate time to providing services and support for their customers. The pharmacy is a small establishment out with all the major surgeries in the town centre, therefore they have had to build up a relationship with local surgeries. A direct approach has been necessary and both
pharmacists have actively sought out opportunities to work with local GP practices in providing cardiovascular clinics. There is a third clinic pending subject to funding. Both Kerry and Claire are independent prescribers. Their work is constantly audited and peer reviewed. Full clinics are held most weeks for hypertension, with an average of twelve patients per half-day session. Claire runs a successful hypertension clinic at Bankfield Medical Practice and also a varenicline prescribing clinic
within the pharmacy consultation room. She offers a weekly clinic, but can see patients on any day of the week by appointment if necessary. Kerry runs a successful hypertension clinic at Fullarton medical practice and is currently working with the surgery at 9 Alloway in Ayr (due to constraints of funding) to facilitate a hypertension clinic. She has also secured another surgery, Barns medical practice, which is very keen to work with her in setting up a hypertension
clinic. Both girls have an excellent relationship with the local smoking cessation group “FreshAirshire” and have a number of direct referrals, not only for the Champix prescribing, but with regards to the NRT voucher scheme and the national PHS smoking cessation. They also actively seek out suitable patients with their patient education table. Kerry and Claire have a long-standing reputation within Rowlands of proactively seeking out opportunities to work collaboratively with other healthcare professionals to provide a seamless care approach for their patients. They recognised that in the west coast of Scotland, diet and lifestyle choices mean that a number of people are at risk of cardiovascular complications. Working as a job share, the girls are able to provide a complete prescribing service six days a week. Their professional reputation in the community has allowed them to approach local GP surgeries through practice managers and attending GP practice meeting, to have more access to pharmacist-led hypertension clinics. “The implementation of clinics,
AWARDS 31 SCOTTISH CHEMIST REVIEW
r Claire Cairns and Kerry Steel with Tony Cordrey, Sandoz
funded by the health board has allowed us extra time with our patients,” said Claire. “It’s very difficult for GPs and practice nurses to fit all this in within a five to ten minute appointment. We have 20-minute appointments which are far longer than we would have in the pharmacy and can really make a difference to our patients. The feedback from patients would indicate that the service has been well received. “It is telling that we don’t actually prescribe a great deal of medication. When patients are asked to come back to be rechecked they have invariably followed the advice and their blood pressure is within normal limits. The extra time we have to educate these patients is paying off with less prescribing, keeping budgets lower and avoiding patients being exposed to unnecessary medication.” The girls provide leaflets certified by the BHF as a written back-up to the personal advice to educate the patients on cardiovascular conditions. Within their clinics they discuss all aspects of healthy lifestyle
management, including alcohol consumption and the importance of a balanced diet. A health promotion table is available within the pharmacy advertising the smoking cessation and blood pressure measuring service. These services are run by the pharmacy team, are wellutilised by patients and often lead to a pharmacist intervention. Due to the wide-ranging commitments to a varity of health initiatives, Kerry and Claire ensure good professional practice is adopted for all aspects of their work. “The security of documents and patient confidentiality is respected at all times,” said Kerry. “We keep a profile on each of our Champix patients in a securely locked cupboard and only we have access to this and our prescribing pads. Claire has adapted the standard paperwork so we have a more in-depth profile on the patient, due to our taking ultimate responsibility for prescribing. We communicate frequently on each patient if we are both involved in varenicline prescribing, however, we try and
deal with one patient personally throughout their twelveweek course so that they have continuity of care.” Patients have been self-referring for varenicline prescribing due to word of mouth. They have been pleased with the service received and recommended the pharmacy to their friends. This has resulted in a review of how they deal with patients. Claire has adapted the standard protocol to make it more thorough as the patient has not had the benefit of the support network, “fresh airshire”. “Patients have commented on the personal approach, motivation and support that the pharmacy has given them to help them stop smoking,” said Claire. “They have also received positive comments via the surgery receptionists that patients in the hypertension clinics appreciate the extra appointment time and the opportunity to have any pharmaceutical queries dealt with at the same time as having their hypertension review without feeling like “we’re too busy and they don’t like to bother us” in the pharmacy.
