INDEX
PAGE
1. Introduction 2
2. Aim 2
3. Background: Better management of minor ailments 3
4. Rollout of scheme 4
5. Service specification 4
6. Key points for pharmacies 6
7. Key points for surgeries 7
8. Service funding 8
9. Claims for payments 8
10.Termination of service 9
11.References 9
12.Clinical governance implications 10
Appendix 1 Formulary 12
Appendix 2 Generic list of competencies 13
Appendix 3 Consultation form 16
Appendix 4 Patients declaration of exemption 17
Appendix 5 Monthly medicines claim form 18
Appendix 6 Passport 19
Appendix 7 Circumstances in which medicines should not be supplied 21
Appendix 8 Rapid referral form 22
Appendix 9 Consultation decision pathway 23
Appendix 10 Locum guide 24
Appendix 11 Model receptionist protocol 27
Appendix 12 Passport log form 28
Appendix 13 Department of Health publications 29
Allergic rhinitis 30
Athlete’s foot 31
Cold sores 32
Constipation 33
Cystitis 34
Dermatitis 35
Diarrhoea 36
Earache 37
Headache 38
Head lice 39
Indigestion 40
Mouth ulcers 41
Sore throat 42
Threadworm 43
Vaginal thrush 44
Verruca 45
Viral URTI 46
Additional notes you want to make 48
Incident Reporting Form 49
THANKS & ACKNOWLEDGEMENT TO PRESTON PCT AND CENTRAL LANCASHIRE LPC
1. Introduction
1.1 Between 100 and 150 million GP consultations per year are for conditions that are potentially self-treatable1. In addition, the latest research from the Proprietary Association of Great Britain (PAGB) shows that up to 40% of GP time is taken up dealing with patients suffering from minor ailments2. Research shows that the management of self-limiting minor ailments can be successfully transferred from general practice to community pharmacy, and that this transfer reduces GP workload in terms of the number of the minor ailment consultations 1,3,4,5. With this in mind, Chorley & South Ribble PCT has developed a minor ailment scheme called ‘Care in the Pharmacy’. Implementation of the scheme will support the delivery of the NHS plan specifically in relation to reshaping care around patients and making better use of pharmacists’ skills as outlined in the key Department of Health documents: Pharmacy in the Future - implementing the NHS plan, 2000 and A Vision for Pharmacy in the new NHS, 2003.
2 Aim
2.1 To reduce demand for GP consultations by patients with minor ailments and improve access for those who have more chronic illnesses.
2.2 To allow patients access to a selected list of free (if exempt from NHS charge) over the counter (OTC) medicines as an initial step in treating a minor ailment.
2.3 To improve the use of community pharmacists for advice and treatment and raise their profile.
3. Background: better management of minor ailments
3.1 A significant amount of a GP’s workload is spent in dealing with minor ailments that could be successfully treated by a community pharmacist. The reasons why patients would rather consult their GP than a pharmacist could be:
· Some people require the assurance that a GP can give
· If a person is exempt from prescription charges they will get all their medicines free via a NHS prescription while if they self treated in a community pharmacy they would have to buy their medicines.
3.2 The scheme has been developed with the second group of patients in mind in particular (though non-exempt patients are not excluded from scheme) as it will give them access to medicines free of charge at the pharmacy. This will encourage them to visit their local pharmacy for consultation and treatment thereby freeing up their GP’s time to concentrate on patients with more serious complaints.
3.3 The minor ailments included (Appendix 1) have been selected based on:
· Their prevalence in the population
· Availability of OTC medicines for treating them (Appendix 1)
· Willingness of GPs to transfer the treatment of these minor ailments into the pharmacy
3.4 Benefits for patients include:
· Waiting times at GP surgeries are reduced
· Quick easy access to treatment
· The scheme provides an alternative to a GP consultation
· No anxiety about 'bothering the doctor'
· Convenient and prompt local access to healthcare
3.5 Benefits for GPs include:
· Helps GPs meet their Access Targets
· Inappropriate consultations are reduced
· Supports the development of higher quality care for people with long term unstable conditions within general practice
· Allows GPs to take on new enhanced and specialist roles
3.6 Benefits for pharmacists include:
· Opportunity to work more closely with the primary healthcare team
· Makes better use of professional skills
· Improve and increase the profile of pharmacy within the community
· Opportunity to emphasize that pharmacists are an integral part of the NHS team
3.7 Benefits for the PCT include:
· Helps meet Local Development Plan
· Helps meet access targets of 24/48 hours in difficult areas
· Provides a service in under-resourced doctored areas.
