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Efi Mantzourani,1,2,* Rhian Deslandes,1,* Karen Hodson,1,* Andrew Evans,3 Lydia Taylor,1 Cherie Lucas4 1Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; 2Primary Care, Digital Health and Care Wales, NHS Wales, Cardiff, Wales, UK; 3Primary Care Services, Welsh Government, Cardiff, Wales, UK; 4Graduate School of Health (Pharmacy Discipline), University of Technology Sydney, Sydney, New South Wales, Australia*These authors contributed equally to this workCorrespondence: Efi Mantzourani, Redwood Building, Cardiff School of Pharmacy and Pharmaceutical Sciences, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK, Tel +44 2920 870452, Email Mantzouranie1@cardiff.ac.ukBackground: A pilot Independent Prescribers’ Service (IPS) was introduced in 13 community pharmacies across Wales in June 2020. Independent Pharmacist Prescribers (IPPs) could prescribe in the areas of management of acute conditions, contraception, or opioid withdrawal, as agreed with local commissioners. Access to the patients’ medical records was provided via Choose Pharmacy, the national community pharmacy IT platform.Objective: To explore the experiences of IPPs delivering the service and commissioners responsible for financial resources regarding the IPS in Wales.Methods: A qualitative methodology was employed, with purposive sampling, semi-structured interviews, and inductive thematic analysis.Results: Five themes were constructed from 13 interviews (n=9 IPPs; n=4 commissioners): (i) patient experience and safety; (ii) professional enablement and rebalancing workload of GPs; (iii) role and limitations of remote consultations; (iv) funding and business model; (v) functionality on Choose Pharmacy to support patient care. The design of the service allowed pharmacists to determine how best to deliver the IPS, maximizing access for patients and promoting a sense of professional value amongst pharmacists.Conclusion: This study builds on the body of evidence on enhanced patient experience with prescribing services in the community, reinforcing that IPPs have a key role in rebalancing management of common conditions from GP surgeries to community pharmacies. Several considerations need to be addressed to ensure future success of the service implementation, delivery and enhanced sustainability, such as formal referral pathways and access to medical records. These can be used by other commissioning bodies in the UK and internationally to build a network of suitably supported IPPs, confident to appropriately deal with uncomplicated acute and chronic conditions; and liaise with primary and/or secondary care when referrals are needed.Keywords: non-medical prescribing, independent pharmacist prescribing, Choose Pharmacy, patient safety, patient experience

Alesha Wale,1 Mark Ireland,2 Rowan Yemm,1 Sarah Hiom,3 Alison Jones,3 John Paul Spark,3 Mark Francis,4 Karen May,5 Louise Allen,5 Steve Ridd,6 Efi Mantzourani1,7 1School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; 2Community Pharmacy Wales, Cardiff, Wales, UK; 3St. Mary’s Pharmaceutical Unit, Cardiff, Wales, UK; 4Swansea Bay University Health Board, Swansea, Wales, UK; 5Cardiff and Vale University Health Board, Swansea, Wales, UK; 6Mayberry Pharmacy, Cardiff, Wales, UK; 7NHS Wales Informatics Service, Cardiff, Wales, UKCorrespondence: Efi Mantzourani Email MantzouraniE1@cardiff.ac.ukObjective: Community pharmacy staff are responsible for obtaining and supplying unlicensed “special” medicines to patients in primary care. Less well-defined parameters for safe and effective use of unlicensed compared to licensed medicines, along with issues around maintaining consistency between care settings or among manufacturers, have been associated with increased risks. This study aimed to explore the views and experiences of community pharmacy staff on accessing and supplying unlicensed “special” medicines to patients in Wales and the perceived impact of challenges faced on patient care.Methods: A qualitative, phenomenological approach was employed, involving semi-structured interviews with pharmacists and pharmacy technicians working at one small chain of community pharmacies in Wales. The interview schedule focused on the personal experiences and perceptions of the participants on the processes involved in accessing and supplying unlicensed “special” medicines from a community pharmacy. Interviews were audio-recorded and transcribed verbatim.Results: A total of six participants completed the interview. Three main themes were constructed from inductive thematic analysis of the transcribed interviews: requirement for additional patient responsibilities; influences on the confidence felt by pharmacy staff when accessing and supplying unlicensed “special” medicines; and continuity of supply.Conclusion: This study gives a preliminary insight into the views and experiences of community pharmacy staff in Wales when accessing and supplying unlicensed “special” medicines. Further research is required to see if these views and experiences are representative of community pharmacy staff across the country.Keywords: unlicensed medicines, “special” medicines, specials, community pharmacy, transfer of care, medicines supply, transmural care, off-label, compounding

