Pharmacy First is primarily a service to support and improve self-care.

Transcription

1 Self-Care Service The Pharmacy First service is commissioned by to provide the local population with rapid access to a pharmacist who can give self-care advice on a range of minor ailments. This will release capacity in general practice and provide an appropriate alternative to the use of general practice or other health care environment (i.e. A&E, Out of Hours Urgent Care). Pharmacy First is primarily a service to support and improve self-care. Cough Cold Earache Sore throat Threadworms Teething Athletes foot Thrush Hay fever Fever Blocked nose Sprain or strain Cold Sores Bites and Stings When referring patients to a pharmacy, GP practices should not give patients the expectation that medication will be supplied. Advice will be given. Medication may be supplied, but this is the decision of the pharmacist. 1

2 Contents List of patient eligibility and common exclusions for Pharmacy First p1 of Frequently Asked Questions... 5 Aims of the Pharmacy First service... 7 Target patients/diversion from usual services... 7 Promotion of the Service to Patients... 8 Medication supply via Pharmacy First... 9 Minor Ailment Consultation Referral for urgent appointment Referral for non-urgent appointment Diagram of Pharmacy First Options Notifications Vulnerable patients Cost to NHS/ Tips for a successful service APPENDIX 1- Notification APPENDIX 2- Formulary

3 List of patient eligibility and common exclusions for Pharmacy First p1 of 2 Patient Eligibility Information Patients must currently have one of The pharmacy will not be able to provide the service where the the minor ailments listed below. patient does not currently have the minor ailment. E.g. Paracetamol cannot be supplied for infants following immunisation just in case they get a temperature later in the day Patients must be exempt from prescription charges to receive medications free of charge. All patients are eligible to receive advice. Patients must be able to attend the pharmacy in person. Those under 16 must attend accompanied by the parent or guardian. Patients must not be sent to the pharmacy with a request for a specific medicine. All of the products included in Pharmacy First are cheaper to buy over the counter than a standard NHS prescription charge. Pharmacists can only treat Pharmacy First patients who attend the pharmacy in person. The pharmacist will decide if a medicine is required and will determine the treatment / medicine requirements of the patient. Patients who require specific medicines / need a repeat prescription for a medicine should see the GP. Condition Athletes Foot Bites and Stings Blocked nose / Nasal congestion Cold Cold Sores Cough NB: No medication will be supplied for a cough Earache Hay fever Exclusions Patients with an exclusions should be offered a GP appointment Diabetic patients Severe athletes foot Secondary infection Patients under 10 years old Secondary infection Recurrent nose bleeds No medication available for children under 3 months old Very high temperature (fever) of 39 C (102.2 F) or above Cold sores around the eyes Genital herpes Secondary infection Asthmatics with a wheeze Chronic bronchitis Difficulty in breathing Blood (rusty red) in sputum Cough for over 3 weeks duration Children under 3 months old Earache lasting more than 24 hours despite pain relief e.g. paracetamol or lasting more than 48 hours Patients under 2 years old Pregnancy Patients with a repeat prescription for hay fever medicines 3

4 List of patient eligibility and common exclusions for Pharmacy First p2 of 2 Patient Eligibility Information Patients must currently have one of The pharmacy will not be able to provide the service where the the minor ailments listed below. patient does not currently have the minor ailment. E.g. Paracetamol cannot be supplied for infants following immunisation just in case they get a temperature later in the day Patients must be exempt from prescription charges to receive medications free of charge. All patients are eligible to receive advice. Patients must be able to attend the pharmacy in person. Those under 16 must attend accompanied by the parent or guardian. Patients must not be sent to the pharmacy with a request for a specific medicine. All of the products included in Pharmacy First are cheaper to buy over the counter than a standard NHS prescription charge. Pharmacists can only treat Pharmacy First patients who attend the pharmacy in person. The pharmacist will decide if a medicine is required and will determine the treatment / medicine requirements of the patient. Patients who require specific medicines / need a repeat prescription for a medicine should see the GP. Condition Headache Oral Thrush Sprains and strains Sore throat Teething Temperature / fever Threadworms Vaginal/penile thrush Exclusions Patients with an exclusions should be offered a GP appointment Children under 3 months Recent head injury within the last 14 days Slurred speech or confusion in patient Children under 4 months Pregnancy Severe pain Pain with no obvious cause Sore throat that has persisted for more than one week Patients unable to swallow Children under 3 months old Children under 3 months old Temperature associated with a rash (unless mild) Patients with confusion Patients with repeated vomiting High temperature (fever) of 39 C (102.2 F) or above Patient with epilepsy Pregnancy Children under 2 year old Patients under 16 years old Patients over 60 years old Pregnancy Patients who have not previously had thrush e.g. first infection diabetic patient 4

