Policy and Context

Table of Contents

Introduction 2

Background to “Pharmacy First” the Minor Ailments scheme 2

Outline of the scheme 2

Objectives of the scheme 2

Access to the scheme 3

Eligibility for the scheme 3

Conditions covered in the scheme 3

Treatments available on the scheme 3

Accessing Pharmacy First 4

Role and responsibility of practice staff 5

Role and responsibility of the pharmacist 6

Role of Pharmacy Assistants 7

Processing Vouchers at the end of the month 8

Managing Risks 9

Appendix

Appendix A 10

Contact Details of Prescribing Team 10

Appendix B 11

Contact Details of GPs 11

Appendix C 14

Flow chart 14

Appendix D 15

Registration Voucher 15

Appendix E 16

Pharmacy Advice Voucher 16

Appendix F 17

Ethnicity Codes ______17

Attachment 1______Service Level Agreement

Attachment 2______Treatment protocols

Attachment 3______Ethnicity Codes

Introduction

Background to “Pharmacy First” the Minor Ailments scheme

It has been estimated that a significant proportion of all GP consultations (up to 40%) is spent dealing with patients with minor ailments.¹ There is evidence from our pilot scheme that was carried out over a two-year period that many GP consultations for minor ailments can be dealt with satisfactorily by pharmacists.

A minor scheme is important if GP practices are to meet the various targets in the new GMS contract and to cope with the increasing pressure of more and more people being treated in the community. Pharmacy First provides benefits to patients in terms of increasing access and choice in primary care.

Pharmacy First was launched tPCT wide on the 7th June 2004 after excellent evaluation results of the minor ailments scheme pilot conducted in the South East patch of the PCT between June 2002 and June 2004.

So far the scheme has been a great success with 46 pharmacies participating and together saving over 2,500 GP consultations a month. With the introduction of the new Pharmaceutical Services (nPhS) Contract, Pharmacy First is now an enhanced service.

Outline of the scheme

Patients with common self-limiting conditions are offered a consultation with a community pharmacist instead of a GP. The pharmacists are able to prescribe a treatment from an agreed treatment protocol so that patients, who would have normally received their medicines on prescription from the GP, would now receive their treatment from the pharmacist. Patients who are exempt from prescription charges will be able to receive treatment free of charge from the pharmacist.

Objectives of the scheme

1.  Reduction in the time between onset and treatment of symptoms i.e. faster treatment for patients.

2.  Reduction in GP consultations for minor ailments - freeing up time in the surgery.

3.  Better utilisation of expertise and skills of pharmacists.

4.  Increasing patient’s options on where and when they can obtain treatment for minor ailments.

5.  Supporting the Priorities & Planning Framework (2003-06) access target which states that: 'by December 2004, 100% of patients who wish to do so can see a primary healthcare professional within one working day and a GP within 2 working days’. 1

1. GPs recommend OTC medicines for 40% of minor ailment consultations. PharmLife news Jul 2002 Available at www.pharmlife.co.uk

Access to the scheme

On first presentation, patients contacting the GP surgery with one of the listed conditions are offered the option of going to their community pharmacy. If the patient accepts the pharmacy option, then the patient is given a pharmacy registration voucher. Thereafter, the patient will register with one particular pharmacy, and would not have to contact the practice before any future consultations for Pharmacy First.

Eligibility for the scheme

Pharmacy First is open to all patients who have a full (permanent) NHS registration with a GP in Hackney and some parts of the City.

Conditions covered in the scheme

The tPCT, GPs and pharmacists have agreed the list of Conditions, for each of which there is an agreed Treatment Protocol. Pharmacists will have the opportunity to rapidly refer patients back to the surgery if there are any concerns.

Over the last year there have been requests from patients, pharmacists and GPs for more conditions to be included in the scheme. The following conditions have now been agreed as appropriate for inclusion in the scheme and will be available from February 2006.

·  Infective conjunctivitis.

·  Cold sores. (Herpes Simplex)

·  Nappy rash.

·  Warts & Verrucae.

·  Primary Dysmenorrhoea. (Period Pain)

·  Haemorrhoids. (Piles)

Treatments available on the scheme

The scheme covers a limited range of drug treatments. These have been agreed by all of the tPCT, GPs and pharmacists in this area. The scheme is for the treatment of acute, short-term conditions only. Under the scheme patients will be limited to a reasonable number of consultations depending on the condition being treated, after which they would be referred to their GP for re-assessment or continuing treatment.

Accessing Pharmacy First

(See Flow chart appendix C.)

Patients can access the scheme in 2 ways

1.  By telephoning the surgery requesting for a GP appointment.

2.  Walking into a GP surgery requesting a GP appointment.

Ø  The receptionists are trained to ask patients if a pharmacist can manage their condition.

Ø  Patients with minor ailments would then be provided with information about the scheme both verbally and by providing patient information leaflets to those who are in the surgery.

Ø  It is important to note that patients are not obliged to go to a pharmacist instead of having a GP appointment. The scheme should be offered as an option not as an alternative.

Ø  Patients who wish to use the scheme would be provided with a registration voucher (appendix D), completed with details of the patient to take to the pharmacy.

Ø  Patients who have contacted the surgery by telephoning will still have to pick up a completed registration voucher (appendix D) from their surgery before going to the pharmacy.

Ø  Patients who do not wish to use Pharmacy First should be offered a GP appointment in the usual way.

Ø  Once a patient has registered with a pharmacy, they can access the scheme directly without contacting the surgery beforehand.

Role and responsibility of practice staff

Ø  Ensure that receptionist and other staff undertake appropriate training.

