Nearly all PH patients in the UK benefit from homecare delivery – where medication is brought to your home. Why do you receive it that way and what are the benefits? Consultant pharmacist Neil Hamilton explains.

Depending on the severity of your pulmonary hypertension, you may be prescribed long-term oxygen therapy, oral medication or more complex treatments needing a nebuliser, sub-cutaneous pump or intravenous infusions given through a Hickman line. The vast majority of our patients across the UK have their PH medication delivered to their home address. This article describes why we use homecare services, how they have come about, the main advantages and also what to do if you experience any problems with your delivery.

There are currently five different homecare companies used by the PH centres; Healthcare at Home, Polar Speed, Lloyds Clinical Pharmacy Homecare, Pharmaxo and Healthnet.  All these have been carefully selected jointly by representatives from each PH centre together with NHS England. The quality of the service is constantly monitored to ensure high standards are maintained. Details of these and others can be found on the NHS website, if you would like to know any more information.

If you don’t receive medicines via homecare delivery, it is inevitable that you will pick up a supply at the outpatient pharmacy at the PH centre instead. This is because NHS England restrict supplies of PH medication to the expert prescribers (doctors, nurses or pharmacists) at your centre. GPs and local hospital doctors are not allowed to prescribe these medicines unless there are exceptional circumstances such as an emergency local admission.

At our centre in Sheffield, the Pharmacy team manages the prescriptions for over 1,200 PH patients. This makes up nearly a quarter of all the patients across the whole Trust receiving homecare prescriptions for a whole range of illnesses.

Homecare delivery has evolved quickly across the NHS in the past 15 years since we first used it for PH medication. There are several reasons for this massive expansion.  Firstly we have seen a shift in the way care is delivered across the NHS. Many services have evolved from hospital-centred care where treatments were given in a clinic to being given at home, either by patients self-administering or nurses coming out to patients in their own environment. Although PH homecare simply delivers supplies, other services have homecare (rather than NHS) nurses giving infusions and taking bloods at home.

Secondly, the NHS saves money by using homecare as medicines dispensed by this route do not incur VAT, hence a 20% saving against all medicines supplied in the hospital. Lastly, and most importantly, homecare delivery allows for specialist medicines to be prescribed by the experts despite you living a long way from the centre. It is unlikely (and maybe unnecessary) that you would need to go to clinic as frequently as you need a medication delivery. Homecare allows for medication to be delivered at an appropriate frequency without the need to involve GPs who often know much less about the management of PH.

You will of course still have to attend regular appointments as instructed by your specialist team. These are essential to ensure that your prescription is still at the right dose for you, that you are benefitting as much as you and we would like and that side effects are not unmanageable for you.

How do I receive homecare delivery?

Your specialist centre will discuss the option of homecare delivery during your visits to clinic. When you start on a PH treatment which will be sent to you via homecare delivery, you will be asked to sign a consent form. Once this has been accepted by the Pharmacy Homecare Medicines team at your specialist centre, your medication prescription will be sent to one of the homecare companies mentioned earlier.

You will then be contacted by the provider who will ask you to specify an address to deliver the medication (it doesn’t necessarily have to be your home address) and the date and time that is convenient for you. It is very important that you are able to accept delivery of the medication because it has to be signed for – it cannot be left on your doorstep or with anyone who has not been specifically authorised by you to receive on your behalf. It may be preferable for your local pharmacy to accept on your behalf, in which case you need to discuss this with the pharmacy and communicate the details back to the homecare company. If you think you might miss a delivery, for example if you go on holiday, please let your provider know as far in advance as possible and they can make arrangements to move the date or send a double supply as appropriate.  

Homecare delivery companies are using technology similar to that used by supermarkets and online retailers to schedule deliveries, so patients can receive delivery slot confirmations and reminders by text and/or email. It is likely that soon there will be apps and websites to enable stock checks and delivery slot choices to be made at patients’ convenience rather than following a call from the company.

What if I have a problem?

If you experience a problem with your delivery you must first contact the delivery company.  The sooner you report an issue after a delivery, the quicker they will be able to resolve it. All patients on complex treatments must check their delivery for accuracy and completeness on arrival (just as you would groceries or any other online shopping). Do not leave the box unopened until you have run out of the previous month’s, only to find an error has missed out the item you need.

If the homecare company are unable to help you, get in touch with your PH centre and they will resolve the matter for you wherever possible. The PH centres meet with the homecare companies regularly to ensure that high standards are maintained and any complaints or incidents are thoroughly investigated.

What are the benefits?

There are huge benefits to patients on complex treatments as the lines, syringes and everything else is brought direct to the door. Faulty pumps are exchanged very quickly, sharps bins exchanged and patients needing blood tests have kits sent out with their tablets.  None of this would be logistically possible directly through the NHS.

In summary, convenience for all should be the main benefit. By using homecare your PH centre can oversee every prescription carefully and ensure that doses are correct and side effects managed carefully. We live in an age when online shopping and home delivery is ever more commonplace, so medication delivered to home should fit in easily. The services offered to PH patients are flexible enough such that nobody should feel inconvenienced by their deliveries.