As the new Community Pharmacist Consultation Service goes live, English Pharmacy Board member Andre Yeung, a key developer of the earlier Digital Minor Illness Referral Service, offers his thoughts on how to make it a success.
How did the Community Pharmacist Consultation Service develop?
My good friend and colleague Mike Maguire and I actually started talking about this right back in the summer of 2014. Back then NHS 111 wasn’t really referring to community pharmacy – they mainly sent patients to GP services, walk-in centres or A&E departments. It got us thinking that community pharmacy could do so much more in this space if we only just connected the network up with NHS 111.
After our NHS Pharmacy Integration-funded pilot in December 2017 we’re now presented with a national roll-out this October. It’s taken some time to get to this point, and it took a little bit of convincing about pharmacists’ role, but I believe the future delivery of this service is really important for community pharmacy and the NHS. We’ve had over 28,000 patients referred into community pharmacies as part of our pilot and community pharmacists have done an absolutely astounding job of clinically assessing, advising, treating, managing and escalating patients within an integrated primary care system. 100% – we’re now the first port of call for minor illnesses here in the North East.
Why do you think the CPCS is so important?
My belief is that Community pharmacy developing a role in acute out of hospital care is more important than the sum of all other commission services that have been commissioned through community pharmacy.
Why? Firstly, because acute care is needed and appreciated by patients! Secondly, it doesn’t just disappear if pharmacy doesn’t do it so it’s needed by the NHS too. Thirdly, the size and scale of this is massive. It seems to me a ‘no brainer’ that if pharmacy helps out our GP and nurse colleagues they too would start to argue that the right place for managing patients with minor illnesses is within community pharmacy. Pharmacy can provide patients with excellent access to services and because of our scale can take pressure off NHS colleagues as we head into the busy winter season.
What are the considerations that are needed to enable around a national roll-out?
It’s a big task to get the best out of this service. In some respects, this is business as usual for pharmacists, in others it’s completely different. I don’t think there’s been a more challenging service launch in the history of community pharmacy. As of October 29th we’ll be connected to the NHS in a way that we haven’t been in the past. People will be monitoring and counting on our clinical interventions so we need to ensure the quality of what we deliver is of a really high standard across the board. If we can do that, and I believe we can, then this could be a seminal moment for our profession – a really positive turning point that leads to further developmental opportunities in the clinical arena. How great would it be to achieve amazing results with the spotlight on us like never before?
What message would you give to front-line pharmacists?
These are a few of my top things to remember about CPCS:
- CPCS about YOUR clinical assessment in the pharmacy. Get the info you need and make your own professional clinical judgement as NHS 111 have only done a triage based on what the patient has reported on the phone. A great clinical assessment keeps the patient safe, is rewarding for the pharmacist and importantly helps patients get well as they have the right plan in place.
- Three most likely outcomes of your assessment will be a) you can help the patient, b) you need to escalate the patient or c) you can’t help the patient but you don’t need to escalate.
- Safety net every patient: advice on when to act and how to act if things don’t improve or get worse.
- Keep decent clinical notes in the IT system, for patient benefit and yours.
- When you escalate in hours, most times you’ll need to speak to the GP not the receptionist. You’ll be escalating because you have a clinical concern so it’s only natural you’ll want to communicate this to the receiving GP – it’s both helpful and courteous to do so! Out of hours you’ll be going back to NHS 111 via the healthcare professional line so be prepared to request a referral or support from the clinical assessment service.
- Reflect on your practice. If you need some additional training then sort this out as part of your CPD.
What are my aspirations for the future of the service?
Initially, this is about community pharmacy the sector maximising this opportunity. It’s about us ‘knocking this out of the ballpark’ so to speak. That’s my main aspiration!
If we achieve this then the NHS have already outlined an opportunity to work with GP referrals into community pharmacy for minor illnesses.
In the future, what would be good would be some additional training, access to some POMs and some basic equipment (oximeters, BP monitors, thermometers etc.). This will allow us to see other types of patients as our functionality increases. Why not see patients with suspected UTIs, with impetigo etc? I know my colleagues at the Royal Pharmaceutical Society will be pleased to hear me say that I think the roll out of Pharmacist Prescribers will eventually come on the back of all of this work. We’ll need them as we do more and more in this domain.
It’s all very exciting! Caveat to all of the above? We MUST deliver this first phase of the service well. Organisations need to support our front line pharmacists and pharmacy teams to deliver quality. They absolutely have the capability to do it, they’re amazing, but they will need our help and support to make it happen!