Why pharmacists should be involved
The community pharmacist is a trusted source of information and advice for their patients and about 90% of the adult population visit a community pharmacy at least once a year. This presents an important opportunity for pharmacists and their staff to motivate and empower their customers to improve their health.
Health Improvement covers a wide range of topics some examples are discussed below and the topics boxes give a little more detail.
Health Improvement targets for Scotland can be found by linking into the Scottish Executive’s website
For further information for pharmacy staff in NHSGGC click here
Stopping smoking
Stopping smoking is one of the most important health improvement interventions. Community pharmacy can supply nicotine replacement therapy or varenicline with behavioural support to help patients stop smoking.
Advice on healthy living
Pharmacists can provide the right advice on healthy living and signpost patients to the best resources to achieve their health improvement goals.
Reduce health inequalities
Community pharmacy offers the Pharmacy First Service (PFS) which encourages people to go to their local pharmacy for support with minor and acute health conditions. Pharmacies undertake a NHS PFS consultation and provide advice, treatment or referral to another healthcare professional if appropriate.
Managing long term conditions
Many long term conditions require health improvement interventions in addition to medicines which might be prescribed.
Mental health
Good mental health is of key importance to maintaining good general health. Pharmacists should know where to signpost patients for appropriate support as they may need more assistance in managing their daily living requirements. Also patients suffering from poor mental health may need more support to make important lifestyle changes.
For any enquiries regarding Pharmacy Public Health Improvement please contact ggc.pharmacyhit@nhs.scot
Alcohol Awareness
Approximately 1 in 8 men and 1 in 24 women have some degree of alcohol dependence. Excess drinking puts long term health at significant risk. Excessive alcohol consumption is associated with an increased risk of a range of illnesses that collectively contribute to a massive impact on morbidity and mortality. Please see Alcohol Consumption Questions and the Fast Alcohol Screening Test (FAST)
For more information visit
- Drinkaware A Charity promoting responsible drinking.
- Alcohol Focus Scotland – is the national charity working to reduce alcohol harm.
- DrinkSmarter A Scottish Government practical website with many handy tools, supporting healthier drinking habits.
- Glasgow Council on Alcohol (GCA) Providing support, counselling, advice, information, group work and training for those affected by alcohol misuse.
- Alcohol Change UK : A charity campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems.
- Al-Anon Family Groups provide support to anyone whose life is, or has been, affected by someone else’s drinking, regardless of whether that person is still drinking or not.
Key points for community pharmacy
- Offer advice on sensible drinking
- Give advice on prescription and Over the Counter (OTC) medicines about interactions with alcohol.
- Signpost patients to local services offering support
- Further Information, Resources and Support (including “Alcohol Before, During and After Leaflet) Alcohol and Pregnancy Leaflet
Some pharmacies may
- Offer alcohol brief interventions using a FAST tool
Cancer
It is estimated that 1 in 3 people in Scotland will develop some form of cancer during their lifetime.
This is a wide ranging topic and there are many different types of cancer. Some are more likely to occur in females e.g. cervical and breast cancer while others in men e.g. prostate cancer.
Many forms of cancer can now be successfully treated if they are identified in their early stages and we now have screening for the commonly occurring breast, bowel and cervical cancers.
Some cancers such as melanoma (skin cancer) may be prevented by health protection measures such as avoiding the sun and using sunscreens. Smoking cessation remains one of the most important health improvement measures to avoid developing cancer.
For more information visit
- Scottish Cancer Index provides links to cancer related websites specific to Scotland.
- Cancer Research UK Helpline 0808 800 4040 Mon – Fri 9-5pm
- Bowel cancer UK providing support and advice. Telephone: 020 7940 1760
- Bowel screening in Scotland | NHS inform information at this website
- Breast Cancer Care providing information and assistance for those affected by breast cancer. Freephone Helpline 0808 800 6000.
- Sun Smart This Cancer Research UK website provides a wealth of information including, information on skin cancer, sunburn and how it damages your skin, advice on protective measures to take – applying sunscreen, staying in the shade, wearing protective clothing and sunglasses, and advice on protecting children from the sun.
- Asthma + Lung UK provides advice on all diseases affecting the lungs including lung cancer.
- Leukaemia Care provides support for people with leukaemia, lymphomas and related disorders. Tel: Helpline: 08088 010 444 or chat via WhatsApp on 07500068065
- Lymphoma Action provides support for those affected by Hodgkin’s disease and non-Hodgkin’s lymphoma. Tel. Helpline no: 0808 808 5555
- Macmillan Cancer Support is a national charity providing expert care and support for people living with cancer. Tel. Helpline: 0808 808 0000
- Maggies Centre provides support organisation for those affected by cancer. One of the centres is in Glasgow.
