The research
IMS analysed anonymised patient records from its database of 210 general
practices across the UK, covering four million patient records and
190 million prescriptions.
Data from 500,000 UK patients who had consulted their
GP about a minor ailment suggested that, in 2006–07, 51.4
million GP consultations a year were solely for minor ailments.
Estimated at eight minutes per consultation, this
represents 18 per cent of GPs’ workload or an hour a day
for each GP.
The total cost to the NHS of these consultations
is £1.8bn and 80 per cent of this (£1.5bn) is attributable
to the cost of GPs’ time.
In addition, 10 minor ailments are responsible for
75 per cent of the cost of minor ailments consultations and 85
per cent of the cost of prescriptions for minor ailments. These
are:
• back pain
• indigestion
• dermatitis
• nasal congestion
• constipation
• migraine
• acne
• cough
• sprains and strains
• headache
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Time spent by GPs providing treatment and reassurance to patients
who could treat themselves is troubling to anyone concerned about efficient
use of healthcare resources. Such consultations have long been thought
to make up a large part of GPs’ work but there has been little
quantitative evidence on this subject.
To fill this gap the Proprietary
Association of Great Britain commissioned IMS Health to examine the
minor ailment workload in general practice.
In
a joint submission to the consultation on the White Paper on pharmaceutical
services, the PAGB and the Pharmaceutical Services Negotiating Committee
set out the results of the research and question current use of NHS resources
and GPs’ time.
The PAGB and the PSNC propose a national scheme for England in which
pharmacy is the first port of call for all cases of minor ailments.
Pharmacies could offer reassurance and advice, or referral to another
part of the NHS and they could supply over-the-counter medicines and
prescription-only medicines on the NHS for people who are exempt from
prescription charges.
The scheme could also support people’s current practice of responsible
self-care and self-medication. People who go to their GP for such treatment
could be given information to widen their choices. National, regional
and local communications could endorse the programme.
Mechanisms to recruit people into self-care and the national minor ailments
scheme could include the use of a “self-care prescription” by
GPs. This would reassure patients and encourage them to go to the pharmacy
in the first instance in future.
In terms of reassurance, pharmacy has a considerable advantage over NHS
Direct or other avenues open to patients, PAGB head of public affairs Gopa Mitra argued
at a press briefing to launch the proposed scheme. “Compared
with NHS Direct — either the website or the telephone service — you
are actually seen.” This factor would, she hoped, help people see
the benefits of a pharmacy service and ensure the scheme becomes a success.
 Roger Scarlett-Smith, president of the PAGB, remarked
that he had struggled to find anyone who would lose out from this scheme. “It seems to
be a win for everybody,” he said.
“It has benefits for patients
in becoming more empowered to treat their own ailments, benefits for
the health service in better targeting resources and making savings which
can then be redistributed, benefits for the pharmacist in actually playing
a more leading role in managing minor ailments and, of course, benefits
for the industry in terms of supporting growth in this area.”
The PAGB and the PSNC have sent details of the research and their scheme
to the pharmacy White Paper team, Lord D’Arzi’s review of
primary care services and the All-Party Parliamentary Group on Primary
Care and Public Health inquiry into GP access, as well as MPs and peers.
Sue Sharpe, chief executive of the PSNC, believes the
figures make a compelling case for supporting the scheme. “The potential to release
time of GPs and allow them to focus on other activities, and the potential
to use the funds that can be released from this to better effect, is
really such that I believe the Government has a case to answer as to
why not, rather than us having a case to answer as to why?”
The imminent White Paper on pharmaceutical services and the Government’s
focus on primary care ahead of the 60th anniversary of the NHS mean the
proposal has come at an opportune moment and offers a chance to push
policy forward, Mrs Sharpe argues.
“Not all aspects of Government health policy lead to measurable
change,” she
said. “Some of them disappear. Some of them simply do not come
to fruition. So this is an attempt to kick start broad policy.” This
is, she says, a way in which pharmacy can move forward to implement some
of what the Government is seeking to achieve in its broader policy objectives.
Mrs Sharpe said she would want to see the scheme implemented in the community
pharmacy contract as an essential or advanced service.
She acknowledged that much of the detail still had to be worked out,
but stressed the importance of minimising the bureaucracy of such a scheme,
so that documentation and form-filling processes do not themselves become
disincentives to participating, but said she hoped the scheme would have
appropriate input from trained pharmacy staff as well as pharmacists.
Wales and Scotland
Ministers
in Wales are considering developing a
national minor ailments scheme (PJ, 24 November 2007, p575).
Scotland’s national minor ailment scheme began in July 2006.
Alex MacKinnon, head of corporate affairs at Community Pharmacy
Scotland, comments: “Patients like it and pharmacists like it and it
has really started to make a difference to the pharmaceutical care
of patients who are exempt from NHS prescription charges. What I
am most pleased about is that it is improving access to consultations,
advice and medicines for common illnesses and allowing community
pharmacists to prescribe where appropriate.”
He adds: “I think the commitment within a national contract
has been important to its success and I can see why our colleagues
in England want to do something similar on a national basis.” |
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The
Pharmaceutical Journal