The
Pharmaceutical Journal Vol 266 No 7141 p413
Transferring the treatment of minor ailments from medical practice to community pharmacies |
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Michael Thompson investigates moves to encourage patients to seek treatment from pharmacies, rather than trouble their family doctors for prescriptions for OTC medicines merely because they are exempt from prescription charges |
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Over a third of patients who want to see a general practitioner about a minor ailment are just as happy to be given help by a community pharmacist provided there is no additional cost to themselves. Those who see a pharmacist are then less likely to seek a second GP consultation than those who saw a GP in the first place. These are two of the findings of a six-month study
“Care at the chemist” designed to compare the management of
minor ailments by community pharmacists and GPs and to find out whether
or not patients and doctors are happy for pharmacists to take on the work
and launched on March 28. |
The key questionsThe Bootle study was designed to try to find the answers to five key questions:
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Deprived area chosen The chosen location for the study, which was carried out by researchers from Manchester university's school of pharmacy and pharmaceutical sciences, was a deprived area of Merseyside served by a five doctor GP practice and eight community pharmacies. Almost all prescriptions from the practice (93 per cent) are dispensed free of prescription charges (PJ, January 29, 2000, p168). The conditions chosen for the study are given in the panel above. Patients who visited or telephoned the practice for prescriptions or same day appointments for any of the 12 conditions were offered the chance to visit one of the pharmacies to obtain a pharmacist prescribed medicine instead. Consultation forms were completed and faxed to the patients chosen pharmacy. The pharmacist then recommended either self-care, treatment or referral back to the doctor. If treatment was recommended, medicines were provided from a restricted formulary and reimbursed by the health authority. Pharmacists were paid £1.50 per consultation and kept appropriate records. The principle findings of the study were that 38 per cent of patients were happy to see a pharmacist and that the GPs' minor ailment workload fell from 8.9 per cent of consultations to 6.6 per cent. Patients thought that the arrangement was convenient. They preferred to see a doctor if they had not had the symptoms before, believed that antibiotic treatment was needed or believed that medical examination was needed. The GPs believed that pharmacists could treat minor ailments, but wanted to be available as a back-up service. No firm conclusions were drawn about cost, although there were indications that pharmacists were cheaper than GPs. The project has met with the approval of both pharmacists and GPs who took part. Dr Kieran Murphy (Moore Street Surgery, Bootle) says that the scheme gives patients a choice and makes medicines more immediately accessible to them when they would normally have waited to get a free prescription. Charges work against poor areas “The prescription charge system works against poorer areas,” he said. “The scheme works well, particularly for working people on low incomes because time is important to them. It also teaches people to use pharmacies and that you don't have to see the doctor. If we didn't have a prescription charge system, we wouldn't have this problem.” One of the participating pharmacists, Mr John Dwerryhouse (Seaforth Pharmacy) said: “People have been very happy with it. It has taken pressure off the doctors for uncomplicated scenarios. Most people around here are charge exempt, so they're only going to the doctor for a free prescription rather than buy the medicine.” He said that the scheme was a good thing because it made use of pharmacists' expertise and put them in a good light. Consideration is now being given to extending the scheme to cover the whole primary care group. Other parts of the country, too, are looking at
similar schemes. Indeed, one Croydon health authority PCG launched one
last month to compare its impact on four GP practices in a deprived are
with four in a well-off area. It, too, is based on 12 ailments. |
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The 12 minor ailmentsTwelve minor ailments were chosen for the Bootle project because of their prevalence, the availability of pharmacy medicines for their treatment and the willingness of participating GPs to see their management transferred to pharmacies. The ailments were:
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Self-care the best option Mrs Helen Hill (community pharmacy adviser, Croydon HA) said that the scheme had taken off like a rocket in the deprived area, but that there had been little take-up in the well-off area. She attributed this to the fact that patients in the deprived area would have sought free prescriptions for medicines rather than buy them at a pharmacy. “We're trying to persuade people that self-care is the best option for these conditions,” she said. “It also increases pharmacists' job satisfaction and reduces the time from onset of symptoms to treatment being obtained.” Another project is also under-way in Scotland. |
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The Bootle project was funded by the Community Pharmacy Research Consortium (which comprises the Royal Pharmaceutical Society, National Pharmaceutical Association, Pharmaceutical Services Negotiating Committee, Company Chemists Association and Scottish Pharmaceutical General Council) and the NHS Executive. Analysis was carried out by researchers from Manchester university's school of pharmacy and pharmaceutical sciences in collaboration with the National Primary Care Reseach and Development Centre and Sefton health authority. Two papers on the management of minor ailments at community pharmacies are published here and here. |
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Michael Thompson is on the staff of The Pharmaceutical Journal |