“Claire and Kerry are outstanding pharmacists who give pharmacy the professional reputation it deserves. Their proactive and collaborative approach is respected and appreciated by local GPs and other healthcare professionals. They have earned respect from customers and professionals through commitment and dedication to put their patients first. They are a credit to themselves and the profession. They exemplify Rowlands value of ‘Caring for you and your pharmacy’” Kenny Black Managing Director, Rowlands Parmacy
32 FOCUS SCOTTISH CHEMIST REVIEW
Tale of one city uout and about
As pharmacists across Scotland battle to survive the onslaught of the current recession and future cuts, SCR takes a look at Perth City and speaks to a few of the pharmacists there to gauge how they are coping. Situated on the banks of the River Tay, Perth is the administrative centre of Perth and Kinross council area and the historic county town of Perthshire. It has been known as The Fair City since the publication of the story, Fair Maid of Perth, by the Scottish writer, Sir Walter Scott, in 1828. Royal Burgh status was given to the town by King William the Lion in the early twelfth century and the town soon became one of the richest burghs in the country, doing trade with countries like France, the Low Countries and Baltic Countries for goods such as Spanish silk and French wine.
Today, Perth serves as a popular retail centre for the surrounding area. This includes a main shopping centre along with a pedestrianised high street and many independent and specialist shops on offer. Following the decline of the whisky industry, the economy of the town has now diversified towards insurance and banking, with The Royal Bank of Scotland, Aviva and Scottish and Southern Energy all major employers in Perth. For Perth, 2010 remained a year of caution as customers spent carefully and retailers remained cautious in terms of
expansion and development. Despite the loss of Jessops, BHS, D2 and independents, Green Squirrel, Party Factory and Romera, Perth also experienced some development, with new independent retailers, including Ivory Whites bridal shop, Theo & Tily, Joules at McEwen’s and Baby Bair. In terms of its pharmacies, Perth provides a microcosm of what’s happening in the industry throughout Scotland. There are currently eight pharmacies operating in the Perth area, of which four are multi-nationals and four are independents. In addition,
Perth has experienced the arrival of the supermarket multiples, which provide the ‘under one roof’ approach to shopping, including an increase in the range of OTCs on offer. Stores like Tesco, Sainsburys and Asda continue to grab an ever increasing proportion of the independents’ market and many fear that the supermarkets’ power will enable them to open many more pharmacies, to the detriment of independent pharmacy. SCR spoke to Perth pharmacists to gauge how pharmacy is faring in the city. Allan Gordon from Davidson’s Chemist, which has two branches in the city, feels that business in general is suffering and will do for some time to come. “Retail conditions are pretty abysmal in general. We have two pharmacies in Perth city – one on either side of the river. One is city centre and the other is on the edge of the city centre. They are two very different types of business. The more suburban pharmacy
FOCUS 33 SCOTTISH CHEMIST REVIEW
of competition. Boots, Lloydspharmacy, Asda, Superdrug and the Co-op are all situated near to us, but I firmly believe that good service to patients will always define which businesses survive and which fail. People want convenience and as fast a service as possible, so it’s vital that the right infrastructure is in place to ensure a high level of customer service. There’s no doubt that consultation rooms take away from retail space, but, in my opinion, they’re for the greater good. We want to be at the cutting edge of changes and so we work hard on our merchandising. As will all businesses, all we can do is prepare ourselves as best we can for what is to come.”
tends to focus on the demographic and so leans towards deliveries and the provision of additional services, such as methadone provision. The city centre one is more retail orientated and there’s no doubt that OTC trading is tough at the moment. Between the VAT increases and the fact that the package of government cuts hasn’t bitten yet, I would say that it is very evident that spending power has been greatly reduced, but what can you do? You simply have to get on with it. “Our prescription growth
will be good to average this year, but there’s no doubt that it will be a very tough year, with income reduced. Between the dramatic cutbacks in Category M, which are very significant, and prescribing changes going on, such as moving patients from higherpriced generics to cheaper brands and from capsules to tablets, there are certainly difficulties to be faced. “As a company we have just completed a review of our warehouse structure. Unfortunately, we have had to make a few redundancies, which obviously no company likes to do, but in this financial climate it’s vital that we make the necessary cuts in order to survive. “We are now starting to look at elements of our business such as delivery services and additional services, which, to date, have been free. We are currently running pilots in a bid to gauge the success of private services and are looking to see if there is a market for charging for private services. “As with most city centre businesses, there is plenty
Let’s Network Perth Let’s Network is a new local networking event, which gives local business people a fantastic opportunity to network with like-minded people. Building relationships and developing a good network is essential for any business and with an average attendance of 75 people, Let’s Network Perth certainly gives you that opportunity. The events are informal and relaxed with no formalities. Simply grab a tea/coffee and start networking. There is no joining fee and just a small event fee of £4.00 per person to cover refreshments. Let’s Network Perth was created by Nick Oswald of Legends and Mark Riddell, Managing Director of m3 Networks Limited. Stephen Gorton of Fraktul Limited recently joined the team.