4. Rollout of scheme
4.1 All pharmacies and GP surgeries located in the Chorley & South Ribble PCT area will be invited to participate from commencement of rollout.
4.2 Details of all establishments wanting to participate will be available to pharmacies so patients can be fully informed on where they can and cannot access the Scheme.
4.3 Training sessions will be held to fully brief pharmacy staff on details and the important points of the Scheme.
4.4 One representative (preferably the pharmacist) from every pharmacy must attend one training session for their pharmacy to be included in the list of participating pharmacies. It will then be the responsibility of the representative to train their colleagues who were unable to attend.
4.5 Surgery staff will be trained separately. However, all pharmacists are encouraged to brief their closest surgery as this new initiative provides an excellent opportunity for pharmacists to liase closely with other members of the primary healthcare team.
5. Service specification
5.1 All patients registered with a GP in the PCT area are eligible.
5.2 The patients can only access the scheme at participating pharmacies that have registered with the PCT and who are able to satisfy the list of core competencies (Appendix 2).
5.3 Only those medicines that have been included in the list as being suitable to treat the minor ailment can be supplied (Appendix 1). These cannot be supplied outside their listed indication.
5.4 Patients can decline to participate in the scheme.
5.5 Pharmacists need to establish that patients are registered on the list of patients of a participating GP. This can be done by:
· Evidence produced by patient of registration by e.g. producing a repeat prescription tear-off slip, NHS card
· PMR records showing evidence of prescriptions dispensed recently
· Confirmation of registration with a participating surgery by phone if patient has not produced suitable identification. Permission from patient must be sought first.
5.6 If registration details cannot be verified then a supply under the scheme should not be made. The patient should be advised of alternative methods of accessing care.
5.7 A Consultation Form (Appendix 3) must be filled in for each and every consultation. The patient must sign this as confirmation that consultation has taken place. Payment will be withheld if signature is absent.
5.8 The patient must complete and sign the declaration of exemption from prescription charges (Appendix 4) on the back of the Consultation Form or pay the appropriate prescription levy.
5.9 A copy of the Consultation Form must be sent to the PCT at month’s end along with the Monthly Medicines Claim Form (Appendix 5), for audit and verification by the PCT. The pharmacy must also keep the Consultation Form for two years.
5.10 An entry into the pharmacy’s PMR record must be made for each consultation.
5.11 A Care in the Pharmacy Passport (Appendix 6) must be supplied to each new patient entering the scheme. A record must be kept on the Passport Log Form (Appendix 12) of each passport supplied.
5.12 Patients who present with a minor ailment outside the scope of the scheme or for whom the listed formulary product/s is/are not appropriate or contra-indicated, should be advised of alternative methods of accessing care (e.g. OTC sale, routine GP appointment). See Appendix 7.
5.13 If the patient presents with symptoms causing serious concern to the pharmacist e.g. symptoms of meningitis, the pharmacist must implement the Rapid Referral Scheme. See appendix 8.
4
reminder points for pharmacists
· Establish patient is on participating GP list
· Provide passport and record details on Passport Log Form
· Consult with patient
· Complete Consultation Form (both sides)
· Enter supply made into patient’s passport
· Collect prescription levy (if non-exempt)
· Enter medicines supplied on pharmacy’s PMR
· Enter interventions/referral made onto patient’s PMR
· Send copy of all Consultation Forms to PCT at month’s end
· Send Medicines Claim Form to PCT at month’s end
A Care in the Pharmacy ‘Consultation Decision Pathway’ has been included for further clarification. See Appendix 9.
6 Key points for participating pharmacies
6.1 The purpose of the scheme is to reduce appointments at the surgery for minor ailments and is not a free-medicines for all scheme. People should not be actively encouraged onto scheme whilst purchasing medicines. Only those patients that self-refer or those that have been referred from the surgery should be dealt with using the scheme.