Ø  Refer only eligible patients into the scheme.

Ø  Ensure that frontline staff does not discourage patients from getting an appointment with the GP if that is what they wish. Pharmacy First should only be offered as an option.

Ø  Fill in the registration voucher (appendix D) with details of the NHS Number, the name and address of the person for whom voucher is being issued.

Ø  Hand the top copy (pink) of the voucher to the patient and file the bottom copy in the appropriate locked place. These should be kept by the practice for reference/audit purposes. When the pads of vouchers are not in use they should be stored in a locked, secure place.

Ø  Ensure the patient is aware that the pharmacist will need to ask them some questions to satisfy their professional obligations regarding the selection of an appropriate treatment. They will need to show evidence of their exemption from prescription charges at the pharmacy as they do for NHS prescriptions.

Ø  Only issue one voucher per person. The registration voucher is to be used only for the first visit to the pharmacy. Thereafter, the patient can register with a particular pharmacist and receive further advice & treatment under the scheme from the pharmacist without having to visit the surgery first.

Ø  In exceptional circumstances where a patient wishes to re-register with another pharmacy, it is acceptable to issue another registration voucher to the patient. The Prescribing Team at CH tPCT must be informed of such changes within 48 hours.

Ø  Maintain details of registration with Pharmacy First in patient’s notes.

Ø  If GPs require copies of minor ailment consultations, ensure this is officially communicated to the lead pharmacist.

Ø  Treat communication from pharmacists with the right level of importance.

Role and responsibility of the pharmacist

Ø  All patients presenting a pink registration voucher must be seen by the pharmacist. After the first consultation with the pharmacist, the patient must register with that particular pharmacy in order to receive future advice & treatment as part of the scheme. On each occasion the pharmacist must see the patient.

Ø  During the consultation with the patient, complete the conditions (and/or code) reported section on the advice voucher (appendix E). After an agreement has been reached about the treatment for the patient, complete the next section on the voucher.

Ø  If you feel that the patient’s symptoms warrant urgent referral back to the GP, fill the second section of the form giving reasons. Make sure to let the practice know that you have seen the patient. Contact details for all practices have been provided (Appendix B). The third copy of the voucher can be used to notify the practice that you have seen the patient.

Ø  If a medicine is to be supplied via the voucher, complete the next section detailing its name, quantity or code (refer to the Formulary if in doubt as these are the only medicines that will be reimbursed).

Ø  Ask the patient to sign the declaration on the back of the voucher. Reimbursement of the pharmacist for the cost of the product will be based on the assumption that there is a signed and completed voucher with any relevant declarations.

Ø  The point of dispensing check on exemption should be completed as it is for all other NHS prescription forms. If evidence cannot be shown for exemption, the medicine should still be provided free of charge. Mark one of the boxes on the bottom right hand side of the voucher to declare whether evidence of exemption has been seen.

Ø  In case a prescription charge applies, you can take the money or alternatively sell the medicine to the patient if it is cheaper. Mark the ‘paid box’ if medication has been sold. The indication that the patient bought medication should be selected while filling out the voucher.

Ø  Complete the lower parts of the voucher by adding your name, signature, pharmacy stamp and date of supply.

Ø  The pharmacist should see all patients presenting a voucher. Handle the voucher in the same way that you would a prescription for the purposes of dispensing and counselling the patient.

Ø  The pharmacist will ensure correct and timely entry of consultation vouchers onto the Webstar software. Data will be submitted to Webstar across the modem at the end of each calendar month.

Ø  The pharmacist will ensure that all vouchers are kept for at least 2 years.

Role of Pharmacy Assistants

Ø  To alert the pharmacist that a patient is requesting a consultation for Pharmacy First since it can only be dealt with by the pharmacist.

Processing Vouchers at the end of the month

Ø  Consultation vouchers will be input into the minor ailment software by pharmacy personnel. Staff should to ensure accurate data entry in a timely manner for consistency of payments.

Ø  Submission of data to Webstar Health will be made by the 5th day of the following calendar month via a modem.

Ø  No vouchers should be sent to the tPCT for processing. Processed vouchers are to be retained at the pharmacy for at least 2 years.

Ø  Payment for vouchers will be calculated based on the agreement stated in the Service Level Agreement.

Ø  Payments will be made by BACS within a month of data submission

Ø  Webstar health on behalf of the pharmacy department will provide pharmacies with a break down of payments, stating separately the consultation and prescription costs.

Managing Risks

In order to understand, monitor and minimise any risks to patients and staff and to learn from mistakes, near miss and incident reporting, systems must be utilised.

In the event of any ‘adverse incident’ or “near miss”, the pharmacist will complete the Incident and Near Miss Report (IR1) Form and send a copy to the Prescribing Adviser at the tPCT. A copy of the completed form will remain at the Pharmacy.

Any complaints about any aspect of the scheme should also be documented and sent via the same route.

Appendix A

Contact Details of Prescribing Team

All clinical correspondence regarding the scheme should be directed to

Barbara Brese

Prescribing Adviser

Ground Floor, E Block

St Leonard’s

Nuttall Street

London

N1 5LZ

Email:

Tel No: 020 7683 4462

Fax: 020 7683 4464

For Administrative and technical support, contact

Veera Vanapalli

Prescribing Support Technician

Ground Floor, E Block

St Leonard’s

Nuttall Street

London

N1 5LZ

Email:

Tel No: 020 7683 4699

Fax: 020 7683 4464

Appendix B

Contact Details of GPs

Practices in the NE patch

Practices in the NW patch

Practices in the SE Patch