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Winter ailments: hitting the target

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Winter ailments: hitting the target

The Department of Health has always struggled to improve flu vaccination uptake in ‘at risk’ groups. With pharmacists in England now offering the NHS flu vaccine, they are ideally placed to target these hard-to-reach patients.

 

Learning objectives

After reading this educational feature you should be able to:

  • Encourage ‘at risk’ groups to take up the offer of a flu jab
  • Understand the thinking behind NHS England’s Stay Well This Winter campaign
  • Encourage customers to self-treat their winter ailments.

 

Last year, in 2014/15, the flu vaccine was given to under 73 per cent of the over-65s, just 50.3 per cent of under 65s in key ‘at risk’ groups and just 44.1 per cent of pregnant women.

The Department of Health says vaccine uptake for adults in ‘at risk’ groups needs to improve significantly this season, particularly for those who are at the highest risk of severe disease and mortality from flu but have low rates of vaccine uptake. This includes those with chronic liver and neurological disease and people with learning difficulties.

All pharmacies in England can now offer a NHS flu vaccine to eligible patients aged 18 years and over, and, with an estimated 1.6 million people visiting a pharmacy every day, they are ideally placed to target traditionally hard-to-reach groups.

“The typical prescribing cycle for medicines to treat long-term conditions means that patients in an ‘at risk’ group will attend a pharmacy up to five times within the flu season for a prescription, presenting opportunities for vaccination,” says Alastair Buxton, director of NHS services at the Pharmaceutical Services Negotiating Committee.

“Many pharmacies are open for longer hours than GP practices, including at weekends, and patients can often walk in for a vaccination without an appointment. Patients can also have the vaccine administered at a location convenient to them, rather than being limited to attending a clinic at their local GP practice.

“Pharmacy groups agree that the implementation of a national pharmacy flu vaccination service is an important step forward. According to PSNC, it makes sense for patients and for commissioners, and shows that messages about the impact pharmacy can have are starting to get through. So pharmacies must make the most of every opportunity.

“Now that this is available nationally, pharmacies can provide a consistent service for eligible adult customers,” says Mahendra Patel, member of the RPS English Pharmacy Board and senior researcher at the University of Huddersfield.

“We are offering a wider choice for patients and a viable alternative to GP clinics. To raise awareness of our extended role, pharmacies need to be putting leaflets in bags when prescriptions are collected or delivered or when staff make an over-the-counter sale. Posters and support materials around the pharmacy are important too.”

Teething troubles

Delays in confirming this year’s NHS flu vaccination advanced service caused significant frustrations and are likely to have affected pharmacy planning and deployment. “A major challenge has been raising awareness among patients who are eligible for the service but have no idea that they can access the flu vaccine from a pharmacy,” says Rekha Shah, chief executive of Pharmacy London and Kensington Chelsea and Westminster LPC.

“If they had known this, they may have been able to access the vaccine earlier, rather than waiting for the clinic at their GP practice or arranging an appointment at a suitable time. Another hurdle was that the national flu service was announced very late this year. Some pharmacies struggled to organise the training and accreditation in time, which put even more pressure on them.”

PSNC has heard from a number of local pharmaceutical committees that have experienced negativity from local doctors and local medical committees. Alastair Buxton suggests that if pharmacists experience negative responses, they should use PSNC Briefing 042/15 to address GPs’ common queries and concerns.

There should be no supply issues related to the commissioning of pharmacy services, for example, since GP practices ordered their vaccine directly from manufacturers earlier in the year, while the risk of ‘double vaccinations’ is low, as pharmacy contractors have to send a notification to the GP practice of patients who have been vaccinated on the same day as the vaccination or the following working day.

“A lot of pharmacies have experienced resistance from other healthcare professionals, particularly within general practice,” says Rekha Shah. “Although the commissioned pharmacy service increases access for patients, the service has not been allowed to fulfill its potential in some areas. Pharmacists work closely with GPs for other services, so it has been important not to jeopardise this relationship.”