Allan’s concerns are shared by Gordon Brown from Browns Pharmacy Healthcare, who also has two branches in the city. Gordon is aware of the difficulties facing Perth as a city in general. “I would say that, over the last five years, Perth has set its sights on becoming a city, but can’t afford to lose its focus on what it actually is – a centre for small businesses with an agricultural hinterland. Recently I have noticed a lot of small businesses on the High Street closing down, which is a real shame. The problem is, however, that Perth’s city centre contains many small retail units, so they are of no interest to the big multi-nationals. The focus therefore will have to be on encouraging new small businesses to come to Perth. This keeps the town interesting and a place people will enjoy to visit.
Let’s Network meetings are all held at the Perth Business Centre - 28 Glasgow Road, Perth and the dates for 2011 are as follows: Thursday 28 April, 9-11am Thursday 26 May 9-11am Thursday 30 June 9-11am Thursday 28 July 9-11am Thursday 25 August 9-11am Thursday 29 September 9-11am Thursday 27 October 9-11am Thursday 24 November 9-11am December dates to be confirmed.
For more information visit www.pkc.gov.uk/ Business+and+trade/ Support+for+businesses/ Business+Advice/ Business+News+and+Events. htm
34 FOCUS SCOTTISH CHEMIST REVIEW
Perth Facts The population of Perth and Kinross on Census night (29 April 2001), was 134.949. This represented an increase of 6.9 per cent on 1991 compared to an increase in Scotland as a whole of 1.3 per cent. Comparison with other local authority areas suggests that, over this period, Perth and Kinross had the fifth fastest growing population in Scotland. The gender split was 48.3 per cent male and 51.7 per cent female. Ten per cent of residents were aged between 65 and 75 and a further 8.6 per cent aged over 75. The older age profile is reflected in that the average age of the population in Perth and Kinross is 41 years, slightly higher than the national average of 39 years. One per cent of the Perth and Kinross population in 2001 was from a minority ethnic group, compared to 0.6 per cent in 1991. After the white ethnic group, the largest numbers of people were from Asian ethnic groups (378), Chinese and mixed background ethnic groups (both with 310 people). As regards illness, 20.3 per cent of the Scottish population indicated that they had a longterm illness or disability; an increase of 14 per cent on 1991. In comparison, 17.8 per cent of people in Perth and Kinross fell into this bracket. Although below the national average, it still represented an increase of more than ten per cent on 1991 figures. A new question in the 2001 Census asked about each person’s general health over the twelve months leading up to the Census. Two thirds (67.9 per cent) of the Scottish population reported that their health had been good. Encouragingly, in
“I agree with Allan in that we are all dealing with the universal problem in pharmacy, ie, the fact that there’s only one paymaster – the government – who, have taken money out of the drug budgets. This has affected the turnover of every pharmacy, so we have thrown ourselves wholeheartedly into the new services, which are coming on board. We intend to capitalise on these services by getting involved quickly and efficiently in the CMS element of the new pharmacy contract. “As with Davidson’s, we also have two branches in Perth; one situated on the High Street and the other near a health centre. The pharmacy near the health centre focuses mainly on dispensing with a high number of walk-in scripts, whereas the city centre pharmacy has a more traditional split between retail and dispensing both pharmacies benefit from an increasing level of prescription collection and delivery. I would say that this is one area in which we do very well as an independent compared to the multiples. “The retail trade is, however, extremely challenging but there’s certainly still a case for having retail space in pharmacies. “Where we would differ from Allan is the fact that we are looking to take on staff rather than cutting numbers. Our focus is very much on service delivery and we are investing in the right staff to deliver new services to our customers.”
Sandy Tinning, who has been in pharmacy for more than 30 years, owns R P Blair in South Methven
Street in Perth where his daughter, Elaine, is the relief manager. Sandy believes that, as a result of current conditions, pharmacists have a major struggle ahead of them. “As we approach the end of this financial year, like many pharmacies in Scotland we will await our annual accounts with a degree of worry. With the increasing financial pressure from Category M, a huge amount of extra work due to stock shortages, and also paying over the odds for many items because of some generic ‘shortages’, how can we expect anything other than significant pressure on our gross profit margin? “It is all very well to say that we will embrace new services, but let’s face it, most of us would rather do without these and carry on as before. After all we are only being asked to do more for less. “As we are not on one of the busier streets for passing trade, our business is pretty well all dispensing, with little retail, and so we must carry on trying to provide the best service we can. We firmly believe that service is the key to maintaining our share of the available business. “It is difficult to be enthusiastic about Perth itself from a retail point of view as, wherever we go in the country, we see the same old shops. That said, it has been good to see a bit of activity recently in the High Street since the arrival of Primark.” To sum up, it would seem that there is room for all of the pharmacies in the city, with all
focusing on the fact that it is customer service that will ensure stability and growth. Vicki Unite, Chief Executive of Perthshire Chamber of Commerce, is optimistic about the future. “Perth has long been famed for its unique and attractive retail offering and I know that the economic climate has had an impact on all city centres on a national level. The USP of Perth has always been its picturesque setting and independent retailers with a good mix of well-known chains and excellent selection of quality places to eat and drink. It is good to see substantial and recent investment in the centre with the arrival of new independents along with a huge investment and over 100 employment opportunities from Primark. We always promote Perthshire’s location, which makes it a perfect base for doing business anywhere in Scotland, offering a very high quality of life.”
