Overview

Blackburn with Darwen/Knowsley started offering General Practice referrals to the NHS Community Pharmacist Consultation Service (CPCS) in October 2019, as part of the NHS England Pharmacy Integration Programme to ensure people see the health professional appropriate for their needs.

The aim of the service is to improve access to primary care by referring patients requiring advice and treatment for certain minor illness conditions from a GP practice to a community pharmacist, ensuring that patients have access to the same levels of care, close to home and with an emphasis on self-care.

This new service can support general practice to ensure patients are seen by the right healthcare professional, in the right place, at the right time and will help make more GP appointments available for those with higher acuity needs.

Key benefits and outcomes

• 1,034 consultations were completed over a six-month period in the initial phase in Darwen by referring patients from three practices to eight participating pharmacies, saving the equivalent of 68 GP sessions;
• a further phase extended the service to two complete integrated care board footprints, bringing together more than 40 pharmacies and 25 general practices in Knowsley with 150,000 patients and 47 pharmacies and 27 general practices in Blackburn and Darwen covering 148,000 patients and involving six Primary Care Networks;
• the practices, pharmacies and patients involved have seen the service as a huge positive and pharmacies adjusted their business models to handle the influx of referrals;
• the service offers effective clinical care with a pharmacist for people with minor illnesses as part of a coordinated service with the patient’s GP, with very high rates of patient satisfaction;
• patients get a consultation and clinical advice the same day the practice makes the referral to CPCS; and
• uses a secure digital process to send electronic referral messages from GP practices to community pharmacy and for post consultation feedback from the pharmacy to the practice.

Background

Practices were keen to start using the GP referral pathway to CPCS as it promotes the role of community pharmacy as the first point of call for advice for minor health concerns. The service reinforces that pharmacists are highly qualified, trusted clinicians who can be accessed quickly and conveniently by patients, to have their minor illness symptoms assessed and a clinical decision taken on next steps.

Partners were NHS England North West Region, Community Pharmacy Lancashire, CCG medicine management pharmacists, GP teams and PCNs.

The aim was to create a sustainable and resilient long-term model for GP referral to CPCS delivering care within the general practice framework.

Results and outcomes

The North West region has found GP referral to CPCS has the potential for 6-8% of practice appointment capacity to be effectively directed into community pharmacy. Following the success of introducing the new pathway, the service is now being expanded into 30% of the primary care networks across the whole of the North West by Autumn 2021.

Training resources have been provided to both pharmacy and GP colleagues to ensure patients get seen by a clinician that best suits their needs. Pharmacists are already trained in managing minor illnesses and providing health and wellbeing advice, using the NICE Clinical Knowledge Summaries to support recognition of ‘red flags’ during the consultation.

In addition to nationally produced resources, further resources are being developed locally to underpin the service delivery and ensure high quality outcomes, incorporating consultation skills development, understanding the integrated urgent care pathway and clinical leadership.

Ann Neville, Practice Manager Lead at Darwen Primary Care Network describes the benefits to local practices by referring patients to CPCS:

“The practices in Darwen were already familiar with care navigation and we were keen to see how implementing CPCS could help us to extend it. Our care navigators found the new process slightly more time consuming initially – as with any new way of working – but quickly picked up speed and the practices started to see the benefits of CPCS, in terms of better use of practice appointments for complex care and referral on to the pharmacists appropriately, particularly during the winter months.

“GP referral to CPCS has allowed us to build our working relationships with our community pharmacy colleagues and patient feedback has been excellent. Receipt of the Pharm Outcomes notification of treatment allows the patient record to be updated and is readily available should another clinician be involved in their care.”

Bruce Prentice, Project Lead and Clinical Advisor to NHS England North West Region said: “General practices and community pharmacies have rapidly changed how they provide patient care to deal with COVID-19. The demand on general practice is highly likely to increase as services are restored following the second wave and having the capability to direct patients to local community pharmacists is crucial going forward”.

Tahir Hussain, Management Support Pharmacist at Cohens Chemist and PCN Lead Community Pharmacist Darwen PCN explains how the service has been extremely well received by patients and GPs alike: “All the patients I have seen have said what a wonderful service this is. They were very happy to be seen by a pharmacist on the same day for a minor illness concern. Around 6-10 patients a day are being referred to us from their practices and the service we offer is flexible and convenient and we have either spoken to patients on the phone –  since the start of COVID-19 – or they can pop in to the pharmacy at a time to suit them.

“I am in regular contact with the practices and if I do hold a consultation with someone that I think does need to see their GP, I call the practice direct and get them booked in for later that day”.

Dr Mohammed Umer, GP at Darwen Healthcare and Clinical Director Blackburn with Darwen Primary Care Networks, said: “The GP referral to CPCS pilot in Darwen has supported our GP practices to refer our patients to a high-quality service, ensuring patients receive same day access to care from a trained community pharmacist. Consequently, as a GP, I have been able to focus my time on seeing more complex problems and helping people who really do need to see a GP”.

Take away tips

1. Start by exploring how primary care colleagues view the role of community pharmacists within a PCN;
2. Discuss how GP referral to CPCS can work across the PCN to share ideas with a view to expand the use of community pharmacists;
3. Once the service is up and running, share data on service referral rates and results of good outcomes and best practice; and
4. Visit the dedicated GP CPCS page on Future NHS for resources and templates to support practice staff to work in their PCNs to implement the service.

For more information about GP Referral to CPCS in the North West, please contact Bruce Prentice, Clinical Advisor, NHS England North West Region: bprentice@nhs.net.