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Leaders' panel seeks self-care solutions

The PAGB convened a meeting of pharmacy leaders in December to discuss how effective use of self-care could help alleviate the unprecedented pressures the NHS is facing this winter and beyond.

Opening proceedings, Michelle Riddalls summarised the key findings from PAGB’s 2022 Self Care Survey of more than 2,000 UK adults. 

The survey found that despite 79 per cent saying people should take more responsibility for their own health, over a quarter (27 per cent) still considered it was acceptable to go to A&E and use GP services for conditions that they could treat themselves at home. 

With fewer than half (44 per cent) currently using community pharmacists as their first port of call, Michelle Riddalls said this lack of engagement “is further exacerbated by the system not fully utilising the expertise of community pharmacists and the existence of a number of barriers that prevent pharmacy from playing a bigger role in primary care, including the confidence that people have around digital [communications] and accessing that trustworthy information”.

Panel members

Chaired by Sir George Howarth MP, the panel comprised Anne Joshua, NHSE Head of Pharmacy Integration; Michelle Riddalls, chief executive of the PAGB; Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA); Helga Mangion, policy manager from the National Pharmacy Association (NPA); and Leyla Hannbeck, chief executive of the Association of Independent Multiple pharmacies (AIMp).

Awareness lacking

So what did the panel think was behind the public’s loss of confidence in treating self-limiting conditions?

Leyla Hannbeck said two elements were at play. “One is the fact that a lot of people prefer to get their medicines on prescription because it is free and the other is lack of adequate awareness around self-care. As an ageing population, we all need to step up and take better care of ourselves and use self-care, otherwise the NHS simply cannot cope in the future.”

A quick win that would boost self-care would be “an effective public campaign”, Hannbeck said, while other panellists suggested extra services could help.

“Commission a national Pharmacy First service so patients can be confident that if self-care isn’t the right solution for them, they will still be able to access the NHS care they need from their local pharmacy,” was Malcolm Harrison’s suggestion, while Helga Mangion wanted to see a “seamless pathway for the patient” with a robust process that allows for referral (to/from) community pharmacy as a start. 

“This coupled with commissioned services such as a minor ailments scheme through community pharmacy would also address any unintended consequences of health inequalities.”

Strategy needed

The PAGB is calling for the Government to develop a national self-care strategy that would facilitate improved access to OTC treatments. 

As part of this, PAGB is encouraging the Government to work with regulators to consider what condition areas might be appropriate for reclassification, as well as on better resourcing for pharmacists.

Malcolm Harrison said these were “good ideas”, alongside “work in progress to enable greater access for patients through enhanced digital integration”.

“Enabling pharmacists to have prescribing qualifications, IT read/write access and the ability to refer to another healthcare professional are also realistic ideas that are already happening in some parts of the country”, said Helga Mangion, but she stressed that pharmacies need to be “empowered and supported including appropriate funding to continue providing the complete solution for patients”.

More calls for Pharmacy First

Recognising the Community Pharmacist Consultation Service (CPCS) has had patchy success across the country since its launch in 2019, the panellists backed a more streamlined version to help more patients, as well as a national Pharmacy First service.

Leyla Hannbeck said AIMp was “currently discussing with the Government implementation of a Pharmacy First scheme, which would allow community pharmacies to provide minor ailments services”, while “making it very clear to the Government that this service can only be offered through pharmacies provided that they are adequately funded”.

Malcolm Harrison said the CCA was pushing for a nationally commissioned Pharmacy First service. “We would also like to see CPCS made into a self-referral service, where patients can walk into a pharmacy and receive NHS care that they currently have to contact a GP or NHS111 for.”

Online campaign

Anne Joshua, NHSE Head of Pharmacy Integration, pointed out there was currently a media campaign running online that uses the NHS111 online symptom checker as a sort of “front door” for carrying out self-directed triage. 

“It uses the same algorithms that are in the background of the telephone service and is a pathway for people to refer themselves into the Community Pharmacist Consultation Service for the minor illness symptom categories, so people can go onto the 111 online tool and see community pharmacies that are registered to deliver the CPCS.

“This is a direction that we think is very valuable and for local pharmacies there is no reason why they couldn’t have those links embedded in their own websites or signpost to them themselves.”

Something else that has recently been enabled on the Directory of Services on the NHS website is for pharmacies to enter the details for the blood pressure check service for people aged 40 years and over. “Some more communications will be going out very soon to contractors around this,” Anne Joshua said, “but it will enable a patient or a member of the public to access that service directly and see which of the pharmacies in their area is offering that.” 

Digital transformation

Standardising digital systems could also be set to herald the introduction of read/write access for pharmacists into GP systems.

“Colleagues are looking at the services we’ve commissioned in the national contract, and at new services, and working with IT developers on certain standards so that systems can be developed digitally for pharmacies to then buy licenses to use those systems”, Anne Joshua said. 

“What that then enables is standardising of information across these clinical services, and when those services are delivered that information can then be sent back to GP systems. 

“This would mean that through the CPCS, community pharmacists can write back to the GP record about urgent medicines and also for flu vaccinations. Something that is coming is the ability to do this for minor illnesses, but it takes time to do these things because a lot of what we are doing is very reliant on GP system suppliers to do the development alongside pharmacy – so work is underway and it is a structured programme, but it is going to take a while.”

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