Prescribing & Medicines Management
page PM2
March 2004

Features

Minor ailments scheme now involves over a third of Sheffield's pharmacists

With schemes that enable pharmacists to treat a wide range of minor ailments now firmly on the health agenda, one of the more established schemes in England has been running for over two years. The Sheffield scheme started in February 2002, with community pharmacists being able to prescribe for a range of self-limiting minor conditions under the NHS. Patients exempt from charges no longer need a GP’s appointment for a prescription, allowing GPs more time to deal with more serious consultations.

To the end of January 2004 a total of 7,782 patients had been seen under the scheme and just under 10,000 items had been prescribed by participating pharmacists. Headlice is the most common condition treated, comprising a third of all consultations, followed by headache, earache and fever and then cough (see Table).

The project lead, community pharmacy facilitator Peter Magirr, says: “We anticipated that treating headlice would figure prominently because we had reviewed GP prescribing for the condition from e-PACT data. The management of this condition in the community pharmacy setting is entirely appropriate and the volumes indicate just how much GPs’ time can be freed with such a service.”

He explains that the scheme initially involved 13 practices and 29 community pharmacies. “This has now increased to 29 practices — around a third of the city’s total — and 44 pharmacies (out of a total of 106), with numbers continuing to rise.”

Dr Magirr was pleased with the view of the Commission for Health Improvement, which described the scheme as “a cost-effective and popular development” in its recent clinical governance review. He also believes that the scheme has helped all four of the city’s primary care trusts to reach their GP access targets.

“The situation is continually evolving,” he says. “The scheme has been shown [to be] effective and all of Sheffield’s PCTs have become convinced of its value and are allowing more surgeries to join. What’s more, the practices see a real advantage in being able to offer this service to their patients.

“It is up to the practices to sign up to the scheme. The service is for their patients. Pharmacies serving that practice are then asked if they want to participate. Patients don’t have to register with pharmacies but the pharmacists must be satisfied that the patient is registered with a participating surgery. This is usually straightforward. Patients are informed of the service when they contact their GP practice for an appointment. They can also self-refer.”

In a telephone survey of patients who had used the scheme, 98 per cent said they wanted it to continue. Over 90 per cent found the service user-friendly, and 82 per cent would have had to see the GP instead had the scheme not existed.

GP practices and pharmacies were also positive, with extensive support for the scheme to be continued and enlarged. Several GPs commented on the change occurring with the mix of consultations that had emerged, noticing an impact from the project.

No extra training was needed for pharmacists. But in the scheme they work to a “fairly robust” protocol treating specified conditions. They prescribe from a formulary aligned with the existing Sheffield formulary. If a patient seeks advice on a condition not in the protocol, or if the patient presents for a third time with the same ailment, they are referred back to their GP. Treatment for children is included within the scheme, with a number of medicines for common childhood ailments included within the formulary.

Dr Magirr says that the protocol and formulary remain under constant review. “Feedback from all involved allows us to improve the service. For example, the treatment of mouth ulcers has recently been added to the protocol with appropriate preparations included in the formulary.”

“We are still learning as we go along,” Dr Magirr continues. “We are working on communication and training issues, particularly with GP practice staff. It is often the receptionist who will be informing patients about the scheme and who will be selling the idea. They often know the patients well but need to be comfortable with the idea themselves.

“We have also improved surgery posters and leaflets explaining the scheme. But, at the end of the day, it is up to the patient to use the service. They are not obliged to go to the pharmacy and can still see the GP if they want. It is about patient education too, about what constitutes a minor ailment or a more serious condition and where is the appropriate place to seek treatment ”

Dr Magirr says that the programme offers good value for money for the NHS. Pharmacists receive a fee of £2.50 per consultation, £20 per month for reaching a threshold number of patients and reclaim their prescribing costs. “This is less than half the cost of a GP consultation.”

It is important to note, however, that GPs still report seeing as many patients as before. This is because patient demand continues to fill their appointment slots. However access to the GP is improved by managing minor ailments in the pharmacy and the total number of patients treated overall is, of course, greater than before.

Another benefit of the scheme, according to Dr Magirr, is the strengthening of links between GPs and pharmacists, who, after all, are now sharing patients, seen “in the most appropriate setting for their condition”.