5 Frequently Asked Questions What s in it for me? The Pharmacy First service can help GP practices manage demand for appointments in patients presenting with a minor ailment included in the service. It better uses the resources of the NHS and the skills of the pharmacist. How will I know which pharmacies are offering this scheme? Most pharmacies within West Wakefield will offer the Pharmacy First service. An up to date list will be available on the West Wakefield website. How is this different to advising patients to visit their pharmacy? Patients using the Pharmacy First service will have a consultation with the pharmacist, who will provide structured advice as specified by the service. This includes a strong self-care message and information such as expected duration of symptoms, what's normal and when and where to go for further advice and the management of future minor ailments. When appropriate the pharmacist will also provide printed information about the aliment. Patients who are exempt from prescription charges and who need treatment from the Pharmacy First formulary will receive the treatment free of charge from the pharmacist as part of this service. What do I do if the patient has already visited the pharmacy? Patients may present at the GP surgery following a Pharmacy First appointment for several reasons: If the pharmacist determines the patient s symptoms indicate the need for a non-urgent consultation with the GP (e.g. the patient has accessed Pharmacy First for the same condition on several occasions), the pharmacist will advise the patient to contact the GP surgery and request a non-urgent appointment Where a pharmacist feels the patient needs to see a GP urgently the pharmacist will contact the surgery directly Patients may present at the surgery as they have not been supplied with the medicine they wanted (pharmacists will only supply medication when needed from a limited formulary) Practices are requested to be mindful to reinforce the key messages of the Pharmacy First service, such as antibiotics are not routinely required for coughs and colds and cough medicines have limited evidence that they are effective. For example, a patient may re-present at the surgery with a cough as they are not happy that they have not been supplied with a cough medicine from the pharmacy. Where this is the case, and there is no rationale for treating the cough, the surgery should reinforce the message that cough medicines are not routinely supplied on the NHS as there is little evidence that they work. The surgery may wish to back this information up with the cough leaflet. This will help to prevent the undermining of the pharmacists advice supplied to the patient. 5

6 What do I do if a patient doesn t want/ refuses a referral to pharmacist? The Pharmacy First service is optional. Patients who do not wish to use the service can access medical care via the usual routes. How will I know if a patient has already consulted a pharmacist under this scheme? The GP surgery will be sent a Pharmacy First notification outlining the consultation. The notifications will be sent to the practice nhs.net account and will usually be with the practice within 48 hours of the Pharmacy First consultation. In what circumstances would a pharmacist refer back to a GP? If a patient presents with symptoms indicating the need for an immediate consultation with a GP, the pharmacist will contact the patients GP directly to arrange an appointment for the patient. The decision to make a referral will be made by the pharmacist as, in their professional opinion, this is the best course of action for the patient. If a patient presents with symptoms indicating the need for a non-urgent consultation with the GP, the pharmacist will advise the patient to contact the GP surgery and request a non-urgent appointment. What if we do not think the referral is appropriate? Direct communication between GP surgeries and local pharmacies is key. Contact the pharmacy to discuss the rationale as to why a patient was referred back to the GP. In turn, the pharmacy may contact the GP surgery to discuss the suitability of patients signposted to the pharmacy by the GP practice. How and when will the leaflets to support this service be made available to GP Practices? Copies of all the leaflets can be found on the West Wakefield website and are available to download in pdf format. A resource pack will also be given to practice representative at the September Council of Members meeting. Copies of the resources available are included at the end of this guide for reference. 6

