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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR8

Unravelling consultations for minor ailments

By Z. Whittington*, K. Hassell*†, P. Noyce*, J. Cantrill*† and A. Rogers†

Introduction Government support for community pharmacists acting as alternative or substitute practitioners from whom advice can be sought for the treatment of minor ailments has been an explicit policy objective.1 The support for shifting demand away from general medical practitioners (GPs) to pharmacists is largely due to the high level of self-treatable conditions being managed within the formal primary health care services. In addition, many GPs perceive consultations for minor ailments as "inappropriate".2 However, previous research has demonstrated that patients who are exempt from prescription charges may be unwilling or unable to use the community pharmacy for advice or treatment for minor ailments.3
The aim of this study was to explore whether and to what extent a number of different minor ailments could be transferred from GP to community pharmacist management when the financial barrier is removed.

Method In August, 1999, the "care at the chemist" trial was established as part of a six-month feasibility study. The trial involved one general medical practice and eight community pharmacies ranging from small independents to large multiples, in a deprived area of Merseyside. Twelve conditions were included, from coughs and colds to thrush. Patients requesting an appointment or prescription at the general medical practice for one of the 12 conditions were offered a pharmacy consultation and, if they accepted, a referral form was faxed to the pharmacy of the patient's choice. Data were recorded on GP minor ailment consultations from the surgery computer records and community pharmacy over-the-counter sales for four months prior to and during the trial. Data on the pharmacy consultations were collected for the six months of the trial.
Under the trial the community pharmacist was able to advise patients and "prescribe" suitable products for 12 conditions from an agreed formulary. Medicine supply was made under the same arrangements as a National Health Service prescription with the same exemptions applying. Therefore the financial incentive for exempt patients to consult the GP rather than the pharmacy was removed. Patients either utilising the trial (19) or consulting a GP (13) for one of the 12 conditions were interviewed by telephone about their experiences of minor ailments and their treatment. The GPs and community pharmacists involved in the trial were also interviewed.

Focal points

  • Patients consulting a GP with 12 minor ailments are offered a consultation with a community pharmacist of their choice instead
  • Pharmacists remain in the community setting and can "prescribe" under the NHS prescription charge and exemption arrangements
  • Thirty-eight per cent of minor ailments presenting at a general practice were transferred to community pharmacy management
  • A range of transfer rates was achieved with different minor ailments (12-83 per cent)

Results Baseline data collected in the surgery indicate that minor ailments accounted for 9 per cent of the GPs' total caseload. Data collected during the evaluation show that 38 per cent (576/1,522) of minor ailment consultations were transferred to the community pharmacy. Of the 576 patients referred to a community pharmacy, 4.7 per cent (27/576) did not visit the pharmacy. However, some minor ailments were more amenable to transfer than others, with vaginal thrush achieving a high level of transfer (76 per cent, 50/66) and earache resulting in the lowest level of transfer (12 per cent, 14/118). Data collected on prescribing within the GP practice indicate that 46 per cent of earache consultations result in a prescription for antibiotics. There were no significant differences in re-attending the GP surgery for the same condition within 14 days following a pharmacist consultation (2.4 per cent, 14/576) than following a GP consultation (3.8 per cent, 36/946).
Qualitative data from interviews with patients using the trial demonstrate high levels of satisfaction especially for conditions where a GP diagnosis is not needed ("I don't tend to see the GP if I have thrush. I will just ask for a script"). Interviews with patients choosing to consult the GP reveal other reasons for consulting, including co-existing conditions, reassurance and perceived need for antibiotics.
Interviews with the community pharmacists involved in the trial indicate that they have less confidence in dealing with some of the minor ailments ("Earache is difficult to treat. I tend to have to refer those patients back to the GP").

Discussion The results of this feasibility study indicate that a number of factors influence patients' willingness to use the community pharmacy for minor ailments. The types of condition, patient expectations of GP consultations and their outcome all contribute to the decision with whom to consult. These factors will need to be borne in mind when developing pharmacy-based services for minor ailments.

*School of pharmacy and pharmaceutical sciences, University of Manchester; &134;National Primary Care Research and Development Centre, University of Manchester, Oxford Road, Manchester M13 9PL

References

1. Department of Health. Choice and opportunity. Primary care: the future. London: The Department; 1996.
2. Hoog S. The self medication market: a literature review. J Social Admin Pharm 1992;9:123-37.
3. Hassell K, Noyce P, Rogers A, Harris J, Wilkinson J. A pathway to the GP: the pharmaceutical "consultation" as a first port of call in primary health care. Family Practice 1997;14:498-502.