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36 PROFILE SCOTTISH CHEMIST REVIEW
Importance of support ualbapharm profile
After leaving one of the larger multiples, Mark Easton joined the world of independent pharmacy five years ago, taking over Parkhead Pharmacy in the coastal villages of Hopeman and Burghead in Moray. “Having spent almost twenty years with Boots, I was used to having a large support network around me to deal with the non-professional issues such as personnel, health and safety and public liability insurance,” said Mark. “As George had been one of the early Albapharm members, and I had no experience in independent sector, continuing this membership was an easy decision. The most significant reason then
was the buying package offered, particularly for generics, and brand equalisation agreements. The kind of support provided by AlbaPharm went some way to bridging the gap between the corporate comfort I had enjoyed and the slightly terrifying freedom I had discovered. “Pharmacists are currently facing some of the most significant challenges ever experienced within the profession. Some, such
as the creation of the General Pharmaceutical Council and Royal Pharmaceutical Society (in its new role) have generated much debate among the politically active minority, but have been observed from a distance by the majority whose main concern is the welfare of their patients. Such fundamental changes are only of interest to them when they impact on the front-line professional’s ability to deliver a high standard of care. AlbaPharm has a role here in lobbying representative bodies with members concerns in a format, which is understood and accepted, taking the view that synergy within the profession is preferred to self-centered isolationism. “Add to this the economic downturn affecting counter sales, the rise and rise of the supermarkets, entry regulations changing, the changing attitudes of banks to small businesses, the financial pressure being applied to all elements within the public sector squeezing NHS payments, not to mention local factors such as, in our case, RAF bases closed and threatened with closure (at time of writing), and you have the potential for crisis. Against this background, it must be recognised that pharmacists are now having to work both harder and smarter to maintain or improve services. AlbaPharm membership provides important support in meeting many of these challenges. Clearly no amount of political lobbying by AlbaPharm directors will singlehandedly save RAF Lossiemouth from closure, or force Pfizer to change its supply model, but, by working in partnership with others, it can reduce the negative impact of such changes to the way we operate. “More than ever, community pharmacists in Scotland need to have a clear focus on where their time and energy can make most impact on their businesses, using additional support bodies to best deliver improvements
within their particular sphere of influence. For example, by offering a partnership package with Alphega, AlbaPharm members can enjoy high quality point of sale to support a special offer package, or easy-to-use SOPs within the dispensary tailored to the needs of the individual member, thus preserving the independent nature of each member. By negotiating with AAH, AlbaPharm deliver a highly competitive generic portfolio, enabling members to spend time implementing CMS rather than searching for the best price on hundreds of lines each day. This kind of support is vital to me as I endeavour to provide a high quality pharmaceutical in two pharmacies on a daily basis, with all the additional challenges involved in operating on two sites. “As community pharmacy comes under increasing external scrutiny with the ongoing rural dispensing doctor-versuspharmacist debate, and the sharing of patient sensitive information between previously unconnected professionals, it is important that we have robust personnel structures in place. Again, the support provided by AlbaPharm takes the worry and uncertainty out of this side of the business. “The provision of strategic partners and preferred suppliers has allowed me to match our offering with the needs of the two villages. For example, we were able to introduce a highly successful flu vaccination service this winter, with a view to expanding this type of service in the future. To find time to implement this was challenging at a time when CMS was taking up large amount of my time, not to mention oxygen delivery, smoking cessation service, AMS, MAS, PHS, MP3 and BBC (oh and did I mention eating and sleeping?). “As we embrace 2011, I am confident that we are well placed to maximise the opportunities which will undoubtedly present themselves.”
