The Pharmaceutical Journal
Vol 268 No 7180 p73-76
19 January 2002

Society summary

Pharmacists sought for NHS Direct and NHS 24 "guardian groups"

NHS Direct, the 24-hour nurse-led telephone advice line, has operated across England and Wales since 2000. A similar service for Scotland, NHS 24, begins in spring in Grampian and will roll out across Scotland in the next two years. Callers are triaged by a nurse, using a computerised decision support system. Depending on their clinical need, callers may be advised to attend a casualty department, to contact their GP or to undertake self-care. Those with urgent, serious problems may be diverted to the 999 emergency service.

NHS Direct (NHSD) has handled more than 7 million calls, to become the world's largest telephone-based health provider. It is many people's first point of contact with the NHS. NHS 24 is likely to fulfil the same role.

At its inception many pharmacists felt that NHSD had overlooked the contribution pharmacy could make. In 1999, Essex Local Pharmaceutical Committee and the National Pharmaceutical Association, backed by the Society, proposed that NHSD should pilot an additional triage endpoint of "referral to the pharmacist". Professor Alison Blenkinsopp and her team at Keele University undertook a review of the computerised protocols (algorithms). After training for nurses and pharmacists, a pilot of the new system began in Essex NHSD in March 2000.

A formal report of the evaluation of this pilot is expected this month from the Medical Care Research Unit of the University of Sheffield, on behalf of the Department of Health. The Department has been sufficiently convinced of the value of referral to pharmacists to launch the scheme nationally. NHS 24 will include referrals to community pharmacy from its launch, and may advise callers to contact their community pharmacist for advice on managing minor ailments, accessing prescription medicines or answering questions on medicines.

Pharmacists have been employed to advise both NHSD and NHS 24 on medicines and pharmacy issues. A similar appointment is expected for NHS Direct Wales.

Clinical assessment system

NHS Direct initially used three different clinical decision support systems. In October 2000, after evaluating the available systems, NHS Direct decided to acquire the CS200 system from AXA Assistance. Now called the NHS Clinical Assessment System (CAS), it is used across England. It is also being used in Wales and will be used in Scotland (NHS 24).

The NHS Executive now has total control over the clinical and functional development of the CAS. A joint development team has been established specifically to develop the system and ensure that it meets NHS requirements. The team comprises NHS clinicians from England, Scotland and Wales, with software developers from AXA.

In England, the joint development team is supported by a clinical reference group, drawn from representatives of the national clinical bodies. Set up in November 2000, the group has one representative each from the Society and the NPA. NHS 24 in Scotland has set up a similar clinical forum.

The aims of the NHSD clinical reference group are to provide a strategic role in the management of CAS, to be available as an expert group for review of clinical content, to provide a focus for marketing the system across the NHS and building relationships with professional bodies, to provide guidance to users; to provide a forum for identification and prioritisation of new developments, and to be responsible for the governance and functionality of the system.

In conjunction with NHSD and NHS 24, the Keele team is again systematically reviewing the clinical algorithms to assess where referral to a pharmacist can be made safely and effectively. This review is expected to be completed in time for the national roll-out of pharmacy as a formal disposition in April 2002, and for the launch of NHS 24.

Maintaining the algorithms

The NHSD/NHS 24 joint development team has created 11 guardian groups to review the functionality of the CAS algorithms. The groups will take responsibility for the ongoing review of the algorithms. It is expected that each algorithm will be reviewed annually, with more frequent review where clinically indicated.

Guardian groups will meet quarterly and review up to seven algorithms on each day they meet. Each group will therefore deal with up to 28 per year. There will be two distinct streams of guardian groups: adult and paediatric. Each group will be chaired by a clinician from the joint development team. Each group will have a core membership, usually consisting of a general physician and nurses and other appropriate professionals, including a pharmacist. This core group will meet quarterly and, depending on which algorithms are being reviewed, will invite appropriate specialists from an extended membership of specialist clinicians.

As the authoritative professional body, the Society is charged with the responsibility of nominating pharmacist members of the guardian groups. The pharmacist members should include pharmacists from England, Scotland and Wales. NHS Direct and NHS 24 will reimburse travelling expenses and, where appropriate, locum expenses incurred in the course of this work.

The Society is now looking for pharmacists to join the guardian groups. Ideally, they should fulfil certain competency criteria, as set out in the panel. Pharmacists who wish to be considered for nomination should send a curriculum vitae and a brief statement indicating evidence of competency against the proposed framework, with details of any appropriate specialist expertise, to Nigel Graham, Head of Practice, Royal Pharmaceutical Society, 1 Lambeth High Street, London SE1 7JN (tel 020 7572 2407; fax 020 7572 2501; e-mail ngraham@rpsgb.org.uk). The closing date is 4 February 2002.