IJPP 2003, 11: 1-9
© 2003 Int J Pharm Pract
Received June 12, 2002
Accepted November 18, 2002
DOI 10.1211/002235702801
ISSN 0961-7671


School of Health and Related Research, University of Sheffield, Sheffield

James Munro, clinical senior lecturer
Alicia O’Cathain, research fellow
Emma Knowles, research associate
Jon Nicholl, professor

Correspondence:
Dr Munro,
Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St, Sheffield, England S1 4DA.
E-mail: j.f.munro@sheffield.ac.uk

Acknowledgments:
The authors would like to thank staff of Essex NHS Direct sites for their considerable help and patience in supporting this research. In particular we would like to thank Linda Wells, Jeni Reed, Sandra Haines, Maggie Blundell, David Oxley and Ash Pandya for their invaluable assistance with data collection, and John Stanley and Georgina Craig for their helpful advice. This study was funded by the NHS Executive. The views expressed are those of the authors and not necessarily those of the NHS Executive.

Original Papers

Evaluation of NHS Direct "referral" to community pharmacists

James Munro, Alicia O'Cathain, Emma Knowles and Jon Nicholl

Abstract
Objectives To evaluate a pilot scheme of referrals from a nurse-led telephone helpline (NHS Direct) to community pharmacists.

Methods A multi-method approach, including analysis of routine data from NHS Direct, postal surveys of NHS Direct callers, analysis of anonymised transcripts of calls, a postal survey of callers referred to pharmacists, and face-to-face interviews with NHS Direct nurses. Setting Essex, Barking and Havering.

Key findings During the first three months of the pilot scheme, 6% (1,995/31,674) of NHS Direct calls triaged by nurses were logged as referred to pharmacists. This built on an existing foundation of informal referral to pharmacists of 4%. There was no measurable change in callers’ views of the helpfulness of advice, enablement, or caller satisfaction associated with the scheme. Conditions sent to pharmacists included skin rash, cough, sore throat, stomach pain, and vomiting and/or diarrhoea. 86% (54/63) of callers referred to pharmacists during the scheme felt the referral was very or quite appropriate and 75% (48/64) attempted to contact a pharmacist. In general, those who did so found the experience a positive one: 65% (31/48) spoke to the pharmacist, and 80% (28/35) of people expressing an opinion were satisfied with the advice offered, but the lack of privacy in the pharmacy was of some concern. Although routine data indicated high usage of the scheme, nurse referral of callers to pharmacists declined over time. Their initial enthusiasm diminished due to concerns about the appropriateness of guidelines, their lack of understanding of the rationale behind some referrals, and the lack of feedback about the appropriateness of their referrals.

Conclusions The evaluation of the pilot scheme has generated a range of recommendations for the wider national roll-out of the scheme, including revision of the guidelines and review of NHS Direct nurse training for referral to pharmacy. NHS Direct and pharmacists should consider how to strengthen the system of pharmacist feedback to NHS Direct.