- Marie Curie Cancer Care. Dedicated to the cure of people affected by cancer and the enhancement of their quality of life through its caring services, research and education. Telephone Support Line: 0800 090 2309
- Oesophageal Patients Association Telephone: 0121 704 9860 (Mon – Fri 9am – 5pm)
- Orchid: Fighting Male Cancer Good range of leaflets on testicular and prostate cancer. National male cancer helpline: 0808 802 0010
- Prostate Cancer UK Telephone: Helpline: 0800 0748383
Key points for community pharmacy
- Signpost patients to appropriate support organisations.
- Many quality, free resources can be ordered to support Community Pharmacy through the patient resources link http://quick-guide-for-patient-resources-v62-jul-23.pdf (scot.nhs.uk)
- Be alert to red flag symptoms such as a persistent cough which might suggest a patient should be referred to their GP for investigation.
- Encourage patient’s participation in national screening programmes e.g. cervical screening whenever possible.
- Only sell a minimum of SPF 15 sun protection products.
Healthy Lifestyle… at any age
Many factors go together to improve an individual’s health. Their health needs change through life as they get older and different issues might impact on men’s and women’s health. However, a healthy lifestyle is important at any stage of an individual’s life.
Diet and nutrition, exercise, smoking cessation and managing alcohol intake are modifiable lifestyle factors that can be addressed to improve health.
Other factors may not be readily addressed by individuals but rely upon society working together to promote healthy living and working environments.
Health inequalities arise when individuals or communities are not empowered to make healthy lifestyle choices.
For more information visit
Child Health
Health in older age
Healthy Living
Community Pharmacy – Signpost patients to appropriate support organisations.
Beware of your patients particular needs. Check out your locality’s health profile.
Long Term Health Conditions
The effective management of long term health conditions (LTHC) can greatly improve a patient’s health and wellbeing. Examples of these conditions include epilepsy, cardiovascular disease, diabetes asthma and chronic obstructive pulmonary disease (COPD).
In addition to taking appropriate medication LTHC patients are often asked to make lifestyle changes such as smoking cessation or alcohol reduction. But at the same time they may be struggling with psychological issues caused by the impact of their diagnosis.
So in addition to understanding the clinical management of patients and the guidelines that are in place for these it is important to consider the patient as a whole and understand their attitudes to their condition and its management.
For more information visit
Key points for community pharmacy
- Signpost patients to appropriate support organisations.
- Know when to call for medical assistance in the event of a heart attack and how to deliver basic resuscitation (CPR) for patients who have collapsed. Details of suitable courses may be found at St Andrews Ambulance Brigade
- Advise on use of inhaler devices for asthma and COPD patients
Some pharmacies may
- Offer health screening such as blood pressure or glucose monitoring
Mental Health
Mental health is a complex topic affecting a significant percentage of people in the UK at any one time. Issues might include depression (including postnatal depression) bipolar affective disorders, stress, anxiety disorders, phobias, eating disorders, schizophrenia and others. Some individuals may suffer from a combination of symptoms.
The management of patients suffering mental health problems may range from self help approaches to in patient care at a psychiatric specialist hospital or facility.
Regardless of how patients are managed, good mental health is underpinned by a healthy lifestyle. Good diet, smoking cessation, exercise, sleep hygeine and alcohol management will not necessarily cure a patient but they will significantly contribute to their recovery.
For more information visit
Key points for community pharmacy
Palliative Care Services
This service is provided by a network of 70 pharmacies across the NHS Greater Glasgow & Clyde area. These pharmacies maintain
- a stock of specific core medicines
- provision of advice and useful contact numbers for specialist palliative care advice
- a support network to other pharmacies within their localities.
Some participating pharmacies are available to dispense out-of-hours urgent prescriptions. This can be arranged through NHS 24. A courier service protocol is available to ensure timely supplies of medicines to palliative care patients in emergencies. The aim is for the first pharmacy contacted (regardless of being a part of the Palliative Care network or not) to ascertain the urgency of the prescription and resolve any supply issues, in order to avoid patients, carers, or nurses needing to phone or visit multiple pharmacies. All community pharmacies are provided with a list of the network pharmacies for this purpose and the specific core medicines list. For more details on the Palliative Care Service, click here or contact: Palliative Care Specialist Pharmacists on the below telephone numbers: 07876 478140 or 07880 786659 or 07775 012560
Quit Your Way
NHSGGC are responsible for a wide range of tobacco projects including the “Quit Your Way” Pharmacy Service.