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38 NEWS SCOTTISH CHEMIST REVIEW
Free advice for workers People with a health condition, who work for a small to medium-sized company, can now access free advice and support. Working Health Services Scotland offers free confidential advice and individualised health support to enable individuals, who work for a company with less than 250 employees, to remain in, or make an early return to work. The service is run by Salus, an NHS Lanarkshire-based provider of occupational health, safety and return-to-work services across the public and private sectors. “Working Health Services Scotland will assist the individual to better understand and manage their health condition,” said Cathy Evans, a senior case manager with the Salus-run service. “This includes individuals, who present with mild to moderate health conditions, who may be experiencing a level of stress or anxiety that they are struggling to cope with, or for individuals, who have issues with, for example, pain. “Interventions may include access to physiotherapy, occupational therapy, counselling and occupational health and safety support.”
Think FAST and save a life NHS Ayrshire & Arran and Chest Heart and Stroke Scotland have joined forces to make the public more aware of the signs of stroke and the importance of starting treatment as soon as possible.
In Ayrshire there are more than 1,000 strokes or mini strokes a year, but if patients can be assessed for thrombolysis (a clot busting drug) within three hours of their stroke, they have a better chance of reducing the long-term effects. Since the service started in June 2009, 21 patients with thrombolysis and a number of patients throughout Ayrshire have benefitted from this new service. Local musician and Westsound DJ, Tommy Truesdale, recently joined patients, carers, NHS staff and even the Bard himself at the new Burns Birthplace Museum to launch a new campaign to raise awareness of the signs of stroke. There are four simple ways of
recognising these signs: F – Face: Can they smile? Does one side droop? A – Arm: Can they lift both arms? Is one weak? S – Speech: Is their speech slurred or muddled? T – Time: To call 999
Wendy Kerr, 42, from Prestwick, was having a cup of tea before starting her shift as a nurse when she felt pins and needles in her left arm and realised she couldn’t get up. Wendy knew something wasn’t right, but thought five minutes in bed would help. Thankfully her partner phoned NHS 24 and, when her mother turned up, she called
an ambulance. The ambulance arrived quickly and Wendy received thromolysis in Ayr Hospital within the three hour window for treatment. She is now back at work and the hole in her heart has been closed. “I consider myself very lucky,” Wendy told SCR, “and, apart from a slight weakness in my right shoulder, I can continue normally at work and still keep fit.”
A ACC For more information visit www.nhsayrshireandarran.com
F – Face: Can they smile? Does one side droop? A – Arm: Can they lift both arms? Is one weak? S – Speech: Is their speech slurred or muddled? T – Time: To call 999
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UK/RET/008b/10 - November 2010
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40 NEWS SCOTTISH CHEMIST REVIEW
The true cost of drug misuse ROBOTIC PHARMACY
New figures from ISD Scotland show that the country’s methadone programme now costs more than £15 million a year. The figures represent a rise of 25 per cent over the past five years and, despite the new strategy to concentrate on recovery from addiction rather than maintenance, the prescribing rates rose by nine per cent in the same period. ISD figures also show that a total of 10,325 people entered drug treatment services in 200910, with two-thirds of those using heroin. Drug injecting remains a major problem, with 28 per cent of heroin users taking the drug intravenously in the month before they sought treatment. The average daily spend on drugs for those entering treatment in the past year was £43. Heroin users spent an average of £33 per day, while cocaine users spent £108 in the same period. There is further bad news in the fact that the number of cocaine
users entering treatment has now dropped from 1200 in 2008-9 to 750 in 2009-10. The number of crack cocaine users who entered treatment in the past year has also nearly halved compared with 2008-9, although the vast majority of users, around 47 per cent, continue to be concentrated in the Grampian health board area. Other points of interest include: • In 2008/09, it was estimated that around one per cent of consultations (face-to-face contacts) between patients and
General Practitioners (GPs) related to drug misuse, which equates to approximately 148,109 consultations for drug misuse (95 per cent CI 108,435 - 187,783). • The GP consultation rate per 1,000 practice population for individuals living in the most deprived areas was over eleven times greater than the rate for individuals living in the most affluent areas, 52.1 (95 per cent CI 39.4 – 64.9) estimated GP consultations per 1,000 practice population compared to 4.7 (95 per cent CI 3.4 – 6.1) per 1,000 practice population (the estimated
Defined daily doses per 1 000 population Scotland
Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles
5 646 1 019 3 030 4 111 2 577 4 153 7 914 1497 2 469 5 440 * 890 3 291 *
19 32 14 9 12 2 12 20 16 14 32 * * 18 .