Achieving targets

To help the Department of Health achieve its targets, patients need to be identified and this can be done in a number of ways, says Alastair Buxton. “Search your PMR to identify a list of patients who could be at risk by looking at dates of birth and the types of medicines they are taking,” he says.

“Explain the benefits of the service to appropriate patients during medicines use reviews and start discussions with patients presenting prescriptions for the treatment of the ‘at risk’ conditions. You could choose a number of ‘trigger’ medicines to prompt the pharmacy team to discuss the flu vaccination service with patients prescribed those medications, while carers can be identified using the guidance PSNC and the Carers Trust have created.”

While pharmacists are the only members of staff who can administer the flu vaccine, the whole pharmacy team can still be involved to make sure the service runs smoothly and efficiently, from preparing clipboards with the paperwork in advance to encouraging patients to fill out forms when they arrive.

“It is a team effort,” says Mahendra Patel. “Staff on the frontline need to be adequately trained so they can mention it at every opportunity to pregnant women, those with diabetes and other chronic conditions, older customers and carers.”

 

Winter health advice

The aim of NHS England’s Stay Well This Winter campaign is to help people to prepare for the onset of winter and to raise awareness among key risk groups, including older people and those with chronic conditions and respiratory illnesses.

The campaign stresses that keeping warm can help to prevent respiratory illnesses and more serious health problems, such as heart attacks, strokes and pneumonia. Emphasis is also placed on the need for regular hot meals and drinks throughout the day, to keep energy levels up and stay warm.

The campaign urges the public to get a flu jab if they are eligible and to get help from their pharmacist if they start to feel unwell, even if it is just a cough or a cold. Research shows that 52 million GP appointments a year are for minor ailments, such as coughs and colds, even though these symptoms can be treated effectively with OTC medicines.

“Pharmacy teams can support patients as part of NHS England’s Stay Well This Winter campaign,” says PSNC’s Alastair Buxton. “They need to help people manage their minor winter health problems before they become more serious and encourage people to keep their medicine cabinets stocked to support self-care. Pharmacists also need to remind patients to collect their prescription medicines before pharmacies close on Christmas Eve and to make sure patients are taking their prescribed medicines as directed.”

 

Keeping up the momentum

In November, the Royal College of General Practitioners reported that surgeries in England were vaccinating over 100 fewer patients per practice than this time last year, with some family doctors claiming their surgery fridges were full of unused flu vaccines.

Last year’s negative media publicity about flu jabs, coupled with the recent exceptionally mild weather, will have left many patients wondering why they should bother, says Laura Reed, Numark’s service development manager. “This is where pharmacy can make a real difference in getting the vaccination rates up. By having regular discussions with all those patients who are eligible, they can reassure them that having a flu vaccination is still the best protection available.

“They can also access those hard-to-reach groups and patients who may have chosen to ignore the letter from their GP or not have been able to make the appointments given. We all need to work hard to push the service throughout the flu season in order to show why pharmacy should be commissioned again next year.”

It will be interesting to see the different rates across GP surgeries and pharmacies at the end of the season, she says, but it may be difficult to determine how low the vaccination rates may have been if pharmacy had not been involved.

To keep the momentum up, pharmacists need to build the new flu vaccination service into their existing pharmacy routine. “From our experience in London, many people who use a flu vaccine service come back to the pharmacy afterwards,” says Rekha Shah.

“This is an ideal opportunity for pharmacists to discuss other pharmacy services and relevant topics. For example, pregnant women often work until the last few weeks before their due date. During their pregnancy, they may have to take time off for all of their medical appointments, so they appreciate the opportunity to pop into a pharmacy for a flu vaccination. This then builds up a relationship, so they come back for other advice and products.”

Mahendra Patel stresses that pharmacies need to raise awareness of the service within the wider community, not just to pharmacy customers, to access vulnerable groups. “They need to reach out using whatever means they can,” he says. “Work with local businesses, clinics, religious centres and community centres. Some pharmacies are even working with local MPs to raise the awareness of flu vaccinations and pharmacy services, particularly if they can get local media involved.”