7 Aims of the Pharmacy First service The Pharmacy First service is funded by. The service is aimed at those patients who do not currently self-care / purchase medicines OTC but who use GP or Out of Hours services when they have a minor ailment. It is hoped that this service changes patient behaviours, educating and assisting patients in how to access self-care and the appropriate use of healthcare services. The service is commissioned from a limited budget, for a specific target group and GPs and practice staff have a responsibility to ensure that the service is used as intended. Aims of the Pharmacy First service Release capacity in general practice. To provide the local population with rapid access to a pharmacist who can give advice on, and treat where necessary, a range of minor ailments. Be an appropriate alternative to the use of general practice or other health care environment (i.e. A&E, Out of Hours Urgent Care). Allow for improved promotion of self-care through NHS111. Objectives of the Pharmacy First service To provide a service to users who might have otherwise attended their GP or A&E for the treatment of minor ailments. To provide a service outside of normal GP opening hours to reduce the use of GP OOH services. To allow for the redeployment of resources more appropriately in other parts of the wider health economy. Target patients/diversion from usual services It is not intended to divert all patients in West Wakefield onto the Pharmacy First Service. People who usually manage their own minor ailments through self-care and purchase of OTC medication should continue to self-manage and treat their minor ailments. This is stated within the service agreement with the pharmacists who provide the service. Eligible patients must be: 1) Registered with a West Wakefield GP 2) Able to attend the pharmacy in person (for child under 16, the parent or guardian must also be in attendance) 3) Exempt from prescription charges to receive medication free of charge. All patients are eligible to receive advice. 4) Currently suffering from the minor ailment which is included in the service 5) Agree to sharing details of the consultation with their registered GP A notable group of patients who access GP services for the management of minor ailments are those on low incomes as the cost of OTC medicines can be prohibitive for this group of patients. The Pharmacy First service removes the payment barrier when access to Over-The-Counter medications is required for patients exempt from prescription charges. i.e. when the pharmacist determines that medication is required, patients exempt from prescription charges receive medicines free of charge. 7

8 NB Patients must not be sent to the pharmacy with the impression that they will get medication. Medication will only be supplied when necessary, and the formulary available is limited, both in the range of medicines and the quantities that can be supplied. Patients should be informed that they are being referred to the pharmacy for a consultation with the pharmacist who will discuss their condition with them and provide the patient with advice on the condition. Medication may, or may not be supplied. The service can be explained to patients during a consultation for a minor ailment, as the GP/ nonmedical prescriber can inform patients that next time they have a minor ailment they can use the Pharmacy First Service. Prescribers are requested that when they do prescribe medicines for minor ailments that they limit their choice to that of the attached formulary (appendix 2). Promotion of the Service to Patients Both community pharmacies and GP practices must only use the provided posters / support materials. This will ensure that any messages within materials relating to Pharmacy First are consistent and the quality of materials is acceptable. If GP / CP practices wish to produce their own poster / materials the design and use must be approved by before it can be used. It is up to individual GP practices to choose appropriate methods of promoting Pharmacy First to their patients which are in line with their existing practices systems. Ideas may include: a recorded message when patients ring the surgery: "If you are ringing up for an appointment for any of the following conditions...you can use your pharmacy first. They will offer you free advice on how to treat your symptoms and if they feel you need medication to help with your symptoms they can provide this too. If you are eligible for free prescriptions you will not have to pay for the medication. Informing patients that they could access Pharmacy First for their condition as part of the practices existing triage system. If reception staff ask the nature of the consultation they can inform the patient that they can go to their Pharmacy First if the ailment fits the inclusion criteria stated in the GP guide. "Did you know you can go to your local pharmacy for advice and if they feel you need medication they can supply this to you free of charge if you do not pay for your prescriptions. You do not need an appointment you can go any time the pharmacy is open." Information on the repeat prescription counterfoil. (Do not include the phrase 'free medicines/prescriptions'). Information on the waiting room monitor. The images and messages must be taken from existing promotional materials. Do not include the phrase 'free medicines/prescriptions'. Displaying posters in the GP practice Distribution of credit card sized promotional information provided Explaining to a patient during a consultation for an ailment included in the Pharmacy First service that the next time the patient has the symptoms they can use the Pharmacy First. Providing the patient with a Pharmacy First card should act as a prompt for them to remember. 8

