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Calls from pharmacy bodies for a national minor ailments scheme for
England are growing louder. And such a desire to see the patchwork of
local services
transformed into national scheme is supported by Chris
Ward, one of the
pharmacists involved with Nottingham’s Pharmacy First scheme, who
believes that a national scheme would help reduce health inequalities.
Nottingham City Primary Care Trust’s Pharmacy First scheme started
four years ago this month. It enables patients exempt from prescription
charges to register with the local pharmacist and receive medicines for
a range of conditions free of charge.
Tania Cook, specialist senior pharmacy technician for primary care at
Nottingham City PCT, coordinates the Pharmacy First Scheme. She explains
that the scheme was initially established by the PCT, which was looking
to expand access through pharmacies.
“The PCT was also short of
28 full-time GPs and so services were under considerable pressure,” she
says. “There were no minor ailments schemes being run locally before
the Pharmacy First scheme was set up so we used experience of other schemes
from around the country.”
The PCT encouraged all the pharmacies in the area it covers to take part
in the scheme and 48 of the 56 pharmacies agreed to participate.
Once the pharmacies were on board, all the pharmacy assistants and pharmacists
were trained on how the scheme works. Pharmacists and pharmacy assistants
can register patients and then pass them on to the pharmacist for the
consultation itself.
Pharmacists are paid for the cost of any drug they
may dispense and for VAT, and they also receive a consultation fee. The
fee is currently £2.48, but it is reviewed every year and the PCT
checks that the rate is fair and comparable to what other schemes are
paying.
The PCT also carried out training in GPs’ surgeries. “We
explained to GPs about the scheme and how they can refer people for treatment
in pharmacies,” Ms Cook says.
“We also trained the reception
staff, because they are the first point of contact for patients or patients’ carers
wanting to make an appointment with the GP, and so they will often be
the ones able to suggest to patients that they can go to the local pharmacy
instead.”
The scheme was then advertised through local papers, in particular the
Nottingham Evening Post. The PCT also contacted patient groups and used
posters and leaflets in pharmacies and GP surgeries and to promote the
scheme. Evaluation and development
When Pharmacy First had been running for a year, a detailed quantitative
and qualitative evaluation was undertaken. “Two things that people
wanted to change came out of that,” Ms Cook says.
“One
was the paperwork. There was too much, both for pharmacists and for
patients, and so we have reduced that to the bare minimum. The other
thing was that patients did not like the fact that they had to use
the same pharmacy they registered with each time they wanted to access
the service.”
Now, instead of being registered to use the scheme at just one local
pharmacy, patients are issued with a family voucher booklet. “This
contains all the necessary patient information so that patients can access
the Pharmacy First scheme at any pharmacy in the PCT,” Ms Cook
says. “Each booklet holds 25 vouchers and can be used by up to
11 eligible family members who are exempt from prescription charges.”
The PCT has also expanded the range of ailments for which treatment is
available through the scheme. “We are keen to revise the system
when necessary so that it benefits patients as much as possible,” Ms
Cook says. “Indications and the formulary are reviewed annually.”
When
it was launched, 11 treatments were offered: head lice, temperature or
fever, sore throat, earache, toothache, teething pain, diarrhoea, threadworm,
haemorrhoids, vaginal thrush and athlete’s foot. In 2005, the PCT
added treatments for bacterial conjunctivitis and, in May last year,
treatments for constipation, warts and verrucas, and insect bites and
stings became available on the scheme.
In addition, in December 2006, the PCT added a patient group direction
for pharmacists to be able to treat simple urinary tract infections with
trimethoprim, bringing the total number of ailments covered to 16.
“The additions have all been in response to feedback from questionnaires
to users of the scheme,” Ms Cook says. “We also looked at
what GPs are writing prescriptions for.” The PCT also had meetings
with GP practice-based commissioning cluster groups and asked them what
they thought should be added.”
The scheme has proved a considerable success. From April 2006 to March
2007, 20,273 consultations were carried out. The PCT estimates that this
has saved about 483 days of GP time. And, of these consultations, only
58 have resulted in referrals back to GPs.
Patients might be referred
onto the GP if their ailment is not suitable for treatment under the
scheme or if they have already used the service twice before in the same
month for the same indication.
“For the latest ailment added, the PGD for urinary tract infections
there were 137 consultations for a six-month period,” Ms Cook says. “As
trimethoprim is a prescription-only medicine patients would otherwise
have to see their GP to receive treatment. So there is a real saving
of GP time.”
A pharmacist’s view of the scheme
Chris Ward, group pharmacy manager at Boots in the
Broadmarsh Centre, Nottingham, has been involved with the scheme
for over three years,
although the pharmacy has provided the Pharmacy First service for
longer than that. He says that the care he provides through the
service is similar to advice he would have given before the scheme
was launched.
“It’s
important to give the best advice with any over-the-counter recommendation,
regardless of whether it is supplied as a service or sale.”In
addition, people who have used the service once return to use it
in the future.
“Just after the service was expanded to include
trimethoprim for cystitis I made a supply to one woman who was pleased
that she didn’t need to see her doctor on this occasion,” he
says. “I then saw her again nearly a year later — she’d
remembered the service and clearly valued the convenience.”
The service has also changed local people’s perceptions of
what pharmacists can offer, he adds. “Some people would have
otherwise visited their doctor because they were unaware about the
services available at their pharmacy,” he says.
“Others
may have previously visited a doctor simply because they could not
afford to pay for the medicines they need, and would be entitled
to prescription charge exemption.”
Mr Ward believes the scheme could be developed further. “I
can see no reason why in the future the scheme could not be expanded
to cover a number of additional conditions, providing the pharmacist
had completed any necessary training: perhaps impetigo — just
to give one example of a common GP referral that could potentially
save a lot of GP time,” he says.
However, the greatest development
Mr Ward would like to see would be the introduction of a national
standard scheme. “Sometimes we are unable to use the scheme
simply because a patient lives outside the geographical limits
of the scheme and a national standard would work to reduce national
health inequalities.” |
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The
Pharmaceutical Journal