Suitable pharmacotherapy (Nicotine Replacement Therapy [NRT] or varenicline) together with personalised advice and support is provided from the community pharmacy for usually up to 12 weeks.
For further details, please contact any participating pharmacy or the Quit Your Way Pharmacy Team (T:0141 201 4945 or e: ggc.pharmacyhit@nhs.scot)
Resources
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This aspect of Pharmacy Public Health deals with the planning for, and managed introduction of new medicines. The Scottish Medicines Consortium is responsible for providing advice on the clinical and cost-effectiveness of all new medicines and important new indications for existing medicines.
The NHS GGC prescribing website provides useful links to the local Medicines Formulary, medicines policies and associated resources.
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Why pharmacists should be involved
The community pharmacist is a trusted source of information and advice for their patients. This is particularly important for those issues which can have high media attention e.g. introduction of a new vaccine or an outbreak of an infectious disease.
Further information and advice can be found in the Health Protection Topics section of this website. Examples of topics included are:-
Infection Control
Knowledge of infection control principles is important to protect yourself and your patients.
And
Immunisation and Storage of Vaccines
Advice on safe storage of vaccines which must be stored in the ‘cold chain’ between 2oC and 8oC at all times.
Communicable Disease, Outbreak Control and Emergency Planning
Pharmacists can recognise symptoms of a notifiable disease in order to appropriately refer patients
Understand how an outbreak is being managed to be able to offer appropriate advice and reassurance to the public.
Maintain Business Continuity Plans to ensure minimal impact on the delivery of patient care in the event of an emergency situation.
Screening for Health Protection
Pharmacists can encourage uptake of screening programmes against several cancers e.g. cervical, breast cancer and bowel. More information may be found on the Screening – Health topics – Public Health Scotland website.
For any enquiries regarding health protection please contact:
mailto:ggc.pharmacypublichealth@nhs.scot
Blood Borne Virus
Three blood borne viruses are the main cause for concern in Scotland, Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C.
There is an effective vaccine only for Hepatitis B. However, there are few effective treatments for Hepatitis C and HIV.
More information
Key points for community pharmacy
Some pharmacies may
- Offer support for dried blood spot testing for Hepatitis C and HIV.
- Dispense antiviral medicines for Hepatitis C.
- Provide ‘Injecting Equipment’ to prevent spread of disease.
Communicable Disease
Public Health Protection Unit – NHSGGC in NHSGGC has a key role in monitoring and responding to the incidence of notifiable diseases e.g. meningitis.
For more information visit
Key points for community pharmacy
- Recognise and refer patients with symptoms suggesting a serious or notifiable disease to the GP or acute services as necessary.
- Compliance with prophylactic therapy e.g. tuberculosi
Community Pharmacy & Infection Control
The NHS GGC Community Pharmacy Infection Control Guidelines provide basic advice.
To reduce the incidence of infection due to antimicrobial resistance in the population, NHSGGC has launched https://handbook.ggc.medicines.org.uk/guidelines/infections/mrsa-eradication-policy/ to be followed in primary care and the prescribing support team has developed a non-prescription pad to encourage patients to seek non antibiotic remedies for viral infections.
More Information
Key points for community pharmacy
- Provide antibiotic stewardship.
- Offer advice to patients on appropriate infection control techniques to reduce spread of disease such as norovirus or influenza.
Health Screening
The NHS GGC Public Health Screening is responsible for a range of health screening programmes.
Key points for community pharmacy
- Encourage patients to participate in screening programmes.
Immunisation Programmes
Immunisation is one of the most effective health interventions.
There are several formal immunisation progammes in the UK. They are Childhood, Adult and Seasonal Influenza.
More Information
- NHSGGC and vaccination schedule | NHS inform
- NaTHNaC – a comprehensive guide to required travel vaccination and other travel health protection issues.
- ‘Immunisation against Infectious Disease’ (‘The Green Book’) – provides detailed information on UK vaccination.
- ‘Promoting Effective Immunisation Practice’ – training available via Turas Immunisation | Turas | Learn
Key points for community pharmacy
- Encourage patients to engage with national and childhood programmes.
Some pharmacies may
- Offer travel and influenza vaccination clinics.
Outbreak Control
Public Health Specialists from NHS GGC Public Health Protection Unit – NHSGGC are involved in identifying and managing outbreaks of disease. They will liaise with infection control teams for example in the case of a norovirus outbreak in an institution or with local authorities if an outbreak is linked to a food supplier in an E. coli outbreak.
