By Mark Robinson, pharmacy lead at New NHS Alliance, director The Medicines Management Partnership, and director Connect2Pharma.co.uk.
It may seem silly to talk about winter pressures in the middle of what is turning out to be a hot summer, but that is when planning should happen.
Chris Hopson, chief executive of NHS Providers, said last year “was the busiest winter ever within the NHS”. He went on to say: “The situation is unsustainable, and we must plan now to ensure we don’t put staff and patients under such intolerable pressure next year”.
The King’s Fund has produced reports showing the increased pressure in general practice. The BMA and the RCGP are both worried about how general practice, which is already in crisis, will again cope with another winter. NHS England seems to understand and has promised extra cash through the GP Forward View.
I am reliably told there will be another ‘Pharmacy First’ campaign that will try to explain to the population that they should visit a community pharmacy for a very wide range of conditions before seeing their GP or visiting out-of-hours or even urgent care services.
The NHS Innovation Accelerator programme was launched in 2015. We learnt then that it was all about finding innovation and making sure that it is implemented quickly in the NHS.
The key phrase in its launch was: “The innovations will help to prevent diseases, speed up diagnosis, improve safety and efficiency of services, and increase patient participation in decision-making, self-management and research. This will lead to better health outcomes and a more sustainable NHS.”
In 2016 a Strep A sore throat test and treat service was announced within the programme as a community pharmacy-based service – a service where patients with a sore throat could be diverted from general practice, out-of-hours and urgent care services, and could be managed within community pharmacy.
The patient would be reviewed using current screening tools and then, if appropriate, tested to see whether he or she had a Strep A infection and would benefit from antibiotics. When a GP sees a patient with a sore throat they use their clinical judgement as to whether it is bacterial or viral and whether they need an antibiotic or not. The community pharmacies within this programme would be able to make a diagnosis based on the presence of Strep A in the throat and take appropriate action.
It is critical to use antibiotics only in patients with a proven infection. The programme was hoped to target the 1.2 million GP appointments over a period where winter pressures are extreme.
We know that the OSOM test used in the published feasibility study is easy to use, has very high sensitivity and selectivity – and it is feasible to run a service including this test. The service is just as much about reducing symptoms in individual patients as it is reducing infection transmission.
We also know that Boots has run sore throat teat and treat pilots and about 250 pharmacies launched a private service.
The innovation network has been talking to CCGs, GPs and community pharmacies and have plans to introduce the service more widely (nationally), aiming for a launch in September.
So this is where we are at. We have evidence that the service is feasible and we have ‘on the ground’ experience. Community pharmacy wants to do it – GPs want community pharmacy to do it as it might remove 1.2 million of their appointments over the winter. And patients will benefit from the choice and convenience. We will ensure that only patients with proven Strep A infections get an antibiotic. But will it happen? It might all come down to money.
If the Innovation Accelerator programme means anything to Mr Stevens, Sir Bruce or Mr Hunt – and if they are really worried about general practice and winter pressures – they should remind CCGs that adopting innovation is not an option, but a responsibility.
Pharmacists interested in offering a private sore throat Strep A test and treat service can obtain Sekisui’s OSOM testing equipment through UNA Health via telephone on 01782 575180 or email firstname.lastname@example.org quoting account 7513. Pharmacists should review patients using a Centor or feverpain score and offer a test if there is a reasonable chance that the sore throat is due to a bacterial infection. The whole process from throat swab to test result should take less than 10 minutes, says the company. The OSOM test has a specificity of 98 per cent and a selectivity of 96 per cent, and was used in the feasibility study carried out by Boots as part of the NHS Innovation Accelerator programme. Supporting materials are available from connect2pharma.co.uk.