NHS walk-in centres: an opportunity for pharmacists
The conference heard that pharmacists have an important
role to play in empowering nurses to fulfill some of their new and emerging
roles. Kathy McGovern, nurse consultant, Croydon and Surrey Downs Community
NHS Trust, stressed that walk-in centres were complementary to other services
and did not seek to compete with general practitioners (GPs), accident
and emergency departments or community pharmacists. She revealed that
the concept of National Health Service walk-in centres formed a part of
modernisation plans for the NHS. “Walk-in centres do address a need
because some people still do not access health care through traditional
routes such as GPs and A&E,” she said. However, she felt that
the development was more consumer driven than clinically needed. She explained
that 43 sites will be open by December 2001, as part of a three-year national
pilot, after which there will be an evaluation period. She reported that
each centre has to identify a target population before becoming established.
In Croydon, the centre has targeted the homeless, teenagers and asylum
seekers, she said.
Ms McGovern said that the service was nurse-led,
and as such it offered a good opportunity for nurses to practise autonomously.
Users seem to value the easy access and long opening hours, she said —
especially those whose working day makes GP visits difficult, or those
not registered with a practice. The early experience has been that attenders
who are acutely ill or injured are unusual; most users suffer from minor
illnesses, in particular self-limiting conditions related to stress and
poor lifestyle. Emergency contraception is a common reason for presentation.
Anne Joshua, principal pharmacist for NHS Direct
and walk-in centres at the Department of Health, presented ideas on how
pharmacists could interact with walk-in centres. She explained that there
are four ways in which nurses can help patients to access medicines:
- Administration or supply under a patient group
direction (PGD).
- Supply under a simple protocol (for General Sale
List and Pharmacy medicines).
- Prescription — some walk-in centres have
access to a GP, but most do not. The drugs which nurses can currently
prescribe are generally not appropriate for walk-in centre clientele.
- Referral to a community pharmacist — some
pilot projects have involved giving patients a referral note from the
walk-in centre to enable them to buy an appropriate medicine after consultation
with a pharmacist.
Ms Joshua highlighted the key role which pharmacists
can play in training. She explained that the practical use and implementation
of PGDs requires a lot of pharmacist input and, even when fully implemented,
it is important that pharmacist advice remains available. “There
are many other opportunities for team work in primary care,” she
said, “in areas such as medicines management and health promotion”.
However, for this to be effective she said that community pharmacists
must see themselves as part of the primary care team, and not just a service.
For example, she suggested that pharmacists close to a walk-in centre
should consider extending their opening hours to match those of the centre
(7am to 10pm on weekdays).
Ms Joshua concluded by suggesting that medicines
information should consider how its special skills could be used to help
improve patient access to primary care services: “The NHS plan states
that by 2004 all patients must be able to see a primary care professional
within 24 hours,” she said.
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