2 389 2 749 1 620 1 699 2 208 1 931 2 101 2 112 1 757 2 990 1 414 1 132 2 278 2 124
91 102 114 193 161 115 158 186 322 82 102 18 53 273
4 646 2 315 3 272 2 870 2 703 2 663 4 594 2 479 3 896 5 046 1 207 1 638 2 897 4 168
1 389 1 721 1 652 1 139 1 633 1 044 1 748 1 208 1 158 1 595 728 343 1 439 2 431
consultation rate remains largely the same across deprivation categories for non-drug misuse consultations). • In Scotland, in 2009/10, there were 510,063 prescriptions for methadone oral solution, around 98 prescriptions per 1,000 population. Individuals may have more than one prescription over the year therefore the number of prescriptions is not indicative of the number of individuals. • The cost of dispensing methadone oral solution (dispensing fees and ingredients) for Scotland in 2009/10 was £15,296,744, around £2,945 per 1,000 population. • Methadone oral solution prescribing rates have risen by nine per cent over the last five years, from 90 prescriptions per 1,000 population in 2005/06 to 98 prescriptions per 1,000 population in 2009/10. This figure remained stable at 96 methadone prescriptions per 1,000 population between the three-year period 2006/07 to 2008/09, before rising slightly to 98 methadone prescriptions per 1,000 population in 2009/10.
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42 PRODUCT UPDATES SCOTTISH CHEMIST REVIEW
Father’s Day - Living Nature’s Skin Essentials For Men Living Nature, the certified natural skin care company from New Zealand, has the ideal ‘skin essentials’ gift for Father’s Day; Skin Essentials For Men (rrp £25.55). This great male-specific set comprises a selection of key face care products from Living Nature’s Skincare For Men range, formulated to help enliven and revitalise male skin, naturally, and provides a fantastic way to introduce men to the Living Nature range for use at home, whilst holidaying or when away on business. All Living Nature Skincare For Men products come to market specifically formulated to care for the needs of male skin. A man���s skin is exposed to an increasing number of environmental stresses and is also subjected to the additional downsides of daily shaving. Each Living Nature Skincare For Men product delivers all that a man’s skin needs, providing powerful purifying, nourishing and moisturising benefits derived from some of New Zealand’s unique natural botanicals. Ingredients such as hydrating, rejuvenating Manuka Honey, soothing Harakeke, antioxidant-rich Totara, and cleansing Kumerahou, are included with pure essential oils, citrus oils, and flower extracts, to create superior-quality, male-specific skin care products that really work. Also, since all Living Nature Skincare For Men products include only 100% natural preservatives, fragrances and ingredients, male skin is left feeling smooth, conditioned, healthier and younger-looking, naturally. Additionally, Living Nature was one of the world’s first companies to produce skin care without the use of synthetic preservatives or parabens, and have all products ‘certified natural’ by BDIH Germany, a world-leading independent auditor of natural skin care and cosmetic products. Living Nature’s eco-credentials also stand up to scrutiny as the company continues committed to adopting ecology-friendly practices and procures botanicals from only sustainable sources. Living Nature’s Skin Essentials For Men gift pack provides the perfect, natural present for Father’s Day this year. Packaged in a reusable, fabric tote bag and wrapped in an attractive male-themed sleeve, Skin Essentials For Men includes 100ml bottles of Gentle Cleansing Shaving Gel, Soothing Aftershave Gel and Soothing Moisturiser. To find out more about Living Nature’s Skin Essentials For Men gift pack for Father’s Day 2011 or the company’s Skincare For Men range, contact Linda Devine at Living Nature (UK) on 0845 2508455, email uk@ livingnature.com or, visit the company website www.livingnature.com.
Panadol Extra Advance set to shake up paracetamol market GlaxoSmithKline launches the latest evolution in pain relief GlaxoSmithKline is set to revolutionise the paracetamol market with the launch of Panadol Extra Advance, combining paracetamol, caffeine and ‘Optizorb’ technology together for the first time, to create a product that gets to work faster AND is stronger on pain than ordinary paracetamol tablets. With speed and strength being the two most widely-sought attributes for consumers when it comes to pain relief, Panadol Extra Advance will provide them with a unique proposition - it can get to work in as little as 10 minutes and is 37% more powerful than ordinary paracetamol tablets . Professor Henry McQuay, Nuffield Professor of Clinical Anaesthetics, University of Oxford and a Professorial Fellow at Balliol College said:“When shopping for painkillers, people are faced with a wealth of options on the shelf which all seem to offer the same benefits, but range significantly in price. It can be confusing to know which one to choose and to understand exactly what branded options offer that generics can’t. “Paracetamol is a highly effective pain killer and due to its wide suitability remains a popular choice amongst healthcare professionals. However, for those people who want to take paracetamol, but also want the added benefits that are often associated with other painkillers, there are very few options available. “Continued developments in the painkiller market are essential to make sure the needs of the consumers are being met.” In response to the consumer need for development , GSK produced Panadol Extra Advance, a double action paracetamol and caffeine tablet that can: • Get to work in as little as 10 minutes • 37% more powerful than standard paracetamol tablets The addition of caffeine boosts the painkilling properties of the paracetamol, whilst GSK’s patented Optizorb technology allows the tablets to disperse in the stomach quicker.
