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Think PharmacyMinor Ailments
Service
March 2015
Welcome
Housekeeping
Agenda• Introduction • Background• GP Perspective• NHS Contract – Next Steps• Conditions and Treatments• Delivering the Service• PharmOutcomes Demonstration• Q&A
Thanks to our sponsors
Lundbeck UK and Teva UK
Jasmeen Islam Deputy Head of Medicines Management, NWCSU
Mark Green GP, St Hilary Brow Group Practice
Sarah Boyd-Short Commissioning Support Manager – Contracts & Delivery
Nicola Bradley Community Pharmacy Manager for the Wirral Minor Ailments Scheme
Nick Thayer Community Pharmacist, Well Pharmacies, Eastern Cheshire
Kevin Noble Pinnacle Health Partnership LLP
Speakers
Introduction and Background
Melanie Carrol
Contractor support and Service Development PharmacistCommunity Pharmacy Cheshire and Wirral
How did we get here?
• West Wirral Minor Ailments Service
• Opportunities to work together
• Urgent Care Board Paper
Additional challenges
• Merger of LPC’s
• Merger of CCG’s
• NHS contract
Working GroupCCG Ian Stewart, Sarah Boyd-ShortGP Hannah McKayCSU Nicola Bradley, Jasmeen IslamLPC Melanie CarrolLPN Suzanne AustinOthers stakeholders when needed
Where are we now……• NHS Contract
• Service Specification
• Level 1 Protocols
• Level 2 PGD’s
GP PERSPECTIVE
Dr Mark Green
Jasmeen Islam
Deputy Head of Medicines Management
NWCSU
March 2015
National Drivers
Five Year Forward View
•Investing in building the public’s understanding that pharmacies can help them deal with coughs, colds and other minor ailments
Community Pharmacy Manifesto
• 5 pledges• Encourage patients
to think ‘pharmacy first’, and use pharmacy to help relieve pressure on GPs and emergency departments
Community Pharmacy- helping provide better
quality and resilient urgent care -NHSE
• Better integrate pharmacy into the urgent and emergency care system
• self-management of minor ailments
Example mapping of prescribing: fever & pain in children
Example mapping of prescribing: hayfever
JSNA
• There is currently one pharmacy for every 3,402 residents, which compares extremely favourably to the national average of one pharmacy for every 5,000 resident population.
The cost of treating a patient with a minor ailment in an A&E department isa) Twice as high
b) 3.5 times as highc) 5 times as high
than the cost of treating the patient in a pharmacy
Statistics…
The cost of treating a patient with a minor ailment in an A&E department is
five times higher than the cost of treating the patient in a pharmacy
Coughs and sore throats cost the NHS an extra £1.1 billion a year when patients are treated in Emergency Departments or
GP surgeries(source: RPS)
Patient experience is high on the agenda nationally and locally
Further Context
• Nigel Mathers, the honorary secretary of the Royal College of General Practitioners:
‘“sensible” that community pharmacists, and not over-stretched GPs, should be the first port of call for common ailments.
Such a move .. would take pressure off the demand for a GP appointment and leave more time for doctors to deal with more complex consultations’
Future Travel…
• National Minor Ailment Service – much discussion…
• National exploration of co-commissioning of community pharmacy services:
potential for future years
• RCGP / RPS collaboration
• RPS video – Minor Ailments
NHS Contract – Next Steps
Sarah Boyd-Short
Commissioning Support Manager – Contracts & Delivery
0151 651 0011 (ext 1790)[email protected]
GOVERNANCE AND REGULATORY
Full Legal Name
Address
Is this the Principal Address YES/NO
Is this the Registered Address YES/NO
Company Number Authorised Signature Name and Title [ ]
Email: [ ]Tel: [ ]
Provider’s Information Governance Lead Name [ ]Email: [ ]Tel: [ ]
Provider’s Caldicott Guardian
Name [ ]Email: [ ]Tel: [ ]
Provider’s Senior Information Risk Owner
Name [ ]Email: [ ]Tel: [ ]
Provider’s Accountable Emergency Officer
Name [ ]Email: [ ]Tel: [ ]
Provider’s Safeguarding and Prevent Lead
Name [ ]Email: [ ]Tel: [ ]
Addresses for service of Notices
Provider: [ ]Address: [ ]Email: [ ]
Provider Representative Title [ ]Address: [ ]Email: [ ]Tel: [ ]
