Since their introduction, directly acting antivirals (DAAs) for hepatitis C (HCV) have been provided through specialist commissioning in most regions due to their cost.
However, Scotland has been providing HCV drugs through community pharmacies for many years and the recent publication of the Dundee DOT-C trial has shown that utilising the established relationship between community pharmacists and people who inject drugs (PWIDs) can increase patient engagement with therapy.
So what progress is being made in England regarding collaboration between NHS England, the British Association for the Study of the Liver and the British Hepatology Pharmacy Group (BHPG)?
If we are going to realise the WHO goal of eliminating HCV worldwide by 2030, and NHS England’s goal of doing this five years earlier, we need to look at more innovative ways of working.
That is why we are scoping new ways of working within drug treatment centres and homeless hostels to enable treatment to be started as soon as the patient is diagnosed and the duration of treatment to be adjusted later.
Where we have faced challenges include the restriction on the number of patients per month that can be treated (and the financial costs associated with this) and how to manage stock in a pharmacy when the first- and second-line treatments change on a six-monthly basis. We are hoping that by the autumn, we will be able to work more closely with our community pharmacy colleagues.
We need to find the patients who do not know they have hepatitis C, engage them to seek care, and retain them in care. We recognise that, for these patients, healthcare is not their primary concern, but know they use their community pharmacy every day.
Obstacles nationally include the cost of the drugs and how these can be purchased by community pharmacies without breaking the bank, and how hepatitis C management can be changed from being a secondary care commissioned service. Another factor would be payment for the enhanced service community pharmacies would be expected to provide.
This is why it is key that LPCs are involved in all negotiations at a local level to ensure that services are costed accurately.
One other major factor if HCV patients are to be treated in community pharmacy is the education of the whole team. We are therefore working with pharmaceutical companies, BHPG, UKCPA and LPCs to scope what the educational requirements will be, and we are also in discussion with CPPE and other educational institutions to look at how we make this training accessible.