Hannah Norbury, Brand Manager for Panadol Extra Advance in the UK said:
“GSK is constantly seeking ways to evolve the Panadol range to ensure that consumers always have a pain reliever that suits their lifestyle. This is why we have developed Panadol Extra Advance. Stronger than standard paracetamol and able to get to work in as little as 10 minutes, it is designed to multitask as well as you can5! It’s fast and effective and that’s exactly why we believe Panadol Extra Advance will play an integral role in today’s pain relief market.” Panadol Extra Advance will be available from March 2011 from all major pharmacies and retailers and will be priced at £1.59 for 8 tablets, £2.39 for 14 tablets and £4.00 for 32 tablets.
PRODUCT UPDATES 43
SCOTTISH CHEMIST REVIEW
World’s first every day fluoride toothpaste with Novamin GlaxoSmithKline Consumer Healthcare, the maker of leading sensitive toothpaste brand Sensodyne®, announces a breakthrough in dental care with the launch of new Sensodyne® Repair & Protect. The breakthrough formula is the first every day fluoride toothpaste to contain patented Novamin® technology. It is scientifically proven to repair sensitive teeth by forming a tooth-like layer over exposed dentine to help continually repair and protect The launch will be supported by a £4 million advertising campaign. Dental detailing and expert education is also paramount in helping consumers understand how Sensodyne® Repair & Protect can help ‘repair’ vulnerable areas of your teeth and the consumer benefit from this advanced technology. Use twice daily, as you would a regular toothpaste; Sensodyne® Repair & Protect will continually help repair sensitive areas and help prevent sensitivity. Plus, it provides the benefits of an ordinary daily toothpaste including all-round protection, cleaning and freshness. Sensodyne® Repair & Protect is an extension to the current Sensodyne® range of toothpastes, brushes, dental floss and mouthwash offering a range of products specially formulated for sensitive teeth.
NEW TV CREATIVE UNVEILED FOR CORSODYL GlaxoSmithKline Consumer Healthcare (GSK) will be supporting Corsodyl Mint Mouthwash (chlorhexidine digluconate) this month with a new TV creative, which builds on the brand’s successful ‘Gorgeous’ TVC using beauty as a powerful motivator to engage people in gum disease. It forms part of a £7.3 million annual above the line spend – the highest ever on the brand. The new creative shows a beautiful woman carrying out a typical bedtime routine, undressing and removing her makeup, hair extensions and false eyelashes to reveal to us her beauty secrets, before finally and shockingly, removing her ‘partial denture’, to show she has a missing tooth. The voice over explains how bleeding gums can be the first sign of gum disease, which if not treated, could lead to tooth loss. It ends with the strapline: ‘Corsodyl Mint Mouthwash is clinically proven to treat gum disease.’ The 30-second creative is in line with the brand’s mission to create awareness about the causes and symptoms of gum disease, and how it can be avoided through an efficient mouth care regime. The TV campaign will break on 14th March and run for five weeks nationally across both terrestrial and satellite channels. It will be reinforced with press advertising in pregnancy and women’s interest titles – which will run from March right through to December ensuring year round exposure. In addition, a two-week outdoor campaign will coincide with the first two weeks of TV, featuring a combination of 48 sheet posters nationwide and London Underground tube car panels. The outdoor creative will build on earlier outdoor advertising, leveraging the key brand equity that has been developed with the factual, straight talking messages in the highly recognised Corsodyl green background. Corsodyl Mint Mouthwash 300 ml £5.00 600 ml £9.80
A FRESH APPROACH FROM CLARITYN ALLERGY
Clarityn Allergy has had a complete facelift this season with new fresh packaging. Hayfever sufferers will start to see the new, contemporary pack in pharmacy from Spring across all the Clarityn product range, which now includes a new 14-tablet pack size. New look Clarityn Allergy is being supported by a £1.6 million spend on a multi-media marketing campaign, including press, TV, PR, digital and high profile media sponsorships. Jo Wilde Clartiyn Product Manager, MSD Consumer Care comments: “Following the great success we had with launching the UK’s first Pollen Forecast iPhone app in 2010, we are continuing to target allergy sufferers on-the-go and will be investing significantly in new media, as well as traditional media.” New Research Insights Despite hayfever being a GSL driven category, new research from the makers of Clartiyn Allergy found pharmacists continue to play a key role in assisting sufferers with their hayfever management.1 