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Andre Yeung, a pharmacist, NHS England (Cumbria and the North East) Local Professional Network Chair and the Digital Minor Illness Referral Service project manager, reflects on a new, pharmacy-led partnership project which is improving access for patients and saving GP time.
In December last year, a new scheme called the Digital Minor Illness Referral Service pilot, known as the Community Pharmacy Referral Service (CPRS) in our area, went live here in the North East and seeks to refer ‘low acuity’ patients from NHS111 directly to community pharmacies to manage their care.
We’re pleased to report that in the first four months of operation over 5,000 patients have been referred – saving the equivalent of 11 weeks of GP time – and the signs are that this could be the start of an exciting development in urgent care. The project has now been extended until the end of September 2018 to enable a full evaluation to take place.
The service, commissioned by NHS England’s Pharmacy Integration Fund, is designed to test the way in which patients who are contacting urgent care services can be supported with managing self-limiting minor illness (conditions which do not require treatment as they will clear up on their own, such as sore throats, coughs and colds) closer to home. It also tests how the national community pharmacy network could be better integrated into urgent and emergency care (U&EC) systems. Our pharmacy providers are required to provide the same or higher quality of care as traditional out of hours locations but closer to home in the communities where people live and with a real focus on education and self-care.
It works by sending a formal electronic patient referral from NHS 111 to a nominated community pharmacy. When the patient presents at the pharmacy they are invited to have a confidential clinical assessment with a pharmacist who makes appropriate notes, gives self-care advice and recommends a treatment for symptom relief if this is required. For most referred patients, we’ve found that these referrals are appropriate, effective and that patient satisfaction scores are high, but there’s also an option for the pharmacist to escalate patients to a GP if they wish to do so.
The project started when Mike Maguire, LPN Chair for NHS England, Durham, Darlington and Tees, and I started talking about the opportunity to refer patients into the community pharmacy network. We were motivated by the simple fact that in 2014 NHS111 was referring around 0.1 per cent of patients to community pharmacy, despite the NHS111 number being the less urgent option for patients. We found that most calls were being sent through to in-hours or out-of-hours GPs.
In partnership with NHS colleagues here in the North East, we created a new pathway for patients that aims to make best use of the established ‘walk-in’ functionality of community pharmacies for clinical advice for minor health concerns. We attended CCG forums, Sustainability and Transformation Partnership (STPs) and Vanguard meetings, applied for funding, delivered presentations and wrote business cases about that one simple concept: to create a link between urgent care systems and the community pharmacy network to deliver benefits to patients across the system. Pretty much everyone we encountered along the way agreed that this was a great idea which encouraged us to continue.
During 2017, our local and national NHS England teams helped us put forward a proposal to the Pharmacy Integration Fund and the rest, as they say, is history. Over 388 pharmacies have signed up to provide the CPRS and they get paid for each referral, participation in the project and evaluation. The service is commissioned by NHS England as a local enhanced service and has been extended to run until end of September 2018.
The CPRS wouldn’t have been possible without some truly amazing colleagues from the following organisations: NHS England team in Cumbria and the North East, North East Ambulance Service, the Directory of Services team at North East Commissioning Support Unit, North East Local Pharmaceutical Committees and Pinnacle Health Partnerships.
I believe that the best ideas come from the people working on the front line so my advice to pharmacy colleagues who are interested in developing new models of care to benefit patients and the NHS would be: ‘don’t wait, just do it’. Talk about your ideas with as many people as possible, and ‘think big’, as too much of what we’ve done in the past has been on a small scale. In the age of STPs and integrated care systems the NHS wants system level solutions.
Three further Pharmacy Integration Fund Digital Minor Illness Referral Service pilots are due to be launched by early autumn 2018, in Devon, London (in a phased approach), and East Midlands. The areas will be adopting the same model used in the North East with some minor adaptations dependent on the local NHS111 case mix. An evaluation will inform any next steps for the project.