Community pharmacy as the front door

Community pharmacy as the front door

We’re facing a very tough winter. No matter where you are, or what you do, the COVID-19 pandemic is affecting the health of us all. With winter pressures causing NHS strain, community pharmacy will prove critical.

As I write this1, daily cases of the virus are estimated to be around 100,000 and our hospitals are starting to fill. This is going to get worse before it gets better.

Difficult as it is to think beyond coronavirus, people will get acutely unwell from other infections and illness, will have exacerbations of existing conditions and worryingly, underlying (ill) health conditions will progressively decline. The NHS has to be able to respond.

Changing behaviour

To address increasing demand on limited resources, healthcare policy makers in England have for some years been talking about the role community pharmacy can play in treating people for minor conditions and keeping them out of GP surgeries and A&E. In a recent interview2, Health Secretary Matt Hancock said, “I think that pharmacists can do far more, and they are the front door to the NHS in the community.”

The pandemic has brought this issue into sharper focus and patients themselves are finding other ways to access healthcare. People’s attitudes to health appears to be changing, with more taking responsibility for their health and looking after themselves if they get ill. Importantly, they are more likely to consult with a pharmacist.

Changing behaviours

The Proprietary Association of Great Britain (PAGB) carried out a survey in June 20203 of more than 2000 adults and found that:

  • almost seven in 10 respondents (69%) who would not have considered self-care as their first option before the pandemic, said they were more likely to do so in the future
  • almost one in three people (32%) have changed their attitude to the way they access healthcare services
  • among those who previously sought a GP appointment as their first option, more than half (51%) said they were less likely to do so after the pandemic
  • 86% agreed that A&E and GP appointments should be used only when absolutely essential
  • 31% are more likely to consult a pharmacist.

This is good news for the NHS who want more patients to use pharmacies, for pharmacies who want to offer more than dispensing and for the public who need quick access to healthcare when they are sick.

Following the initial pandemic crisis period to June 2020, we have seen a number of initiatives further embedding and integrating community pharmacy into NHS care pathways.

Community Pharmacist Consultation Service

Currently NHS 111 is referring patients to pharmacy through the Community Pharmacist Consultation Service (CPCS). This national commissioned service offers a consultation on minor illnesses to patients as well as management of urgent supplies of medicines when a patient has run out. The service has been designed to provide patients an alternative to visiting their GP or an urgent treatment centre. Almost a quarter of a million minor illness referrals4 have occurred in almost one year of the service and are expected to accelerate with the national roll-out of GP referrals into the scheme, starting November 2020. The roll-out will be managed by each NHS Region and implemented at Primary Care Network (PCN) level. Local collaboration between GPs and pharmacies will be critical in making this service a success, enabling pharmacy to see more acutely ill people as the first entry point into the NHS.

Structured Medication Review

The 2020/21 Network Contract Directed Enhanced Service (DES) Specification includes requirements relating to delivery of a Structured Medication Review (SMR) and medicines optimisation service by PCNs. Guidance5 outlines the tools a PCN should use to identify and prioritise patients who would benefit from a SMR and must include patients in care homes; with complex and problematic polypharmacy (on 10 or more medications); on medicines commonly associated with medication errors, and using potentially addictive pain management medication. Within this guidance PCNs are required to work with community pharmacies to connect patients appropriately to the New Medicine Service (NMS) which supports adherence to newly prescribed medicines. The service currently supports people with the conditions outlined below, who have been prescribed a new medicine.

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Type 2 diabetes
  • High blood pressure (hypertension)
  • On anti-coagulants or anti-platelets.

The community pharmacy 2020/21 Pharmacy Quality Scheme (PQS) Part 26 further incentivises community pharmacy to engage with their PCN through a community pharmacy network lead. Pharmacies can earn points each worth a minimum £48 by engaging with PCNs on increasing the total number of patients over 65 who receive a flu vaccination through the community pharmacy NHS National Community Pharmacy Flu Vaccination Service. Protecting this high-risk group during the winter against flu is seen as a critical part of the NHS winter pressures strategy. PQS further supports community pharmacy to develop their skills in reducing antimicrobial resistance through antimicrobial stewardship and reduce risks associated with missing red flag symptoms and sepsis when undertaking a consultation for a ‘minor’ ailment.

Discharge Medication Review

The final piece of the community pharmacy jigsaw for this winter is the imminent launch of the Discharge Medication Review (DMR) service, planned for January 2021. I highlighted this important interface service between primary and secondary care in an exclusive article for Pharmafield website in March 2020 and, whilst the pandemic delayed implementation, it is now progressing. It will allow hospitals to digitally notify community pharmacies when patients who have recently been discharged may require advice on taking new medicines, as well as any changes to their prescriptions. The service aims to reduce the number of hospital readmissions caused by side effects or complications relating to medicines prescribed while a patient is in hospital.

It seems that the vision for pharmacy within the NHS Long Term Plan is finally being realised, enabling community pharmacy to play its part in addressing demand on NHS resources.

References

1 30 October 2020
2 LBC’s Call The Cabinet television segment (7 September 2020)
3 www.pagb.co.uk/latest-news/pagb-self-care-survey/
4 To 27 October 2020 NHSBSA
5 www.england.nhs.uk/wp-content/uploads/2020/09/SMR-Spec-Guidance-2020-21-FINAL-.pdf
6 www.england.nhs.uk/wp-content/uploads/2020/09/B0039_Pharmacy_Quality_Scheme_guidance_22_September_2020.pdf