6.2 Surgery staff may be doubtful about usefulness of the scheme, as they may not see a reduction in appointments. However it must be emphasised to surgery staff that this is a scheme that reduces minor ailment appointments and not appointments per se as it will free up doctors’ time to see more patients with chronic/serious illnesses. Thus pharmacy staff should liase closely with the surgery staff for increased cooperation and successful outcomes.
6.3 All patients must be present in the pharmacy so direct consultation with the pharmacist can take place. Patients’ carers and/or relatives cannot access the scheme on behalf of patients. Where children are concerned pharmacists must use their own judgement e.g. a child with athlete’s food should be seen but a parent with a child in bed with fever and flu should be supplied with appropriate medicines.
6.4 We do not recommend dispensing medicines from bulk in the dispensary for OTC supply, as a Patient Information Leaflet (PIL) needs to be provided to the patient as a requirement for this scheme (part of its Standard Operating Procedure). Thus an OTC pack should be supplied as standard.
6.5 The fee of £3 payable to the pharmacist is for a consultation that is documented on the consultation form and leads to a supply being made. It is not a fee for OTC counselling (advice and/or referrals) as this is considered to be the pharmacist’s normal practice.
6.6 The fee of £3 payable is per consultation under the scheme and not per minor ailment treated; therefore, if a person requires treatment for a cough & cold plus headache, only one fee will be paid not two, as only one consultation will have deemed to have taken place.
7. Key points for participating surgeries
7.1 Patients presenting in person to the GP surgery (who wish to take part in the Scheme) should be provided with the Patient Information Leaflet stamped by the practice and advised to use the pharmacy where they normally obtain their prescriptions provided that the pharmacy is participating in the Care in the Pharmacy scheme.
7.2 Surgeries should be aware of the need for an effective Rapid Referral Procedure from the pharmacy to be in place.
7.3 GP surgeries should endeavour to advertise the scheme using posters and leaflets provided by Chorley & South Ribble PCT.
7.4 If GP surgeries request a copy of the pharmacy Consultation Form they should record the medication supplied by the pharmacist on the GP electronic patient record or in the patient notes stating the name of the pharmacy providing the service.
7.5 Practices may find the model Receptionist Protocol (appendix 11) helpful in understanding the scheme.
8. Service funding
8.1 The Pharmacy payment structure paid by Chorley & South Ribble PCT will consist of:
¨ Consultation fee £3.00
¨ Medication cost will be reimbursed as agreed in the service specification. These costs have been based on the Chemist and Druggist/Drug Tariff cost price plus VAT (currently 17.5%). These will be updated six monthly.
9 Claims for payments
9.1 Claims for payment should be made by the 5th working day of the following month using the monthly claim form. See appendix 5. Late submission may delay payments.
9.2 The pharmacy should retain the Consultation Form for at least two years and as such should allow Chorley & South Ribble PCT access to these documents as and when required. Breach of this may result in termination of the service.
9.3 Payments will be made by LASCA (Lancashire and South Cumbria Agency) at the end of the month following that to which the payment relates.
9.4 Incomplete forms will be deemed invalid and as such will be returned to the contractor for resubmission, which may delay payments.
10 Termination of service
10.1 Either party may terminate this agreement by providing written notice of their intention to do so. A period of 28 days should be given as notice.
11 References
1. Whittington. Community pharmacy management of minor conditions – the ‘Care at the Chemist’ scheme. PJ 2001 266 425-432.
2. GPs recommend OTC medicines for 40% of minor ailment consultations, PharmaLife news Jul 2002.
3. Hassell, Managing demand: transfer of management of self-limiting conditions from general practice to community pharmacists BMJ 2001 323 146-147.
4. Schafheutle, Direct supply of medicines in Scotland – evaluation of a pilot scheme. Research findings. Scottish Exec 2003.
5. Sheehy & Jones. Direct supply of medicines in Scotland – extended monitoring of a pilot scheme. Research findings. Scottish Exec 2003.
12. Clinical Governance Implications
12.1 Continuing Professional Development
12.1.1 This can be achieved by e.g. completing the CPPE distance learning pack on minor ailments. Thereafter keeping up to date via e.g. Pharmaceutical Journal updates, C&D updates etc. The same applies to front-line counter staff and locums. Updates need to be kept in a labelled folder specifically for them and be accessible to all pharmacy staff. All staff need to be made aware of this information source.