Success of walk-in consultation service led to more funding
A community pharmacy walk-in consultation service (WiCS) in Humber and North Yorkshire has gone way beyond its initial aim of making an additional 6,000 appointments with a community pharmacist available to patients across the regions.
In addition to the NHS Community Pharmacist Consultation Service (CPCS), WiCS offered consultations into which patients self-referred without having had prior interaction with general practice or NHS 111. Consultations followed the format of the national CPCS and contractors were paid the same fee per consultation (£14).
Managed by Community Pharmacy Humber, the service launched in September 2022 with an original end date of March 31, 2023. By the beginning of January 2023, 83 pharmacies in Humber and North Yorkshire had signed up and 70 were actively providing the service, with over 3,000 consultations carried out by that point.
“It was a bit of a slow starter,” says Paul Robinson (pictured), chair of Community Pharmacy Humber, “but began to pick up from about November, and then following the Strep A situation that we saw across the country in December.”
The service was rolled out first in Humber, with North Yorkshire coming on board later. Both areas were up and running by early November, each with a slightly different approach.
“GP CPCS hadn’t really taken off in Humber despite all our best efforts,” says Paul. “GPs just send people straight to pharmacy and we also have a couple of areas where GPs use online triage for their patients, which tends to bypass referral into GP CPCS. So the WiCS was a great opportunity for pharmacists to earn a fee they should have been getting anyway.”
After the first two waves rolled out, the WiCS expanded to out-of-hours late-night pharmacies – of which there are “a lot” in Hull – and then to all contractors who wanted to take part.
Originally set to run until the end of March this year, by February the service had exceeded its 6,000-appointment cap, with 6,095 consultations having taken place – an average of about 400 a week.
“Our original budget was to cover 6,000 appointments but we made the case to NHSE to continue with the service, and they increased the funding and allowed us to carry on for another 13 weeks. This equated to around an additional 5,500 appointments,” says Paul.
Nottinghamshire scheme decommissioned
With the prospect of a national Pharmacy First service in England and the success of local walk-in schemes, the management of minor ailments as a commissioned service in pharmacies has made great strides recently. But it’s not all good news. A long-standing Pharmacy First-type scheme running in 81 pharmacies across Nottinghamshire was decommissioned earlier this year.
NHSE said its decision to close the scheme was due to the service “sitting outside of the national guidance around people taking responsibility for their own self-care and the NHS’s recommendations to GPs that items listed as of limited therapeutic value are no longer prescribed”.
“We were advised early summer 2022 [that the service was being decommissioned] and tried various approaches to keep or review and ideally make it better, but to no avail,” says Nick Hunter, Nottinghamshire LPC chief officer, “and unfortunately it seems to have fallen between the cracks in NHS reorganisation.”
With no direct replacement for the service, the LPC says NHSE has suggested that the Community Pharmacist Consultation Service (CPCS) is an alternative, which is offered by the majority of community pharmacies in Nottingham and Nottinghamshire. However, as the LPC’s letter to contractors pointed out: “CPCS is a consultation service, whereas Pharmacy First [was] primarily about supply of an OTC medicine [and] people cannot access CPCS by walking into a pharmacy without a referral from a practice or 111.”
Nick Hunter warned that the decommissioning will have “far-reaching consequences for patients, especially those in the more deprived communities, which are also the areas with greatest activity.”
An early review of user feedback showed resounding support for WiCS, with 4,192 patients saying they would have gone to their general practice if not for the service, and 758 saying they would have tried to access an out-of-hours service. In addition, 9 per cent of service users in Humber and 19 per cent in North Yorkshire said they would have gone without seeking any healthcare intervention or advice if they could not have gone to the WiCS.
The 4,000 patients who accessed the WiCS in Humber (via 46 contractors) and the 2,000 in North Yorkshire (via 36 contractors) also showed some interesting age demographic differences.
“Thirty-four per cent of patients in Humber were under 13 years of age, but only 15 per cent in North Yorkshire,” says Paul. “I think that’s because our patient base in Humber is used to going to a pharmacy to get minor ailments help for their children as there is a dedicated service there, but North Yorkshire doesn’t have one.”
WiCS offers patients five potential outcomes following a consultation:
- Advice and OTC sale
- Advice and minor ailment treatment supply
- Signposting to GP
- Escalating to urgent GP.
“In Humber only 10 per cent of all contacts resulted in an escalation, whereas in North Yorkshire it was 25 per cent,” says Paul. “For advice only, it was 16 per cent in Humber versus 25 per cent in North Yorkshire.
“Advice and OTC sale was 37 per cent in Humber and 50 per cent in North Yorkshire, and advice and minor ailments supply was 36 per cent in Humber and nothing in North Yorkshire as, again, they don’t have a minor ailment service there, so people are not used to accessing one.”
Our original budget was to cover 6,000 appointments but we made the case to NHSE to continue with the service, and they increased the funding and allowed us to carry on for another 13 weeks. This equated to around an additional 5,500 appointments
Part of the aim of the CPCS is to progress the integration of community pharmacy into local NHS urgent care services, providing a more convenient and effective offer for patients.
Community Pharmacy England says that while CPCS “will remain core” to improving urgent care access in primary care, the availability of self-referral services like WiCS “further enhances the impact that community pharmacy can have to ensure that patients can be seen by the right person, in the right place, at the right time, which in turn increases the opportunity for clinicians in general practice to treat and care for higher acuity and urgent conditions”. It remains to be seen how these services will dovetail with the new national Pharmacy First service in England.
The WiCS service has certainly made GP appointments more readily available by releasing patients seeking help for low acuity conditions, says Paul. “There is no doubt we have saved GP appointments – over 4,000 during the winter – so of course we are all hopeful that there could be a national version of a proper walk-in service.”
As for WiCS, as well as other pharmacy services, Paul says there is plenty of room for expansion. “From the 93 accredited providers for WiCS there are currently 83 active sites, but there are 330 pharmacy contractors in NHS Humber and North Yorkshire Integrated Care Board. We would love to expand access to all our pharmacy services. And as WiCS has been such a good example,we are hopeful of doing this.”
Cornwall service saved 6,000 GP appointments
Community pharmacies in Cornwall have delivered more than 8,000 face-to-face consultations with a pharmacist in a consultation room, without the need for a patient appointment or referral.
Eighty per cent of people who used the walk-in consultation service over 12 months had their symptoms successfully treated on-site. In a post-consultation survey, 100 per cent of patients who were questioned found the service easy to use and were happy with the consultation. Over 6,000 GP appointments were averted. After each consultation, a record was sent to the patient’s GP for information.
“Community pharmacies are already a trusted place for patients to receive clinical advice and intervention,” says Nick Kaye (above), chief executive at Cornwall and Isles of Scilly LPC. “This service builds on that but joins up the consultation by placing full details in the patient’s notes at their GP practice automatically. This allows for fully joined-up care and relieves pressure on GPs, and helps bring much needed funding into community pharmacies after seven years of static funding that is forcing pharmacies’ doors to close.”
“Sometimes we just need to start something and see, rather than wait for something to come along,” says Marco Motta, interim head of prescribing and medicines optimisation at NHS Cornwall. “I am super proud of what Cornwall has been able to achieve over the last 12 months. This service shows what integration and innovation means, with the ultimate goal of supporting our community.”
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It is estimated that up to 11,600 consultations will have taken place by the time the service finishes at the end of this month (June). A bid has been submitted to extend the service until September 30, equivalent to another 26,000 consultations, but is currently on hold while the ICB carries out a clinical review of all local pharmacy services.