Conditions and Treatments
Nicola Bradley
Service Provision• 2 distinct levels:
• Level 1 Service • Patient assessment - accredited pharmacist• Provision of P or GSL medicine or appliance • Advice on condition
• Renumeration:• £4.50 per consultation• Formulary tariff for medicines provided
Service Specification• Level 2 Service
• Patient assessment - accredited pharmacist• Provision of a Prescription Only Medicine • Patient Group Direction
• Specified conditions• Specified Criteria
• Communication to patient’s registered GP to advise treatment provided
• Renumeration:• £8.20 per consultation• Formulary tariff for medicines provided
Level 1• 24 Level 1 Treatment Protocols• Adapted from those used in:
– West Cheshire, East Cheshire, Vale Royal, and South Cheshire
• Definition • Inclusion/Exclusion criteria• Treatment Choice• Counselling and Advice• Referral
Level 1
• Clinical Knowledge Summaries
http://cks.nice.org.uk/
• Summary of Product Characteristics
www.medicines.org.uk
• Patient.co.uk
http://www.patient.co.uk/doctor/
Level 1 Conditions Acne Vulgaris(mild) Acute Bacterial Conjunctivitis AllergyAthlete’s FootCold SoresConstipation CoughCystitisDermatitis / Eczema (mild)DiarrhoeaGenital ThrushHaemorrhoidsHeadache, Pain (including Dental Pain)
Hay fever (Seasonal Allergic Rhinitis)Head liceIndigestion and HeartburnMouth UlcersNappy rashNasal CongestionOral candidiasis ScabiesSore throatThreadwormWarts and verrucae
• Cough – Simple linctus
• Cystitis – Lifestyle advice, analgesia
• Dental Pain – Ibuprofen, Paracetamol
• Head lice – Bug busting kit
Hedrin 4% (Second line)
Level 1 Treatment Protocols
Level 2• Adapted from those used in:
– West Cheshire, East Cheshire, Vale Royal, and South Cheshire
• NICE Good Practice Guidance GPG2 (September 2013) https://www.nice.org.uk/guidance/mpg2/resources
• Competency framework: For health professionals using Patient Group Directions
Patient Group Directions
Patient Group Directions (PGDs) provide a legal framework that allows some registered health professionals to supply and/or administer a specified medicine(s) to a pre‑defined group of patients, without them having to see a prescriber.
NICE Competency Framework: For health professionals using Patient Group Directions
Domains Competency areas
The patient consultation Knowledge
Options
Shared decision making‑
Safe and effective Safe
Governance
Always improving
PGDs in context Information
The healthcare system
Collaboration
NICE Competency Framework
Each competency area includes:–a statement that gives a general
overview of what the competency area covers
–a list of individual competencies, referenced to relevant good practice recommendations, where applicable.
NICE Competency FrameworkIndividual health professionals need to consider:
– how they will use the competency framework
– how each competency applies to their scope of practice and individual responsibilities
– what evidence can be collected and documented to demonstrate competency e.g. case studies
Level 2 PGDsAcute Bacterial Conjunctivitis Fusidic Acid Eye Drops
Chloramphenicol Eye drops/ointment
Uncomplicated Urinary Tract Infection in Women Trimethoprim 200mg
Hay fever (allergic rhinitis) Beconase nasal spray
Impetigo Fucidic acid 2% Cream
Migraine Sumatriptan 50mg tablets
Oral candidiasis in infants <2 years Nystatin oral suspension
Uncomplicated UTI in Women
Diagnosis of UTI - Quick Reference Guide for Primary Care https://www.gov.uk/government/publications/urinary-tract-infection-diagnosis
CPPE - Antibacterial resistance - a global threat to public health: the role of the pharmacy team
Uncomplicated UTI in Women
Severe or ≥ 3 symptoms of UTI:• Urgency• Polyuria • Dysuria • Frequency • Suprapubic tenderness
NO vaginal discharge or irritation
Delivering the Service
Nick ThayerWell Pharmacy
Eastern Cheshire
PharmOutcomes
Kevin NoblePinnacle Health Partnership LLP
Sarah Boyd-Short 0151 651 0011 (ext 1790) [email protected]
Nicola Bradley0151 643 [email protected]
Melanie Carrol0752 305 [email protected]
Contact Details
Any Questions?
