The NHS winter crisis that recently hit A&E departments and ongoing pressures in general practice re-ignited the debate about how to widen access to healthcare and encourage patients to make more appropriate use of the full range of NHS services.
One focus has been on the service that community pharmacies can provide. Over recent years a number of schemes have been launched encouraging patients to seek NHS treatment or advice for minor ailments such as coughs, colds, sore throats and diarrhoea from pharmacists, in a bid to ease the strain on GPs and A&E departments.
While people have long been calling in to their local chemist to seek help for such illnesses, these schemes go further in tackling patients’ entrenched mindset that GPs must be the first port of call. Crucially they remove the financial barriers to visiting a pharmacist.
Under a common ailments scheme people who qualify for free prescriptions still receive any necessary medication free of charge – placing GPs and pharmacists on a more equal footing in terms of free access to healthcare.
The concept is not that new. A national ‘Minor Ailment Service’ was launched nine years ago in Scotland. But it is only more recently that such schemes have been commissioned elsewhere.
Research published by the Royal Pharmaceutical Society (RPS) last October highlighted that common ailments cost the NHS an extra £1.1bn a year when treated in a GP or A&E setting. The cost of treating a patient for such illnesses in community pharmacies is £29 a year. For GP practices that rises to £82 per patient and for A&E, £147. Treatment results were equally good regardless of where they were treated, the report says.
The study, Community Pharmacy Management of Minor Illness, estimated that 5.5 % of GP consultations for common ailments could be managed by community pharmacies equating to more than 18m consultations every year that could be diverted.
The cost savings and easing of workloads in high demand settings are benefits that speak for themselves. But these schemes are also aimed at encouraging greater joint working between NHS heath practitioners, particularly GPs and pharmacists, to provide a more linked up system of care. The service also widens access – patients can drop in to their pharmacist without an appointment, unlike their GP.
In Wales a ‘Choose Pharmacy’ pilot was set up in two areas in October 2013. Eventually, the Welsh government intends the scheme be rolled out nationally. The service there is slightly different, offering free treatment to everyone since prescription charges don’t apply.
One of the key lessons of the pilot has been that involvement of GPs is crucial, both in engaging with the scheme and in helping to promote it among the patient population.
An interim evaluation report released by the Welsh government in February 2015 said ‘to a significant degree the success of the scheme hinges upon local good relationships’.
Though take-up has been modest so far this was put down to the fact its ‘soft launch’ resulted in low levels of awareness among patients and GPs.
Significantly, an increase in the volume of pharmacy consultations in April and May 2014 ‘seems to have resulted from an increase in the targeted promotion of the service – especially by GP practices’ said the report.
Benefits for GP practices
Dr Sanjiv Khanna, a partner at Hirwaun Medical Centre in the Cynon Valley area, one of the pilot sites, said his practice's experience has been positive.
‘GPs were, at first, a bit sceptical because they were unsure how it would work. There was a concern about pharmacy capacity to run the service but also what would happen to patients told they then had to see a GP instead. Might they then just immediately turn up to the practice?
'But these concerns haven’t been the reality. It is working quite well now. Joint working has been improved and we have had positive meetings.’
Dr Khanna adds: ‘This is the future. Patients have easier, quicker access, treatment is free at the point of contact, pharmacists are better using their skills and it should ease pressure on general practice. If successful, this model could be extended to out of hours as well.’
To make the service workable, it has been agreed that GPs and pharmacists give consistent advice or treatment. Dr Khanna explains: ‘There is an agreed formulary and an agreed list of ailments. When a patient visits the pharmacist for a common ailment an information sheet is sent back to us that goes into the patient’s notes and tells us what the treatment or advice was given. That way we can be consistent with a patient who might then visit their GP about the same problem but seeking different treatment.’
Changing habits in the long-term
GPs are now stepping up the publicity campaign around the service to encourage take-up, emphasising that the service is free and confidential. Dr Khanna says that his practice is giving out patient leaflets about Choose Pharmacy at every opportunity, as well as placing posters up in reception.
‘We give the information to every patient even if they come to see us for serious conditions to raise awareness for future use,’ he explains. ‘This awareness is what is key to the success of the service.'
Steve Simmonds, National Pharmacy Association representation manager for Wales, who was involved in the stakeholder reference group created for the scheme, says that the aim is to change patients’ habits over time.
‘Fast forward 10 years into the future we want people to automatically go to their community pharmacy for treatment for minor ailments on the NHS,’ he says.
In Manchester a similar service, funded by the city’s three CCGs, was launched in July 2014. Patients exempt from prescription charges can receive free treatment at their local pharmacy. Manchester pharmacists have carried out 4,458 consultations between its launch and 21 January 2015, figures from Manchester CCGs reveal.
Patient feedback also highlighted that 74 per cent of people who had a consultation said they would have gone to see a GP if the service were not available. This equates to more than 3,000 GP appointments.
One practice manager based in North Manchester says they have welcomed the scheme. ‘It encourages patients to utilise NHS services better and eases the pressures practices face.’
The RPS has called for a common ailments service to be provided on a national basis throughout England, although it concedes further robust evaluation of existing schemes is required.
However, Dr Khanna cannot see why the service should not be extended. ‘There is definitely scope for a wider roll out,’ he says. ‘Pharmacists are part of primary care and should be utilised fully to take the pressure of GPs so our appointments can be used for more complex cases.’
|Key to success of a minor ailment scheme|