Community Pharmacy Briefing - Direct Access to Chest X-Ray Pilot V20

Community Pharmacy Briefing - Direct Access to Chest X-ray Pilot v20

The CCG is working with a range of partners on a 12 month pilot to evaluate whether the introduction of direct access to chest x-ray by community pharmacists increases early detection of symptomatic lung cancer presented as non-emergency, in the Doncaster area.

The Primary objective:The hypothesis is that through community pharmacy detection of symptomatic lung cancer will be detected earlier and patients will therefore not present at accident and emergency with advanced lung cancer.

The Secondary objective:to diagnose previously undetected lung abnormalities other than cancer.

ELIGIBILITY CRITERIA

40+ smokers or ex-smokers and who have one of the following symptoms not explained by obvious causes such as current lower respiratory tract infection, know heart failure or known cancer etc.

All patients presenting at the community pharmacy who answer yes to one of the following questions:

Cough for three weeks or more
Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss
Coughing up blood (haemoptysis)
Persistent or recurrent chest infections

They will be eligible for further assessment by the community pharmacist.

Community Pharmacist Training

All participating pharmacists will have

(i)skills around ‘sensitively sharing information’

(ii)reviewed the lung cancer awareness training slides from January 2015

(iii)training on the signs and symptoms for referral which will include- respiratory chest symptoms from the Local Lung Cancer MDT lead from DBHFT in July 2015

(iv)attended IRMER training,Understanding the Implications ofIonising Radiationprovided by DBHFT

Listed below are:

the pathway
a list of participating pharmacies and practices
the notification form GP’s will receive from pharmacies when they refer a patient for CXR

Pathway stage

Community Health promotion

/ Be clear on Cancer Lung Cancer 2014
DMBC Public Health Lung Cancer 2014
CCG/Doncaster Rovers, Pharmacies in house promotion and awareness training on signs and symptoms January 2015

Pharmacy Counter staff

/ Counter staff identification – All patients presenting at the community pharmacy for cough medications, nicotine replacement therapy, pain killers, nutritional supplements; collecting prescriptions for respiratory medications such as inhalers; asking advice on smoking cessation or respiratory conditions
40+ smoker or ex-smoker and who have one of the following symptoms not explained by obvious causes such as current lower respiratory tract infection, known heart failure or known cancer etc.
Who answer yes to one of the following questions:
Have you had any of the following symptoms:

Cough for three weeks or more
fatigue

shortness of breath
chest pain
weight loss
appetite loss
coughing up blood ( haemoptysis)
persistent or recurrent chest infections

Refer to Pharmacist if patient has any one of the symptoms above.

Pharmacist

From either:
-Counter staff (2)
-Meds use review
-Inhaler review
-Smoking cessation
-Other 1 to 1 / Confidential consultation
Pharmacist questions to be asked:
40+ smoker or ex-smoker and who have one of the following symptoms not explained by obvious causes such as current lower respiratory tract infection, known heart failure or known cancer etc.

Cough for three weeks or more
Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss
Coughing up blood (haemoptysis)
Persistent or recurrent chest infections

A chest x ray/ GP referral for a chest x-ray will be requested by the community pharmacist.
Discuss:

Pathway below if any one of the above symptoms

Information/advice
Smoking cessation
Inhaler technique review
OTC product

Pharmacists to confirm which GP practice patient is registered with …
Pathway A
Explain to patient what will happen
Screening if patient safe for x-ray (IRMER)
Pharmacists will advise patient to see their GP if they have had a CXR within 1 month.
Complete DA Referral form for chest x-ray
Complete notification form for GP – copy to GP, copy to patient
Record on PharmOutcomes
Patient takes form and has x-ray
Pathway B
Advise patient to see their GP
Complete notification form for GP – copy to GP, copy to patient
Record on PharmOutcomes
Patient visits GP
Pathway C
If patient is registered with a practice which does not appear on the list, pharmacists will verbally advise the patient to see their GP and record on PharmOutcomes. (Do not complete notification form).

/ Timeframe – the x-ray will be reported as ‘Urgent’
The report will automatically go to the patients GP practice and a copy will go to the pharmacist
There will be a code to show that the patient was referred by a pharmacist.

Follow up

/ Any suspicious CXR results will be picked up by the chest physicians as per standard care.
A copy of the CXR result will be sent to community pharmacist and GP. The community pharmacist will NOT be responsible for following up any abnormal CXRs the GP and chest physician will.
The referring community pharmacist will contact the patient one week after the referral and ask the Friends and family test question.
“How likely are you to recommend this service to family and friends if they needed similar care or treatment?”
Any additional comments made can also be captured in the blank text box.
6 month follow-up will be undertaken by Doncaster CCG performance team.

COMMUNITY PHARMACIES and GP PRACTICES

Pharmacy / Area / Locality / Proposed GP practice coverage / Pathway / List Size
Sharp, D & R (Chemists) Ltd / Coliseum Buildings / Bentley / North West / Bentley Surgery (C86023)
Scawsby Health centre (C86032)
Petersgate Medical centre (C86038)
The Nelson Practice (C86613) / A
A
A
A / 7228
5905
8723
3938
Sharp, D & R (Chemists) Ltd / 21 St David's Drive / Scawsby
Weldrick's Pharmacy / Amersall Road / Scawthorpe
McGill, J M Ltd / 125-127 Wath Road / Mexborough / South West / Mexborough Health Centre (C86005)
The New Surgery (C86034)
The Mexborough medical practice (C86605) / B
A
A / 5883
Lloyds Pharmacy Ltd / 24 High Street / Mexborough / 6837
8643
Eightlands Pharmacy TA Pharmacy M / The New Surgery, Adwick Road / Mexborough
Weldrick's Pharmacy / 14 High Street / Carcroft / North West / Carcroft Dr’s group (C86001) / A / 10,699
Chestnut Carcraft Ltd T/A Chestnut Pharmacy / Carcroft Health Centre / Carcroft
Ann Raine Weldricks / 54 Brecks Lane, Doncaster DN3 1JR / Kirk Sandall / Central / Kingthorne (Branch) / A / 9907
Maximum potential population reach / 67,763

Pharmacy to GP Lung symptoms

/
FOR INFORMATION - NO ACTION REQUIRED AT THIS TIME
Pharmacist details: / Patient’s Details:
Name: / NHS No:
GP Practice:
Name:
Address:
Tel No:
DOB: Male / Female (Circle)
Ethnicity:
Address:
Tel No:
Fax No:
Date of notification:
Presenting symptoms
Tick if criteria applies

Age (40+)

Smoker?
Ex smoker?
Order urgent CXR /

Tick if criteria applies

All 40+ smokers or ex-smoker who have one of the following symptoms not explained by obvious causes such as current lower respiratory tract infection, known heart failure or known cancer etc.

Cough

Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss
Blood when coughing (Haemoptysis)
Persistent or recurrent chest infections
Chest x ray form completed, given to patient and copy for GP with this referral form
I have advised this patient to arrange an appointment with your practice
Pharmacist signature ………………………………………………… Date ……………………………………
Branch Code ………………….