9 Participating Pharmacies It is anticipated that most pharmacies in West Wakefield will offer the Pharmacy First service. Pharmacies will display a Pharmacy First window sticker if they are a site offering the Pharmacy First service. will send each practice a list of pharmacies providing the Pharmacy First service and an up to date list will be available on the West Wakefield Health and Wellbeing website. Practices should consider speaking to their local pharmacies to discuss how the Pharmacy Service works and the target patients. GP Practices cannot refer patients to a specific pharmacy, but should hold a list of pharmacies in the locality who are offering the service. Where similar Pharmacy First services have worked well and hit the target audience for the service this has been achieved by strong, ongoing communication between the local pharmacies and GP practices. Dialogue about the patients referred back to the GP, the suitability of patients signposted to the pharmacy by the GP practice and the conditions included in the service has resulted in clear pathways for patients. Medication supply via Pharmacy First Patients should not be directed by the GP practice to ask the pharmacy for a specific medication. The pharmacist will assess the patient, provide advice and, only if necessary, recommend the most appropriate medication. The pharmacy will only supply medication if the patient currently has the minor ailment and treatment will only be supplied if necessary. Care should be taken when referring a patient to the Pharmacy First to ensure that their expectations are managed. Patients are not only being referred to the pharmacy for medicine, but for advice on their condition. Coughs The West Wakefield Pharmacy First service does not include any cough preparations within the formulary. The rationale being there is no good evidence from trials that cough medicines are effective, reduce the severity or length of a cough. Cough medicines are considered to be drugs of limited clinical value and GPs are encouraged not to prescribe them. Additionally the MHRA has stated that cough medicines containing antihistamines, cough suppressants, expectorants, or decongestants should be avoided in children under 6. Patients presenting with a cough to the Pharmacy First service are treated by the provision of information regarding the management of coughs Where a patient presents with a cough, eligible patients can still be sent to the pharmacy for a Pharmacy First service. The patient must not be given an expectation that medication will be supplied as no cough medicine can be supplied to a patient. Patients will receive advice on the 9

10 cough and informed that cough medicines are not available as they are of limited clinical value. The Pharmacy First cough leaflets are available for practices to print and provide to patients. 10

11 Minor Ailment Consultation The Pharmacy First consultation will be recorded by the community pharmacy on a consultation form, this form will include a patient declaration section, including consent to share information with their GP. Practices will receive a GP notification via their practice NHS net account. It is important that mechanisms are put in place to ensure that the practice NHS net address is regularly checked and any notifications received appropriately READ coded and scanned onto the patient record in a timely manner. Full details of the GP notification including the READ code to be used can be found at Appendix 1. The consultation will include: Nature and duration of symptoms Concurrent medication and medical conditions Exclusion of serious disease / alarm / red flag symptoms Identify if patient is pregnant/ breastfeeding Identify any medication already supplied / taken for the minor ailment Expected duration of symptoms, what's normal and probable duration of ailment Self-care messages o What patients can do for themselves o Dispel any misconceptions about visiting GP/ OOH for minor ailment being different from visiting the pharmacy o Where (and when) to go for further advice / treatment if necessary e.g. If the cough lasts for more than 3 weeks visit your GP o When and where to go for further advice and the management of future minor ailments Antibiotic stewardship messages o Discuss with the patient the key messages about antibiotics not being required for viral infections the usual cause of coughs, colds, earache, sinusitis, flu and sore throat o Highlight the potential harms of taking antibiotics such as: Side-effects are common and include diarrhoea, rashes and nausea Potential allergic reactions are possible Antibiotics can kill off normal 'defence' bacteria which live in the bowel and vagina. This may then allow other infections - for example, thrush - to develop Some antibiotics can cause you to be sick if you also drink alcohol and some cause reactions to sunlight Provide printed information. Pharmacy First leaflets on coughs and antibiotics are available for practices to download. Referral for urgent appointment If a patient presents with symptoms indicating the need for an immediate consultation with a GP, the pharmacist will advise the patient and contact the patient s GP / Out of Hours service by phone and arrange an appointment for the patient. If the surgery should receive a request from a pharmacy for an appointment for a Pharmacy First patient the surgery should do their best to make an appointment available as soon as is possible, and preferably on the same day. 11

12 Referral for non-urgent appointment If a patient presents with symptoms indicating the need for a non-urgent consultation with the GP, the pharmacist will advise the patient and refer the patient back to their GP. For example, if a patient presents more than twice within any month with the same symptoms and there is no indication for urgent referral, the pharmacist will consider referring the patient to their GP. The pharmacist will not contact the surgery but advise patient to contact the GP surgery and make an appointment (as per usual care). Diagram of Pharmacy First Options Notifications GP practices will be notified of all Pharmacy First consultations. The notification will be ed to the practice s nhs.net account. The account used is provided to the pharmacy via the CCG. If you wish the notification to be sent to an alternative account then please contact Ruth Buchan (ruth@cpwy.org). Vulnerable patients The NHS Choices website can be translated into over 50 different languages just by clicking the translate button at the top of the page, so you may find this a useful resource for people who don t speak English as a first language. 12