Efi Mantzourani,1,2 Ricky Hicks,1 Andrew Evans,3 Emma Williams,2 Cheryl Way,2 Rhian Deslandes1 1School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; 2NHS Wales Informatics Service, Primary Care Services, Cardiff, Wales, UK; 3Welsh Government, Health and Social Services, Cardiff, Wales, UKCorrespondence: Efi MantzouraniNHS Wales Informatics Service, Cowbridge Road, Cardiff, UK and School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff CF10 3NB, UKTel +44 29 20 870 452Email MantzouraniE1@cardiff.ac.ukObjectives: To explore the views and opinions of community pharmacists regarding their initial experience of and levels of preparedness for the pathfinder sore throat test and treat (STTT) service in Wales.Methods: A phenomenological qualitative approach with constructivist paradigm was adopted as the first cycle of ongoing action research. Semi-structured interviews with community pharmacists who had completed at least three consultations within the first 3 weeks of the service were conducted, with informed consent and audio recorded. Interviews were transcribed ad verbatim and data were thematically analysed both inductively and deductively.Results: A total of seven interviews with pharmacists who had conducted more than three consultations identified three main themes: 1) perceived impact of the service on patient care, including the value of the structure and technology infrastructure, the role of STTT towards antimicrobial stewardship, and its potential role in rebalancing primary care resources so that workload is distributed appropriately among healthcare professionals; 2) factors that empower pharmacists to deliver the service, in particular quality and consistency of training, appropriate staffing resource and internally motivated willingness to engage; 3) interface with GP surgeries such as nature of existing relationships before implementing the service, role of GP staff and GP perceived value of STTT.Conclusion: The pathfinder STTT service has been well received by pharmacists who recognised the service’s role in providing patient education and contributing to principles of antimicrobial stewardship and described factors that would empower them to deliver the service confidently. Results have been fed back to the service implementation team to inform future developments.Keywords: sore throat test and treat, point-of-care testing, community pharmacy, antimicrobial stewardship, pharmacy services

Hamde Nazar,1 Gregory Maniatopoulos,2 Efi Mantzourani,3 Neil Watson41School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK; 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK; 3School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; 4Pharmacy Services, Royal Victoria Infirmary NHS Hospital Trust, Newcastle upon Tyne, UK An emerging clinical role for community pharmacists is to become actively involved in the follow-up care of patients who are discharged back into the community (transfer of care services) by promoting better medication adherence and by contributing to the safe, effective, and efficient use of medication.1 Recent research highlights how this extended role of community pharmacists could help to reduce drug-related adverse events, unnecessary health provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the healthcare system.1,2

Efthymia Mantzourani,1 Cheryl M Way,2 Karen L Hodson1 1College of Biomedical and Life Sciences, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, 2NHS Wales Informatics Service, Cardiff, Wales, UK Objective: The aim of this study was to explore the views of community pharmacists participating in the pilot of a secure online platform in Wales, the Choose Pharmacy application (CPA), with particular interest in the electronic Discharge Advice Letters (e-DALs) and online Discharge Medicines Review (DMR) form.Materials and methods: A qualitative approach with semi-structured interviews was adopted. A gatekeeper from National Health Service Wales Informatics Service identified 35 pharmacies, of the 43 pharmacies where the CPA had been implemented, that had completed at least one DMR, and these were therefore invited to an interview.Results: A total of 17 pharmacists were interviewed. Overall, the results were positive and CPA and e-DAL were perceived to facilitate continuity of care between care settings. The design and usability were perceived as good as pharmacists could navigate the CPA without problems; many felt this was due to the level of training they had received. Many pharmacists were happy for other services to be included on the platform due to its ease of use and automatic reimbursement. Several pharmacists felt that communication between primary and secondary care can be further improved as the uptake of e-DAL increases.Conclusion: CPA was found to streamline the completion of online DMR improving continuity of care between primary and secondary sectors, which in turn should improve patient safety on discharge from hospital. Keywords: continuity of care, electronic Discharge Advice Letter, Discharge Medicines Review