Last year, NHS England commissioned London pharmacies to add the pneumococcal vaccine to their existing flu vaccination service. Pneumococcal pneumonia, the commonest type of pneumonia, affects up to one in 100 adults every year in the UK, with over one in five hospitalisations for pneumonia occurring in people under 65 years. Many pharmacies are seeing the value of initiating a private Prevenar 13 vaccination service alongside existing flu clinics.

“Vaccination is a simple, preventative measure that is successful and cost-effective in protecting individuals from preventable diseases,” says Darius Hughes, head of Pfizer Vaccines UK. “The recent commissioning of a national flu service for pharmacy has really opened up the opportunity for pharmacists to show how they can help improve access and uptake of vaccination in their communities. I believe that this is the first of many services that could be commissioned through pharmacies and that there’s an opportunity for pharmacies to add private vaccination services, such as travel and pneumonia, to their service offering.”

 Pharmacy can make a real difference in getting the vaccination rates up

If customers fall ill...

Pharmacy teams are ideally placed to encourage customers to manage many winter ailments themselves. Most people can treat – and possibly prevent – common cold weather-related illnesses themselves, rather than going to their GP.

Colds

Most colds last a week at the most and get better on their own, so customers don’t always need any specific treatment. The main symptoms are a sore throat, nasal congestion and a cough. Some people also experience flu-like symptoms, such as a high temperature, aching muscles and headache.

At the first sign of a cold, pharmacy customers should be advised to drink plenty of fluids and rest as much as possible. If their nasal congestion is particularly troublesome, they could try decongestants, but these shouldn’t be used for longer than a week and aren’t suitable for people with certain medical conditions or taking some medicines. Steam inhalation and vapour rubs may be a suitable alternative, especially for babies, young children or people who can’t take conventional decongestant products. Simple painkillers, such as paracetamol or ibuprofen, can help with any pain and/or fever.

Coughs

Most coughs caused by a cold or flu clear up within three weeks. If customers have a more persistent cough, they should see their GP. There’s no specific treatment for a viral cough, although some people find OTC cough medicines and remedies very helpful for symptomatic relief. A home-made remedy of honey and lemon or a warm drink to lubricate the throat can also be tried.

Flu

Flu symptoms tend to start more suddenly than those of a cold and are usually more severe and persistent. The main symptoms are a fever, headaches, aches and pains, and a dry chesty cough. Flu can make people feel so exhausted that they struggle to get out of bed.

If pharmacy customers are otherwise fit and well, they should be able to ease their flu symptoms with bed rest, drinking plenty of fluids and keeping warm. They could also take OTC analgesics to lower a fever and relieve aches and pains. Customers should see their GP if they are over 65 years old, pregnant or have diabetes or a chronic health condition that affects their heart, lungs, kidney, liver or immune system.

Sore throat

Most sore throats are caused by a viral infection, rather than bacteria. They usually clear up on their own within a week. If people are finding it painful to swallow, they could take/use OTC analgesics/sprays or suck on lozenges, hard sweets, ice cubes or ice lollies.

Gargling regularly with an antibacterial mouthwash or warm, salty water can reduce any swelling and inflammation. Customers should be advised to avoid hot food or drinks as this can cause further irritation.

Norovirus

The winter vomiting bug causes sickness and diarrhoea for a couple of days. Some people may also have painful stomach cramps, fever, headache and aching limbs. At the first sign of symptoms, customers should have plenty of drinks (water, squash or fruit juice) to avoid dehydration. They will need to drink more than their usual daily amount.

If they are struggling to keep anything down, taking small sips regularly should keep them hydrated. High-risk groups, such as young children and the elderly, may benefit from using oral rehydration sachets. Paracetamol can help ease aches and pains and reduce a fever. If customers feel like eating, they should choose foods that are easy to digest, such as soup, rice and pasta.

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