Pharmacies

My Lords, I thank the noble Lord, Lord Clement-Jones, for bringing this important debate to us today. I shall speak about the role of the pharmacist in the management of Parkinson’s disease. In doing so, I declare an interest in that I chair the All-Party Parliamentary Group on Parkinson’s Disease. Parkinson’s is an incurable degenerative neurological condition that affects around 120,000 people in the UK. It is caused by a gradual death of the nerve cells in the brain that produce the chemical messenger dopamine, and is mainly treated by a complex cocktail of drugs that needs to be taken throughout the day for people to remain mobile—that is, to be able to walk, get dressed, talk and carry out all the normal activities of daily living. The correct prescription of drugs and, importantly, the correct timing of those drugs are vital to the successful management of a person's condition and ensuring their quality of life. Community pharmacists can make an important contribution to the monitoring and management of a person with Parkinson’s. They are well placed to support the specialist multi-disciplinary team in making sure that people understand the medication they have been prescribed, are taking it correctly and are not experiencing any damaging side effects. I welcome the introduction of medicine use reviews, which were first implemented in 2005 and of which 10 Parkinson’s-specific pilots have just been launched by GlaxoSmithKline and 10 Manchester pharmacies. A medicine use review is a free appointment with a pharmacist to help patients manage their medicine more effectively. Research by the Royal Pharmaceutical Society has shown that almost one in 10 people say that they do not fully understand what their medication does or how it treats their condition. Medicine use reviews are especially important to people with Parkinson’s, owing to the complex nature of their condition and the numerous drugs that they may need to take. There are a number of side effects of Parkinson’s medication, including compulsive behaviours such as compulsive gambling and compulsive shopping. It is vital that these side effects are explained to patients before they start taking the medication and possibly develop those effects, which may have devastating consequences for them and their families. Again, the importance of ensuring that medication is taken on time is another issue on which the community pharmacist is in an excellent position to back up the doctor and nurse and explain the prescription to the person with Parkinson’s. Pharmacists are an integral part in the multi-disciplinary team for people with Parkinson’s. Pharmacies are generally easily accessible for people with the disease, who often have mobility problems and are unable to travel far. The pharmacist will also often be able to develop a closer relationship with the person, due to the regular visits that patients will make to collect prescriptions. It may be the pharmacist who is the first to notice that a person with Parkinson’s is deteriorating or that their behaviour has suddenly changed. Pharmacists are able to refer a patient back to the specialist team if they feel it is necessary. This can result in cost-saving early interventions, which will occur only if the relationship between the pharmacist and the primary care team is maintained. Although I strongly welcome medicine use reviews as an extremely positive initiative, I am disappointed that their uptake has been slow. There are still a number of barriers to the take-up of medicine use reviews, particularly for people with Parkinson’s. For the reviews to be effective it is necessary for pharmacists to learn a new skill set, such as one-to-one listening and negotiating skills. They also need specific knowledge of complex conditions such as Parkinson’s in order to carry out a meaningful MUR with this group of patients. However, there is currently a lack of training of this sort. That is particularly problematic for complex conditions such as Parkinson's. There is also a chronic lack of awareness among the general public about medicine use reviews and their advantages. People need to be encouraged to use their pharmacies and to take full advantage of these reviews. As I mentioned, a pilot for 10 Parkinson’s-specific MURs has just been launched. Not only will this scheme help to brief patients on how to manage their condition better, it will also help to identify people with Parkinson’s who have failed to see a specialist in the past 12 months. The Parkinson's Disease Society's member survey showed that more than 1,000 people are waiting over a year to have their medication reviewed, in which time their condition may have changed significantly. With the right information, pharmacists should be able to offer the kind of support that can make a real difference to the quality of life of someone with Parkinson's. I am hopeful that, after this pilot, it will be possible to share best practice and see these pilots duplicated across the country. As chair of the All-Party Parliamentary Group on Parkinson's Disease, which has just carried out an inquiry into access to Parkinson's services, I know the importance of access to a full multi-disciplinary team for a person with Parkinson's and their carer. I feel strongly that the pharmacist should be an integral part of this multi-disciplinary team to enable the best support, monitoring and management of a person with Parkinson's. Will the Minister ensure that there is adequate training in place for pharmacists to conduct medicine use reviews, and that the good practice established in the pilot is rolled out across the country?