The Pharmaceutical Journal
Vol 268 No 7203 p861-867
22 June 2002

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University of Sheffield: Medical Care Research Unit (more)

NHS Direct referrals to pharmacy fall as nurses lose enthusiasm, but callers happy with pharmacy advice

Nurses taking calls for NHS Direct are less likely to follow computerised prompts to refer callers to community pharmacists the more they use the system.

Analysis of the first three months of a project to test pharmacy referral from NHS Direct in Essex shows that 6 per cent of calls were logged as referred to pharmacists. Callers who were advised to contact a pharmacist found the experience a positive one. Most (86 per cent) were happy to be referred in this way and believed it was appropriate. Four out of five people who subsequently spoke to a pharmacist were satisfied with the advice they received, although there was some concern over the lack of privacy in pharmacies.

The evaluation also revealed clear evidence of the willingness on the part of both NHS Direct nurses and community pharmacists to see a greater role for pharmacy in principle, although there were reservations over how this should operate in practice.

Overall, the scheme was only partially implemented, with initial enthusiasm and use of the pharmacy referral in accordance with the prompts of the decision support system giving way to a falling use of the pharmacy disposition over time, despite system prompts.

This was because the nurses thought that they should have been involved with revising the decision support system and believed some of its guidelines to be inappropriate or lacking in a clear rationale. There was also nurse uncertainty over the role of community pharmacists, and a lack of clarity over when a visit to a pharmacist was advised as an alternative to a GP contact rather than as being in addition to self-care. In cases where the pharmacy visit was additional to self-care, nurses were concerned to balance the potential benefits of any visit against the degree of inconvenience or cost.

The researchers found that although nurses continued to record pharmacy referrals as having been made, they had, in fact, only advised callers on self-care. They said that nurses needed to be involved in the revision of NHS Direct triage protocols and that the system should set out a clear rationale for advising callers to see a pharmacist. The software should also be changed so that the advice given to callers was accurately logged.

Pharmacy referral is to be implemented nationally through NHS Direct later this year. Recommendations arising from the research have been taken on board to overcome the difficulties identified. Each NHS Direct site now has a pharmacy co-ordinator and clinical placements for nurses are being introduced to give them first-hand experience of what pharmacists do.

Paul Jenkins, national project manager for NHS Direct, said: "This report shows that patients are happy to be referred to a community pharmacist and with the advice they are offered once they are there. There are over 20,000 pharmacists working in the community in England, so the profession has the potential to be an invaluable and easily accessible resource for callers to NHS Direct."

Marshall Davies, President of the Royal Pharmaceutical Society, said that the success of the Essex NHS Direct pilot had helped pave the way for all NHS Direct sites to have systems in place to refer callers to pharmacists.

"It has demonstrated to the public and other health professions the benefit of community pharmacies, as well as the professionalism of the services they provide. This report's findings give the profession the opportunity to further develop its contribution to NHS Direct."