Derby scheme repeats success for pharmacy referrals for minor ailments
Pharmacy First, a scheme in Derby for referring patients with minor ailments to see a pharmacist rather than a general practitioner, saved around 500 GP consultations a month. The scheme is the latest to demonstrate
the benefits for patients and GPs of such services and comes as the
merits of incorporating a national scheme in the new pharmacy contract
are being debated.
Under the Central Derby Primary Care Trust scheme, patients from six
inner-city GP practices could be referred by a receptionist to one of
11 pharmacies. The practices are in some of the most deprived areas of
the city. As part of the referral, each patient was given a booklet listing
the non-prescription medicines available under the scheme. If the patient
visited a participating pharmacy, the pharmacist made a record in the
book of any medicines prescribed. Medicines were given free of charge
to patients exempt from National Health Service prescription charges.
Pharmacies taking part in the scheme were paid an annual retainer of £50
and a consultation fee of £2.50 per patient visit. Medicines were
reimbursed at Drug Tariff prices.
During a six-month audit in the second half of 2002, there were 3,686
referrals made. The average cost of medicines supplied for each referral
was 75p. Adding pharmacy fees and PCT administration costs, the total
cost was £11,982 or £3.51 per referral. No estimate was made
of the costs of the community pharmacists’ time in carrying out
the service.
Lisa Flint and Dr Peter Rivers of Research and Evaluation Services, University
of Derby, analysed the scheme and say that pharmacists, GPs and patients
all appreciated the service. They recommend that it should be extended
to other practices and pharmacies. Some of the areas for development
identified include extending the formulary of medicines and reducing
the amount of paperwork associated with the scheme. Concerns were expressed
by pharmacists and their staff that they felt under pressure to prescribe
medicines to all patients referred to them and that some patients had
used the scheme to get medicines even though they were not entitled to
do so.
At the same time, the Pharmaceutical Services Negotiating Committee is
continuing to press for a similar scheme to be included as part of the
new national pharmacy contract. The PSNC wants this to be one of the
core, or essential, parts of the contract. The Department of Health currently
favours making such a scheme an additional service that PCTs can choose
to implement locally if desired. The Department is understood to be concerned
about the cost implications of any nationally promoted scheme.
Alistair Buxton, head of NHS services at the PSNC, told The Journal: “All
the schemes similar to the one in Derby that we are aware of have not
increased the cost of prescribing medicines.”
In Scotland, it has been agreed in principle to make a minor
ailments scheme a core part of the new community pharmacy contract (see p165). |
