Provider survey: Medicines support in adult social care

Published: 14 August 2024 Page last updated: 14 August 2024

This research looks at what support adult social care providers are receiving to ensure medicines are managed safely and how the support impacts the quality of care they are able to deliver.

We commissioned Ipsos to carry out this research and write the summary below.

Purpose of this research

The Care Quality Commission (CQC) commissioned Ipsos to undertake research with adult social care providers to understand what support providers are receiving to ensure medicines are managed safely, how the support impacts the quality of care that providers are able to deliver, and future support needs.

The key aims of the research were to gather evidence to provide an improved understanding of:

The support adult social care providers are receiving to ensure medicines are managed safely, from primary, secondary care and other relevant organisations (such as integrated care boards (ICB) and local authorities);
Where the gaps in medicines support exist;
Providers’ views on the impact of these gaps on the quality of care delivered and people’s outcomes.

Methodology

An online questionnaire was sent out to adult social care providers. Ipsos and CQC worked collaboratively to develop the questionnaire for the research. The questionnaire contained 25 closed questions with an additional 7 open-ended questions.

The survey was sent to adult social care providers (care homes, domiciliary care providers, extra care housing services and community-based services). In total, 26,644 were included in the sample.

The initial survey invitation was emailed on 13th February 2024, and the survey closed on 6th March 2024.

A total of 2,331 participants completed the questionnaire. An additional 153 providers partially completed the survey and were included in the results having completed the main part of the questionnaire. Corrective weights have been applied to the final data to ensure the results are representative of eligible providers.

Medicines support received from community pharmacies

Adult social care providers commonly received advice on medicines side effects, over the counter medicines, and how to safely administer medicines.
Care homes were more likely to receive a range of support from their supplying community pharmacy compared with other types of adult social care providers.
Just under half (49%) of adult social care providers say the support they receive from community pharmacies fully meets their needs (39% say it meets their needs to some extent, 8% say it does not meet their needs, and 4% did not know). Care homes were more likely to say the medicines support they receive meets their needs, while other types of adult social care services were more likely to say their needs are not being met. Care providers in London and the East Midlands are also more likely to say the support they receive fully meets their needs (61% and 57% vs 49% on average).
Around half of adult social care providers said the medicines support they receive from their usual supplying community pharmacy has not changed over the past 12 months (34% said support was better, 13% said the support was worse).
Well over half (59%) say the support they receive around medicines governance and audit fully meets their needs (33% say it meets their needs to some extent, 6% said their needs are not met, and 2% did not know). Two fifths of participants said this support has been better over the past 12 months (51% said support was unchanged, and 7% said it was worse).
Around two thirds of adult social care providers said the support they received to monitor and review medicines errors fully meets their needs (28% say it meets their needs to some extent, 7% say their needs are not met, and 5% did not know) and over a third said the support has improved over the last 12 months (55% said support was unchanged, and 4% said it was worse).
Participants who felt their needs were not being fully met by community pharmacy highlighted the following issues: difficulties and delays with medication (including delivery and shortages), communication and availability of community pharmacy staff and challenges around administration and training provided.

Medicines support received from other healthcare professionals

Adult social care providers commonly receive medicines support from other healthcare professionals, such as GPs, GP practice-based pharmacists and pharmacy technicians, care home support team pharmacists, practice and district nurses, external consultancies, NHS mental health teams, local authorities, internal support with their organisation and peer support from other adult social care providers.
Care homes were most likely to access support from other healthcare providers when compared to domiciliary care services and other service types. A higher proportion of services supporting older people and services supporting people with dementia accessed support from other healthcare professionals.
Internal support within the organisation was higher for services with an outstanding rating.
Participants who accessed support from these other healthcare professionals mainly accessed clinical medicines support.
Support provided by local authority teams, internal support within the organisation and peer support from other adult social care providers was more often support for governance and audit and support to review medicines errors.
Around two thirds of participants said the support provided by their healthcare professionals fully met their needs. Further medicines support from other healthcare professionals was needed for a third of participants.
For participants who said the support did not meet their needs, the main issue raised was difficulties in making contact and issues with responsiveness from healthcare professionals.
The majority of participants said the support had remained unchanged or had got better over the last 12 months. The biggest improvement was to internal support provided within the organisation (60% said it had got much better or better).

Impact of gaps in medicines support and advice

Participants were asked what impact not being able to access or receive the medicines support or advice needed from their community pharmacy or other healthcare professionals had on the care their service was able to receive. Half the participants (49%) said they have always been able to access the medicines support they need.
A fifth of participants (21%) provided a comment at this question. Not being able to access or receive medicines support had the biggest impact on service delivery. It was noted it caused delays in receiving medication and providing care, and had an impact on medication reviews and changes to medications.
For some participants, it was noted that a lack of medicines support directly impacted the health, quality of life and safeguarding of the people they cared for. It was noted that a lack of support and advice led to increased errors with medicines.
To overcome gaps, some participants looked for alternative sources of support and advice, for example emergency services or 111.
Participants commented that the lack of support and advice increased staff workload due to the time spent both trying to reach, and chase, GPs and pharmacies.

