Following on from a successful pilot within BNSSG ICB with GP CPCS, we were involved in an NHSE pilot between November 2021 and June 2023. This involved referring into NHS CPCS from Urgent and Emergency Care (UEC) settings. Initially, the pilot started within South Bristol Urgent Treatment Centre (UTC) and then rolled out to UHBW Accident and Emergency Departments and Clevedon and Yate Minor Injury Units (MIU's).
Aims
• Digitally refer appropriate patients with minor illnesses and urgent repeat medicines supply requests from UEC settings to a consultation with a community pharmacist (CP).
• Relieve pressure on UECs.
• Standardise the pathway for the treatment of minor illnesses across the integrated care system (ICS)
• Educate patients on the role of a community pharmacist.
• Educate patients about self-care.
Method
Patients that arrived at the UEC's with a minor illness were referred formally to the CPCS via a digital referral using a desktop App (Pharmrefer). Only a small number of pharmacies were chosen close to the UEC's (4-5 per site). They were chosen on the location of the pharmacy, engagement with GP CPCS and local PGDs (Patient Group Directives) and opening hours. This enabled the patient to receive a printout of the referral with the details of the pharmacy which not only formalised the process but acted as a reminder to the Pharmacists.
Results
During the pilot 990 referrals were undertaken via CPCS from the UECs to a Community Pharmacist. The most common conditions treated were sore throat, skin rash, earache, UTI, insect bites or stings and red or sticky eyes.
Outcomes were as follows:
Overall, 74% (733) of consultations were completed by the community pharmacist, 17% (168) sign-posted to another healthcare professional or back to the GP for a non-urgent appointment and 8% (79) patients were escalated for an urgent appointment.
Conclusion
Almost 1000 referrals were taken out of the UEC which has helped ensure consistency across the ICS that community pharmacists can treat minor ailments. One of the biggest achievements relates to the improved relationships between the UECs and community pharmacists and understanding each other's roles. In addition, educating patients the scope of minor ailments that a pharmacist can treat.
Learning from the pilot
• It is important that the community pharmacists are already engaged with GP CPCS.
• Engagement from UECs & Community Pharmacists –to ensure they work as a team.
• Regular meetings with the team to understand any issues.
• Review of data and follow up any issues promptly.
• Implementation of local PGDs (eg UTIs, Sore Throat, Impetigo) increased referrals.
• Training gaps identified –Commissioned 30 Pharmacists to receive otoscopy training and developed a PGD for Otomize
• Referral method needs to be simple and provide data.
• The most successful site used the reception team to sign post.
• Escalation out of hours needs to be robust.
• Strong leadership and engagement of LPC/ICB, need implementation time and include face to face training.