Chemical Biological Radiological and Nuclear (CBRN) outbreaks
Local authorities and health boards are required to have plans in place to manage accidental events such as major oil or chemical spills or deliberate terrorist acts. For further detail see: Chemical, biological, radiological and nuclear incidents: recognise and respond – GOV.UK
Key points for community pharmacy
- Provide reassurance to patients.
- Keep Business Continuity Plans up to date.
Patient Group Directions (PGDs)
Patient Group Directions (PGDs) are legal documents that enable suitably qualified healthcare professionals to administer and supply medicines (P or POM) in a defined clinical situation where the patient may not be individually identified before presenting for treatment. The individual using the PGD must have signed and been authorised to use the PGD prior to administering or supplying any medicines named in the document.
NHS GGC uses PGDs to allow nursing staff and Health Visitors to administer vaccines for the routine child immunisation programme and travel in specialist clinics.
More Information
Key points for community pharmacy
Seasonal Influenza
Individuals are most likely to catch influenza in the winter months. The season runs from October to the end of February occasionally into March, peaking in December/January.
Seasonal influenza can affect anyone. It is an acute viral infection of the respiratory tract. There are three types of influenza virus: A, B and C. Influenza A and influenza B are responsible for most clinical illness.
It is difficult for an individual to develop long term immunity to influenza as the make up of the viral strains change slightly on a regular basis. So vaccination against seasonal influenza has to be undertaken annually.
More Information
The government resource Immunisation against infectious disease – ‘The Green Book’
In the United Kingdom immunisation for influenza for certain groups including ‘at risk’ patients is provided on the NHS and in Scotland the Chief Medical Officer (CMO) will send a letter detailing which groups are eligible for vaccination. Letters from the CMO are available here.
Egg allergy isn’t always an absolute contraindication for receiving flu vaccine. The British Society for Allergy and Clinical Immunology website advises on managing individuals with egg allergy
An e learning course for healthcare professionals undertaking immunisation is available. Registration is required to undertake this course.
NHS Inform has key patient information on all types of immunisation
NHS GGC: Immunisation – NHSGGC
Key points for community pharmacy
- Encourage at risk patients to attend for vaccination
- Advise on management of symptoms
- Some pharmacies offer private flu vaccination clinics
Sexual Health
Sandyford co-ordinates a wide range of sexual health services in NHS GGC.
The Free Condoms web-site provides, support for practitioners involved in condom distribution, information on how to sign up as a distribution point, where to find condom distribution points and general advice on condom use and products offered
It is important that pharmacists and their staff understand what they should do if they have any concerns about a child and sexual health issues. Access information at NHS GGC Child Protection Unit’s website
More Information
Key points for community pharmacy
- Be able to recognise and differentiate between symptoms of sexually transmitted diseases.
- Refer all men consulting with symptoms of discharge or thrush infections to Sandyford or their GP.
- Be aware that there is no charge for vaccine supplied by a Sandyford Clinic.
- Supply of emergency hormonal contraception or bridging contraception under PGD.
Substance Misuse
Pharmacists play an important part in providing information and advice about substances liable to misuse controlling the availability of medicines, and the associated risks and in providing harm reduction programmes e.g. methadone and the supply of injection equipment.
More Information
Key points for community pharmacy
- Give advice on wound care and management, safer injecting practices and remind clients of the importance of safe disposal of syringes.
- Know which pharmacies are ‘Injecting Equipment Providers’
- Be able to sign post clients to other services as necessary.
- Know how to deal with needle stick injuries
Travel
NaTHNaC gives the most up to date information for both public and professional use.
Key points for community pharmacy
- Provide patients with pre-travel advice.
- Encourage the use of sunscreen with a minimum SPF15.
- Advise on the carriage and storage of medicines abroad e.g. insulin.
Vaccine Storage
NHS GGC Guidelines on Vaccine Storage and Handling are available in the NHSGGC Guidelines Repository
More Information
Key points for community pharmacy
- Remind patients collecting travel vaccine of the storage requirements. It is preferable that they collect vaccine immediately before their appointment for administration.
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For queries about the service please contact the Queen Elizabeth University Hospital Biochemistry Department on 0141 354 9060.
About the service
The Scottish Biologic Drug Monitoring Service is delivered by the Biochemistry Dept. within the Lab Medicine Building on the Queen Elizabeth University Hospital site, Glasgow.