Access to medicines supplies and support with medicines administration

Most providers agreed that they had access to a supply of medicines at the right time for people at the end of life (62%) or that they have access to support and advice to help with safe administration of medicines at the end of life (65%) and only 4% disagreed that they had access to the supply of medicines or support or advice at end of life. About a third neither agreed nor disagreed or said they did not know to each statement.
Care homes with nursing (81%) were more likely than other types of providers (care homes without nursing, domiciliary care providers, extra care housing services and community-based services) to report access to a supply of medicines at the right time for people at the end of life. Larger care homes (85%) were more likely than smaller care homes to report access to a supply of medicines at the right time for people at the end of life. Findings were similar for access to support or advice to help with the safe administration of medicines at the end of life.
Less than a third reported receiving support with encouraging people they care for to self-medicate (30%) with 41% not receiving support. It is notable that a quarter reported that it was not relevant to them, even though self-medication is potentially applicable to most providers.
The most common type of support with self-medication was the provision of reasonable adjustments such as multi-compartment compliance aids, mentioned by two in ten of those receiving support.
Delegation of more complex medicines administration tasks (such as injections and feeding tubes) to care workers was relatively uncommon. Only one in five (20%) reported that medicines tasks were delegated to care workers in their service. Two in five (40%) were not delegating because of lack of access to a healthcare professional who would delegate tasks and a quarter (25%) were not delegating because of workload capacity issues in their service.
Care homes with nursing were most likely to report that medicines tasks were not delegated due to workload capacity (45%) compared with care homes without nursing (17%) and domiciliary care services (24%). Care homes without nursing and domiciliary care services were more likely to report not being able to access a healthcare professional who could delegate (44% and 43% respectively) compared with 22% of care homes with nursing.
The most common employers of those delegating complex medicines tasks were their own service (53%) and district nursing teams (46%).
Two in five (42%) of services use eMARs but this was more common among domiciliary care services (57%), followed by care homes with nursing (41%), and less common in care homes without nursing (26%). Nearly all (97%) who use them find them useful.
Over a third (36%) of services use NHS Mail and most (85%) of those who do reported it is useful.

Information and training on medicines

Nearly all participants had used some form of medicines training provision (98%). The most common training was internal training, either in-person (59%) or online (57%). A third of participants accessed other external training provision (35%) or online Skills for Care endorsed provider training (32%).
Few participants accessed community-based pharmacy training either in-person (9%) or online (9%) or in-person Skills for Care endorsed provider training (10%). The majority of participants (98%) had accessed information and guidance to help them manage medicines safely.
Overall, guidance was considered to be useful to help manage medicines safely. Nearly all participants said the CQC guidance (97%) and NICE guidance were useful (99%).
Participants who had faced challenges when requesting medicines-related information from healthcare professionals said the most common issue was receiving medication. Lack of responsiveness and difficulties in contacting healthcare professionals was a common theme.
Data sharing and access to medical records was a challenge for some participants, in particular domiciliary care services and services supporting people with learning disabilities or autistic people.
Medicines reconciliation was viewed as time consuming with some participants noting information not being provided in a timely manner could lead to missed medications. Participants said medicines reconciliation required good communication between adult social care providers and healthcare professionals.

Future medicines support

The key areas for future support were considered to be further training, in particular from healthcare professionals, and regular audits with support from GPs and community pharmacists.
Participants noted that better communication and access to healthcare professionals would improve workloads and reduce delays in medications and service delivery. Participants noted that better communication about medicine changes would be useful.
Support with medicines was noted as an area for improvement and participants would like further support from visiting healthcare professionals. Participants were particularly interested in support and advice on administering medications.
For participants who provided further comments on how CQC could further support adult social care providers (18%), the main comments were linked to CQC providing further advice and guidance, particularly in relation to the management of medicines.
Participants wanted CQC to provide a range of further training and some participants commented they would find the sharing of best practice helpful.
Participants felt that CQC facilitating more collaborative working between healthcare professionals would improve working practices although some noted that there needed to be a clear understanding of the needs of adult social care providers.

Conclusions

Overall, the research shows that adult social care services have access to a wide range of different types of medicines support from a variety of sources, including community pharmacy and a range of healthcare professionals. However, not all care providers are receiving support from community pharmacy or other healthcare professionals. Where support is received from community pharmacies, just under half (49%) say it fully meets their needs with 39% saying it meets their needs to some extent and 8% saying it does not meet their needs. Support received from other healthcare professionals was viewed more favourably, with around two thirds of participants saying the support fully met their needs and relatively few saying it does not meet their needs at all. For both community pharmacies and other healthcare professionals, where support did not meet needs, this was related to issues of communication, making contact with pharmacies and healthcare professionals and access to medication.

Support is generally available when supporting people at the end of life. Access to medicines support is generally felt to be unchanged or improving over the last 12 months (with improvement most common for internal support within the organisation), though a minority of providers reported access getting worse. There is also good use made of guidance which is found by adult social care providers to be helpful. When asked about the impacts of lack of access to medicines support half said they have always been able to access the support they need. However, not all services have access to this support and this research explored where the gaps are and the impact this had on delivery of services. Impacts include delays in receiving medication and the delivery of care, increased medicines errors and greater staff workloads, all of which affect the health and quality of life of people being cared for and supported.

Further support would be welcomed in the form of training, consistent advice and guidance and easier contact with pharmacies and healthcare professionals.