Sunderland Community Learning Disability team, part of Northumberland Tyne Wear NHS Foundation Trust, have developed two clinic models to begin to undertake reviews of people with a learning disability taking powerful psychotropic drugs (antipsychotics, mood stabilisers etc) for the control of challenging behaviour.
This has been highlighted as a major concern with 30,000-35,000 prescriptions being issued each day for this unlicensed and poorly evidenced reason.
Both clinics have been developed around a pharmacist non-medical prescriber as a novel way of safeguarding medical time.
Clinic 1 has been developed with a Community Nurse (Sam Laight) under the watchful guidance of a Consultant Psychiatrist (Thomas Fischer) and has identified 50% of the caseload that can be managed by the pharmacist and nurse. This collaborative approach has involved regular client and carer appointments to grow confidence in this new clinic model. Photo 1) Mock up photo of the clinic (Sam Laight, Thomas Fischer, David Gerrard and Sarah Minto playing the part of the patient)
Clinic 2 has been developed between the pharmacist and the Positive Behavioural Support stream led by a Clinical Psychologist. This utilises the flowchart to identify individuals requiring a medication review and stipulates clear criteria for entry into the process. Outcomes will be captured showing changes in presentation including any quality of life improvements.Both clinics follow the guidance given in NICE NG11 balancing non-pharmacological and pharmacological interventions in the control of challenging behaviours.
NICE stipulates the use of non-pharmacological interventions as first line treatment and both clinic models will build on these principles.
When it comes to de-prescribing medication the clinics will incorporate the principle in reverse ensuring every possible chance of reducing medication burden.
https://www.nice.org.uk/guidance/ng11/chapter/1-recommendations
The lessons learnt will be shared within the other community teams in the trust and with NHS England who are interested in any examples of work related to this initiative.
The Trust has worked with other regional groups to help scope the potential for STOMPLD related reviews in primary care.
A pilot is being developed with selected GP surgeries across the North East and Cumbria region to gather data and best practice from a primary care perspective.
NTW will help co-ordinate awareness sessions and specific training in relation to this work to enable primary care staff (GPs, practice based pharmacists etc) to feel more confident in undertaking medication reviews. All learnings will be captured with regional partners. This work is being overseen by the Learning Disability and Autism Clinical Reference Group, set up within the Trust, to further best practice in this important field. The multidisciplinary group meets monthly to discuss progress in all areas of the work being undertaken in relation to people with a learning disability.
Contacts for this group and the above project include……………………. David Gerrard Advanced Pharmacist Practitioner. [email protected] Sam Laight Community Nurse [email protected] Cahley Hemm Clinical Psychologist [email protected] Caroline Wills Learning Disability Clinical Development Lead [email protected] Clare Scarlett GP Lead Learning Disabilities. Newcastle North Tyneside and Gateshead CCG.[email protected]