Backed by £4.5bn of NHS England funding, the rollout of primary care networks (PCNs) is now well underway, with community pharmacies poised to play, according to the Government, an “essential role” within them.
Building on the core services available from healthy living pharmacies, for instance, NHS England sees the initial priorities for community pharmacy engagement in PCNs to be supporting the provision of integrated urgent care services, such as NUMSAS and DMIRS (or local equivalents) and contributing to the prevention agenda, such as provision of public health interventions and services.
Locally, other priorities may be agreed with PCNs depending on need, which may initially include optimising and building on the provision of existing pharmacy services.
Although most decisions on how pharmacy will be utilised within PCNs are yet to be decided, PSNC advises community pharmacy teams to consider how they can develop or enhance their relationships with other local health and care providers, particularly GP practices, who are in the driving seat.
With a focus on providing clinical services, contractors wanting to get ahead of the game can draw inspiration from a host of innovative initiatives yielding successful results in the north-east.
In early 2019 Sunderland CCG led the development of the All Together Better Alliance, which includes the CCG, local authority and healthcare providers working together to transform out-of-hospital services.
Community pharmacy has become one of the key stakeholders within the alliance, involved in the design of the model for clinical pharmacy services in primary care networks in Sunderland. As well as the design, community pharmacy will be involved in creating shared posts and integrated professional networks across the system.
Ewan Maule, head of medicines optimisation at Sunderland CCG, says the aim is to create a staffng structure to support a “PCNplus model for Sunderland”, which will have, among other things, “a range of skills at all levels of the pharmacy portfolio to provide appropriate career and development pathways to retain staff, and a unifed integrated team per PCN to deliver all elements of the pharmacy portfolio. This includes medicines optimisation work for that PCN, with wider collaboration across the other PCN pharmacy teams in the city”.
With a broad patient stretch across the whole Sunderland population, Maule says any pharmacy or pharmacist thinking of getting involved should speak to their CCG medicines optimisation lead as well as the PCN clinical director.
NHS 111 referrals mean patients now see community pharmacy as part of the NHS in the same way as a GP
Following a successful 18-month pilot in the northeast, NHS England has extended the Digital Minor Illness Referral Service (DMIRS) scheme to London, Devon and the East Midlands, to help reduce pressure on urgent GP care and A&E departments.
Part of a Pharmacy Integration Fund work programme, the service enables NHS 111 call handlers to refer patients to community pharmacies for advice and/ or treatment for low acuity conditions including rashes, constipation, diarrhoea, vaginal discharge, sore eye, mouth ulcer, failed contraception, vomiting, scabies and ear wax.
Over 390 pharmacies across Durham, Darlington, Tees, Northumberland, and Tyne and Wear originally took part in the scheme, which was run by the NHS in partnership with local pharmacy contractors and the North East Ambulance Service (NEAS). The scheme saw 26,000 referrals made to community pharmacists. An assessment of the north-east scheme found that within the pilot area, minor illness cases being referred to GPs from NHS 111 fell from 70 per cent to 40 per cent.
Ann Gunning, head of services and support at North of Tyne Local Pharmaceutical Committee, says that what made the scheme work so well was engaging the NHS 111 call handlers themselves. “This not only involved explaining what the DMIRS service was meant to do, but also what community pharmacy is capable of, so call handlers were comfortable referring patients there.”
This “formal referral” of patients to community pharmacy by the call handlers has really made a difference, she says, “as it has meant patients now see community pharmacy as being part of the NHS in exactly the same way as a GP, which many didn’t before – so much so that this explanation of the role and ability of community pharmacy is now part of standard training for all 111 call handlers”.
The LPC is keen to hear from other contractors who would like to get involved. In the meantime, 14 community pharmacies in the region are getting ready to deal with a further inﬂux of patients from the newly launched DMIRS GP pilot, which works in exactly the same way but with patients being referred electronically from their GP practice rather than from NHS 111.
The DMIRS GP scheme is similar to the GP2Pharmacy pilot that was launched in 35 community pharmacies in South Tyneside in January, which enables GP reception staff to book fxed time appointments for suitable patients (depending on symptoms and conditions) at their local pharmacy as opposed to waiting for an appointment with their GP.
Suitable patients have a consultation with the pharmacist and provision of advice and/or medicines is supplied through the locally commissioned minor ailments scheme with PGDs in place, as well as signposting or referral back to the GP as appropriate.
The GP2Pharmacy pilot runs until September, offering 8,000 pharmacy appointments at around 30 locations in South Tyneside, including some weekend slots.
In the north-east and north Cumbria alone, prescribing readily available OTC medicines costs the NHS £6.64m every year – the equivalent of paying for 440 breast cancer treatments or 6,579 Alzheimer’s drug courses.
My Medicines My Health was developed by CCGs in the region in an attempt to reduce unnecessary pressures and strain on the NHS. The campaign’s aim was to inform the public of simple and easy-to-follow health advice in order to reduce prescribing pressures and spread seasonal health messages, particularly over the peak summer and winter months.
Campaign materials were distributed to all pharmacies, walk-in centres, A&E departments and GP practices across the north-east and north Cumbria. So far, the initiative has seen over £1m saved on the prescribing of products for hayfever and simple pain relief alone, between April 2018 and March 2019.
PSNC’s resources and guidance to support LPCs and community pharmacy teams get involved in local PCNs.