Key findings from the research among purchasers of allergy products included: • Almost half of people (49%) who purchase allergy products seek advice from their pharmacist for their experience on what is the best and most suitable product to alleviate symptoms1 • 66% of severe sufferers prefer to ask their pharmacist for information on hayfever treatment above approaching their doctor, or looking to advertising or the internet1 • For 66% of sufferers a product that provides all day relief is the most important factor when choosing their allergy medication, with over half of sufferers (54%) making a purchase for the non-drowsy benefit1 Jo Wilde comments: “This new research confirms that pharmacists’ opinion on treating allergies are highly regarded. When customers seek their advice, pharmacists should consider recommending a 14 or 30-tablet pack size over smaller packs. This provides a more economical solution for people who suffer with hayfever throughout the season, and represents a higher value sales return for the pharmacist.” Clarityn Allergy contains the active ingredient loratadine, which is an effective non-sedating antihistamine.2,3 It can offer relief as early as 10-20 minutes after taking the first dose, with the majority of sufferers’ symptoms improving within 45 minutes.4 Clarityn Allergy keeps working – a single dose offers 24 hours relief from hayfever symptoms.5
References: 1. Ipsos ASI, Clarityn UK Usage and Awareness Study, 22nd-30th November 2010 2. Bruttmann G et al. Evaluation of the efficacy and safety of loratadine in perennial allergic rhinitis. J Allergy Clin Immunol 1989;83:411-16 3. Wilken JA et al. Cognition and allergy: CLEAR study results. Annals of Allergy, Asthma & Immunology. 2006;96:190 4. Soto Roman L. Onset of Action of Loratadine in Seasonal Allergic Rhinitis. Today’s Ther Trend 1988; 6: 19-27 5. Banov CJ. Comparative Efficacy of Once Daily Loratadine Versus Terfenadine in the Treatment of Allergic Rhinitis. Int Med Res 1989;17:150-156
44 APPOINTMENTS SCOTTISH CHEMIST REVIEW
Divisional Nurse Director
NHS Lothian has appointed a new Divisional Nurse Director to lead nursing across the acute hospital services in Lothian. Sarah Ballard-Smith will take up the post as Divisional Nurse Director for NHS Lothian’s University Hospitals Division (UHD) in April 2011, following the retirement of Libby Campbell last year. In her new role, Sarah will take charge of nursing across Lothian’s acute sites, including St John’s Hospital, the Royal Infirmary of Edinburgh, the Royal Hospital for Sick Children and the Western General Hospital. Sarah is joining NHS Lothian from Southend University Hospital NHS Foundation Trust where she has been Director of Nursing since 2007. Before being appointed at Southend, Sarah worked as Director of Nursing for Queen Mary’s, Sidcup, NHS Trust in Kent for four years. During her career Sarah has held a number of senior posts throughout NHS trusts in England, and has over 20 years’ experience in nursing.
Head of Retail
Lloydspharmacy has appointed Jeff Wemyss as Head of Retail. Jeff joins Lloydspharmacy with over fifteen years’ experience in the retail sector. He comes u from the Carphone Warehouse, where he was Head of Group Cellular Buying. Prior to this, he was Trading Director at Superdrug, where he helped lead the strategic repositioning of the brand in the market. He has also held key roles in the health and beauty buying teams at Boots and Safeway. Jeff will lead a 26-strong retail team at Lloydspharmacy, and will be focusing on developing and enhancing the proposition delivered to customers in the chain’s 1600-plus UK stores.
Highland Council and NHS Highland
Senior officer appointed
East Lothian and Midlothian Community Health Partnerships
David Small has been appointed as the new general manager for East Lothian and Midlothian Community Health Partnerships (CHPs). Previously general manager for Edinburgh Community Health Partnership (CHP), David has worked in the health service for many years including his role as Head of Health Services for West Lothian Community Health and Care Partnership. David Small takes over his new role from the former general manager, Gerry Power, and will be responsible for all primary care and community services in East Lothian and Midlothian.
NHS Highland has appointed two senior officers to lead the planning for the integration of health and social care. Jan u Baird, the Director of Community Care for NHS Highland, will become the Transitions Director, leading a team of seconded staff from the Council and NHS Highland to develop and take forward the integration plan. She has been a front-line health practitioner and manager for many years, and has had lead responsibility for children’s services and community care services to adults, and for joint work with Education, Police and Social Work.