13 Cost to NHS/ When used appropriately, Pharmacy First provides good value for money as patients who usually use the GP for a minor ailment can access the pharmacist, free of charge to the patient, but at a cost of 4.50 to the NHS. Pharmacy First is funded from a limited budget and GP practices must ensure that Pharmacy First is used as intended in the way it has been commissioned. GP practices should not use Pharmacy First to divert patients to community pharmacy for repeat items, even if they are available through Pharmacy First. It would not be appropriate if a patient attending a GP / Independent Prescriber consultation is subsequently diverted to the Pharmacy First service, rather than being issued with a prescription during a consultation. If patients who have seen the GP are then asked on the same occasion to use the Pharmacy First for the supply of their medication then this does not represent value for money to the NHS, as the NHS has funded the GP appointment and then has to fund the pharmacist consultation fee ( 4.50) plus the cost of any medication supplied. Patients can be advised that if they get the same symptoms on a subsequent occasion then they could use their Pharmacy First. Tips for a successful service A team approach will be essential in ensuring the service is successful in your locality. All the practice team, including reception staff, practice nurses and GPs, need to be aware of the service and how it operates to ensure the practice offer the service to relevant patients. Actions Discuss the Pharmacy First service with the team Explain the target patients for the service and the service aims Ensure that staff are aware of the eligibility criteria and common exclusions to ensure that patients sent to the pharmacy can be managed under Pharmacy First Agree how practice staff will signpost suitable customers into the service Contact the local pharmacies to discuss the Pharmacy First service Ensure that all staff understand that the service is not intended to divert patients from OTC sale onto the Pharmacy First service Key Contacts Rachel Urban Pharmacy Coordinator Pharmacy Co-ordinator West Wakefield Health & Wellbeing 30 Queen Street Horbury Wakefield WF4 6LP Tel: Mobile: rachel.urban@westwakefield.org.uk 13 Community Pharmacy West Yorkshire Ruth Buchan Service Development Manager Brooklands Court, Tunstall Road, Leeds LS11 5HL Mobile: Tel: ruth@cpwy.org

14 APPENDIX 1- Notification GP Notification of Pharmacy First Consultation Patient Details Patient Name DOB Patient Address Postcode GP Surgery Minor Ailment Consultation Date of consultation Indication for treatment Second indication for treatment Summary of Treatment decision Medication 1 supplied Medication 2 supplied Medication 3 supplied Community Pharmacy Details Pharmacy Address Contact telephone GP Surgery Action Read code added to patients notes Scanned onto patient notes Pharmacy service (XaC7k) (date scanned) 14

15 APPENDIX 2- Formulary Pharmacy First Formulary Aciclovir 5% cream Loratadine syrup 5mg/5ml (100ml) Beclometasone 50 mcg nasal spray (200 sprays) Loratadine 10mg tablets (30) Cetrizine 10mg tablets (30) Mebendazole suspension (30ml) Cetirizine solution 5mg/5ml (200ml) SF Mebendazole 100mg tablet (1) Chlorphenamine Syrup (150 ml) SF Mebendazole 100mg tablet (4) Chlorphenamine Tablets 4 mg (30) Miconazole 2% cream (30g) Clotrimazole 500mg pessary (1) Miconazole 20mg/g oromucosal gel sugar free Clotrimazole cream 1% (20g) Paracetamol 500 mg Tablets (32) Fluconazole 150 mg Cap (1) Paracetamol soluble tabs 500mg (24) Hydrocortisone 1% Cream (15g) ParacetamolSusp SF 120 mg / 5 ml (100ml) SF Ibuprofen suspension 100mg/5ml (100ml) SF ParacetamolSusp SF 250 mg / 5 ml (100ml) SF Ibuprofen tablets 200mg (24) Sodium chloride 0.9% nasal drops (10ml) Ibuprofen tablets 400mg (24) Lidocaine alone or with Cetalkonium /Cetylpyridiniumteething gel (10/15g) 15