The service currently delivers Infliximab and Adalimumab levels and their respective total anti-drug antibodies (ADA) for optimising care predominantly in gastroenterology patients with inflammatory bowel disease. The service uses both WHO standards for drug levels and a patient pool sample for ADA assay to monitor performance. It is involved in sample exchange with other laboratories.
The service employs a reflex ADA testing strategy based on drug level result. When a drug level result is within or higher than the therapeutic target range, and when ADA level has previously been undetectable, reflex ADA testing is not routinely performed. Since the introduction of reflex ADA testing approximately 50% adalimumab samples and 37% infliximab samples have not had a reflex ADA test performed.
There may be some clinical scenarios where ADA titres are desirable even when drug level results are therapeutic. Requests for additional ADA testing should be indicated clearly at the time of test request or can be arranged by contacting the lab directly.
During 2019 there were 2821 Infliximab and 2920 Adalimumab samples analysed from health boards across Scotland.
TDM tests should be requested according to local biochemistry/immunology laboratory requirements. The previously used paper request forms are no longer required. Local teams are encouraged to collate data related to TDM use and outcomes as this may be required to sustain future rounds of service funding.
Specific Rheumatology guidance
Specific Gastroenterology guidance
Vedolizumab drug level and antibody testing
Vedolizumab drug level testing is now available. The utility of testing drug and anti-drug antibodies for vedolizumab has yet to be fully ascertained. Target drug levels for vedolizumab have not been clearly established. The current evidence is covered in these articles:
Vedolizumab testing is not part of the nationally commissioned TDM service. The cost per sample is £20.
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Clyde Biochemistry Laboratories (those based at Royal Alexandra Hospital, Inverclyde Royal Hospital and Vale of Leven Hospital) has been accredited with UKAS to standard ISO 15189:2012 for much of our test repertoire. The certificate of accreditation is available online.
The scope of our accreditation includes the majority of the tests performed by our laboratories, with a small number of tests not falling within our accreditation status (for example, no fluid analyses (on fluids other than CSF, urine or blood / serum / plasma) are accredited) – see the link above for details of our accredited scope.
Specialist services including Protein Electrophoresis and less often requested endocrine assays are based at RAH.
All routine GP work within the Clyde Sector is also based at RAH.
Please accept our apologies for the behaviour of links on this webpage. This is due to a global setting which is outwith the Biochemistry Department’s control.
Service Hours
Routine operating hours
- Monday to Friday, 8.30am to 5.00pm
- Saturday and Sunday, 8.30am to 12.00pm (Inverclyde Royal Hospital) and 9.00am to 12.00pm (Royal Alexandra Hospital)
- There is a 24hr emergency service for urgent samples outwith these hours
Contact Details
Royal Alexandra Hospital (RAH)
- Address: Corsebar Road, Paisley, Renfrewshire PA2 9PN
- Telephone: 0141 314 6157 extension 06157
Inverclyde Royal Hospital (IRH)
- Address: Larkfield Road, Greenock PA16 0XN
- Telephone: 01475 504827 extension 04827 – Emergency requests extension 04213
Vale of Leven Hospital (VOL)
- Main Street, Alexandria G83 0UA
- Telephone: 01389 817568 extension 87568
POCT issues / Cryoglobulin testing
For routine issues with gas analysers or blood glucose meters and to arrange training / barcode for meters please email:
Cryoglobulin testing can also be arranged via this email address.
Clinical Advice
Both Primary and Secondary care professionals served by the Clyde Biochemistry Laboratory can obtain clinical advice by email:
Nutrition team referral process
Feedback
We are committed to providing a quality service to users. If you wish to provide feedback on the Clyde Glasgow Biochemistry service, please contact our Quality Manager by emailing Pamela.craig6@nhs.scot
Handbooks and Manuals
Laboratory Newsletter
The most recent laboratory newsletters are available below:
Previous issues of the newsletter are stored in the Clyde Biochemistry Document Library:
Memos
Primary Care
Secondary Care
Previous memos can be found in the Clyde Biochemistry Document Library, linked above.
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Hosted Resources – Detect Lung Cancer Ealry
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The Human Fertilisation and Embryology Authority (HFEA) are the Government regulatory body for all fertility clinics in the UK. They collect data on all treatment cycles started and outcomes of those treatments, including success rates. They are currently updating their clinic data submission system and once complete in 2025, you will be able to see data on treatments from January 2020 to December 2023, and births from January 2019 to December 2022. In the meantime, you can visit their clinic profile for Glasgow Royal Infirmary ACS for the most recent inspection ratings, reviews and verified success rates.
Clinic profile for Glasgow Royal Infirmary | HFEA
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