#SMR should target 🎯 people with complex or problematic polypharmacy at greatest risk of med related harms, ergo those:
1️⃣ in care homes
2️⃣ with polypharmacy >=10 meds
3️⃣ on meds associated with errors
4️⃣ with severe frailty
5️⃣ on addictive pain meds
All agree so far?
🧵 2/12
Naturally the devil is as always in the detail
For example, only GPs & nurses or pharmacists with IP & advanced Hx taking & Exam techniques can deliver #SMR
For pharmacists means enrolled on or completed @CPPEPCPEP (acronyms++)
-OR-
CPPE Certified equivalence to PCPEP
🧵3/12
So, these rules mean some experienced pharmacists w/o CPPE are excluded from delivering #SMR, and #PCN pharmacy teams are not yet ‘mature’
SMR for a frail complex elder on 10 meds is a demanding, time consuming task requiring advanced person centred skills (all agree?)
🧵 4/12
As effective #SMR delivery is a complex skill, it is entirely reasonable to establish a baseline accredited skill set for pharmacists (most agree) [GPs & nurses too??]
The evidence based intervention that is SMR has attracted investment in ARRS funds & training
£££££++
🧵5/12
Welcome investment in primary care pharmacy teams has naturally come with targets & incentives….
Introducing the IIF !
An “incentive scheme focussed on supporting PCNs to deliver high quality care… & the delivery of the priority objectives”
including #SMR
I’ve long said a privilege of spending time with older people is hearing about their lives, these autobiographical stories can transform ones perception of an individual from frailty to one of admiration & awe -#BlackHistoryMonth has reminded me of such an encounter @nhs
Over a period of several years I got to know a couple who would visit my pharmacy, we would talk and chat about the usual pleasantries, until one day the husband let slip about his ‘thing on’ at the Victoria and Albert Museum. I was then presented with a copy of ‘their book’ #BHM
Modest by nature, I had to press hard for fascinating details of a whole lifetime of activism and campaigning now deposited in archives #BHM2019cityoflondon.gov.uk/things-to-do/l…