CHS professionals and their roles

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Chapter: Hospital pharmacy : Community health services

Pharmacy support for CHS staff needs to include access to advice and information, input to the development of policies, procedures, and associated education and training.

CHS professionals and their roles


Pharmacy support for CHS staff needs to include access to advice and information, input to the development of policies, procedures, and associated education and training. Information on the medicines that the different pro-fessionals can prescribe, supply and/or administer can be found in Medicines, Ethics and Practice. A document on the National electronic Library for Medicines explains more fully the training, qualifications and roles of these CHS professionals.


District nurses (also called community nurses)


District nurses (DN) are registered general nurses with a postregistration specialist qualification who provide skilled nursing care to patients, generally within their own homes. DN are located in community clinics or in GP practices. DN are community practitioner nurse prescribers who prescribe from a limited list of medicines providing they have fulfilled the educational requirements. The majority of pharmaceutical items that they use should be obtained on FP10 or private prescription. However, the local policy may be to have a stock supply system for dressings. At the back of the British National Formulary there is a list of the medicines they can prescribe. As DN prescribe and administer medicines they need to be able to access pharmacy advice about, for example, product information, stability, routes of administration and support for compliance.


Health visitors


Health visitors (HV) are registered general nurses with a postregistration qualification. Their roles mainly involve health promotion and develop-ment of the family, particularly relating to children less than 5 years of age. Some HV specialise in providing services to older people, well-woman groups, smoking cessation and so on. HV are also community practitioner nurse prescribers but as their roles are advisory and educational they tend to prescribe less than DN and have a minimal need for pharmaceutical supplies. HV need to be able to access pharmaceutical advice on topics such as drugs in breast milk, medicines in pregnancy, immunisation, treat-ment of head lice infection and use of medicines in children and in the elderly.


School nurses


School nurses (SN) are responsible for the health of children in primary and secondary school, both in providing medical checks at key stages of develop-ment and in implementing the school vaccination programme that includes school-leaver boosters. The support they need from pharmacy is mainly information about, for example, maintaining the cold chain for vaccines, working under patient group directions (PGDs) and specific vaccine queries. They may also need to access advice about the management of prescribed medicines in schools. SN also work in special schools to support children with severe learning and physical disabilities. These SN need access to more spe-cific advice relating to the safe management of prescribed medicines, for example, for treatment of epilepsy.


Specialist nurses


Some nurses develop specialist expertise in defined areas such as stoma care, diabetes, paediatrics, continence and palliative care, and need pharmaceutical advice such as on policies and procedures. Many of these nurses will be nurse independent prescribers.


Many nurses now work in ‘walk-in’ centres and other first contact care facilities. These services are often nurse-led, although some have sessional medical input. These nurses will supply and administer an agreed range of medicines, either under PGDs or they may be qualified as nurse independent prescribers.


With care moving closer to the patient’s home the role of the community matron has developed in England, their role including to assess and support patients, and thus prevent unnecessary admission to hospital. Many of these nurses will also be non-medical prescribers.


Employed dentists


Community dental officers are generally based in community clinics (these are those employed rather than the contractor dentists who provide general dental services). They provide dental care for the community with particular emphasis on schoolchildren, antenatal and postnatal women and people with physical or learning disabilities. They may also provide domiciliary care to patients who are unable to attend a clinic, including those living in care homes. Most individual patient treatment is provided on FP10 prescription. Local anaesthetics and other pharmaceuticals routinely needed in dental ses-sions will generally be supplied by the pharmacy service. General anaesthesia is now almost exclusively performed in a hospital setting but some community dental services may provide conscious sedation. Dentists need to comply with current guidelines for dental emergencies such as anaphylactic shock and cardiac arrest.




Podiatrists (registered as chiropodists) who work within CHS are registered with the Health Professions Council and provide services to older people, diabetics and to the same groups of patients as dentists. Podiatrists who hold a certificate of competence in the use of medicines may sell or supply certain medicines in the course of their professional practice. It is important to ensure that proper labelling requirements are being met. Podiatrists who hold a certificate of competence in the use of analgesics may administer certain local anaesthetics parenterally. Podiatrists are also included in the list of health pro-fessionals who can administer and supply medicines under a PGD. Podiatrists who have additional training can offer surgical foot services. Many podiatrists now provide services within GP practices.


Other healthcare professionals


Other healthcare professionals who work in CHS include dieticians, speech and language therapists, physiotherapists and occupational therapists.


Although use of medicines may not be a major component of the roles of these professionals, they may need access to pharmacy advice and support. Examples include: dieticians involved in advising on/initiating sip feeds or recommending the use of fortified recipes; speech and language therapists involved in poststroke support and treating swallowing difficulties; physio-therapists providing musculoskeletal services who may be injecting intra-articular steroids; and occupational therapists in rehabilitation services who assess activities of daily living, including ability to open containers.


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