According to England’s chief pharmacist David Webb, around 7,000 Community Pharmacist Consultation Service (CPCS) referrals are dealt with by community pharmacies every week, with GP referrals becoming “the highest volume referral pathway” into pharmacy.
However, the Association of Independent Multiple pharmacies (AIMp) maintains that GP referrals have remained low – although the pandemic and Covid vaccination programmes have potentially distracted focus.
Nonetheless, there are some areas of the country that have taken up the CPCS baton and really run with it. For example, between July 2021 and March 2022, CPCS referrals in Somerset increased from 720 to 1,714 per month.
The 6Es of success
Engineer the programme based on the national service specification with defined process flows and patient pathways for PCNs, practices and pharmacies using the Patient Access, PharmOutcomes or PharmAlarm platforms
to record interventions and outcomes
Engage people and get partnerships in place
Enrol GP practices with PCN-scale onboarding and a formal PCN and practice signup programme with preparation and an info-gathering checklist alongside the appointment of PCN and practice-based champion leads
Educate the ‘care navigators’ (i.e. the GP receptionists) using expert trainers to appropriately and smoothly refer patients
Embed the CPCS process into practice using quantity and quality analysis, as well as weekly drop-in sessions with the implementation team to encourage problem-solving and idea generation, and mop-up training “for the missed”.
Enhance the process with refinements to the platform, and ease and format of data reporting, mapping opportunities for expanding the scale and scope of service, and plan in continuous improvement cycles for the next 12 months.
Taking February 2022 as a snapshot, this approach saw CPCS referrals in Somerset deliver 74 per cent telephone and 26 per cent face-to-face consultations, resulting in:
- Appropriate advice on its own given in 42 per cent of consultations
- Appropriate advice given and the sale of a medicine (26 per cent)
- Patient signposted (18 per cent)
- Patient escalated (9 per cent)
- Appropriate advice given and referral made to minor ailments service [MAS] (3 per cent)
- Appropriate advice given and referral made to a local PGD service (2 per cent).
Getting it right
“The simple aim of CPCS is right patient, right place, right time and right professional,” says Michael, “with the resulting reduction in general practice clinician demand, leading to increased staff morale and long-term patient education about the role of community pharmacy.”
Michael does add a caveat to the success of patient relationship building, pointing out that, “if you have good relationships with patients, they come straight to pharmacy in the first place, which means you don’t get the CPCS referral fee”. The solution, he says, is to have all channels covered by CPCS, “so patients can walk into the pharmacy, but we have also optimised the GP CPCS channel. Whatever route they choose, the patient benefits”.
Straight to pharmacy
Until that multi-channel coverage becomes established, one approach that has worked in Cornwall is a walk-in consultation service, initially commissioned by the CCG between December 2021 and March 2022, in a bid to address what Cornwall and Isles of Scilly LPC called “minimal” uptake of CPCS by practices in the region, yet still triggering a consultation fee for pharmacies.
Patients could be treated for a range of specified self-limiting minor ailments through the service following a discussion with a pharmacist in a private consultation room with no appointment required. Those with red flag symptoms were referred back to their GP.
The CCG commissioned up to 10,000 consultations through the service, although only around 2,500 were delivered during its duration. Nick Kaye, Cornwall and Isles of Scilly LPC interim chief executive and partner at Veor Surgery in Cambourne, is not perturbed. “My view was always to have more commissioned than we could deliver in order to help us find our capacity level,” he says. Indeed, the service has continued beyond the initial three-month window.
Initially paid for through winter pressures funding, NHS Kernow’s director of primary care, Andrew Abbott, gave it the green light to roll on until the end of June. Nick is hopeful it will keep going even beyond then. “We are making a difference to the system and adding value,” he says. “Eighty out of 98 pharmacies are engaged county-wide.”
“When I’m in community pharmacy I’ve also seen an increase in GP CPCS referrals because of the results and feedback we’ve had from the walk-in service,” he continues. “We are now co-creating a business case with the medicines optimisation team so the ICB can see why they should value the service and recommission it.”
Stressing that he doesn’t want to “turn off the GP CPCS pathway”, Nick suggests it can “grow into a better referral pathway for other things we can do, such as the lower acuity work you can move from general practice to community pharmacy via that dedicated referral pathway and linking it into independent prescribing.”
“The aim is right patient, right place, right time and right professional”
Good relationships key
By combining his independent prescribing skills and the services at Kingsdown Pharmacy in Bristol, pharmacist Josh Mallinder has worked out some strategies for success. The pharmacy sees about 30 CPCS patients a month.
“Having a good relationship with your local surgeries will help for starters, as well as being a champion of the service and continuing to plug it,” says Josh. “Minor ailments services are locally commissioned so will differ from place to place, but get on board with those too and let the GP surgeries know you can offer it.
“We couple CPCS with our existing PGDs, so we get the service fee for CPCS but also one for the minor ailments PGD as well. The ‘real time difference’ is what you are providing with CPCS, and it works for everyone when it works – patients, surgeries and pharmacies. This is what
a service should be about.”
The experience in Somerset, Cornwall and elsewhere shows how CPCS can be a success. Contractors who can leverage these ways of working into their existing service provision could find they are making more of the financial and professional rewards that are on offer.