MINOR AILMENTS


there is a health economic argument that that is more cost-effective. And it’s better for patients. The additional cost in terms of any prescribing is going to be small in comparison with the cost of, say, an A&E visit.


The success of this will be down to whether we can change the public’s mindset to make them aware that pharmacy can do this for them, and then see how they can access these services responsibly. At the moment, community pharmacies are restricted in how they can advertise these services and this is something that we have talked to the Scottish government about on numerous occasions. We can only use Scottish Government-approved literature to promote the services and that tends to be just a poster in the window of the pharmacy and perhaps a few leaflets. Certainly, in Inverclyde, there has been a concerted effort between the health board and Inverclyde GPs and community pharmacy teams to have posters in both the GP surgeries and the pharmacies and for everyone to know all about it. And it goes beyond making more patients aware of it to there also being a definite referral pathway in the GP practices and community pharmacies where there is an expectation that if a patient comes with a minor ailment or one of the extended conditions that the pilot has been looking at, then they will be referred into the local pharmacy.


JM: OUTWITH INVERCLYDE, IS THERE A DOWNSIDE TO THE MAS AT THE MOMENT OF PEOPLE THINKING THEY ARE ELIGIBLE WHEN THEY ARE NOT?


MB: That is a challenge for community pharmacy teams. I have been in that position myself. I have had a patient who has come in who is not eligible for the MAS and I have to explain to them that this is not something that they can use. Just trying to find out the exemption status of a patient can be awkward. Of course, this wouldn’t have mattered if the same person had come in with a prescription from their GP as the eligibility is no longer a consideration in Scotland.


JM: WHAT IMPACT DO YOU THINK IT WOULD HAVE IF THE MAS WAS OPEN TO EVERYONE?


MB: It would take away that bureaucracy and that barrier for patients and for community pharmacy staff. There is to be a detailed evaluation of the Inverclyde pilot, which should show the positive impact


for the public accessing the service, and we will be able to see the impact of the awareness raising on the registration numbers and the impact on prescribing under the scheme.


Under the current MAS, out of a population of five million people in Scotland, just under 50 per cent of people are eligible for it. We have just short of 900,000 currently registered, so it’s reasonable to suggest that we could see numbers double. The evaluation will be very interesting, also, in its qualitative evaluation of the patients’ experience: would they have gone to their GP or A&E? Would this make them think twice about where they should go in future?


JM: BUT IT IS BY NO MEANS A LONG LIST OF MEDICINES UNDER THE MAS AND ALSO PHARMACY FIRST. YOU ARE QUITE RESTRICTED AS A PHARMACIST AS TO WHAT YOU CAN PRESCRIBE COMPARED WITH A GP.


MB: Like GPs there is a local formulary in place for the conditions that are defined as a minor ailment or included under Pharmacy First. Of course, while we by and large follow this, ultimately a pharmacist can make a professional clinical decision to move outside that formulary to treat a condition that comes under the MAS with a medicine that isn’t on the formulary.


JM: WE ARE MOVING TO A NATIONAL FORMULARY SO SHOULD THERE BE A NATIONAL MINOR AILMENTS FORMULARY?


MB: That is something that I think pharmacists on the ground would quite like, particularly pharmacists working across more than one health board. With minor ailment formularies, there is a degree of similarity between them but enough differences for some of my colleagues to find that a product they are recommend to use for a condition in one board area is not included, and replaced by something else, on a neighbouring formulary.


JM: IS THE FACT THAT YOU DON’T YET UNIVERSALLY HAVE ACCESS TO THE EMERGENCY CARE SUMMARY HINDERING PROGRESS FOR COMMUNITY PHARMACY?


MB: I think certainly that we are getting to that point now. We, alongside our colleagues at the RPS, the Royal College of Nursing and the allied health professions, recently developed a statement on


appropriate access to medical records for pharmacists and other healthcare professionals. We think appropriate access would be hugely beneficial for patients and I think would be a huge enabler for us to deliver services in a more seamless way.


Working as I do ‘out of hours’, it would mean I could have appropriate access without having to phone NHS 24 and asking the patient in front of me for permission. I don’t want access to everything, but it would make the process much better if I was able to see their diagnosis, medication history, allergies and perhaps recent blood results. I like the phrase ‘role-based access’. For me, that means that the information that would be useful for me is all that I need.


Working as a locum in a pharmacy across the road from a GP surgery on a Saturday morning, patients are astonished when they realise that I cannot see what the GP prescribed for them the day before. And they are sometimes not too pleased that I need to go through a convoluted ten-minute process through NHS24 to get that information – and, by the way, you will need to speak to NHS24 to give your consent. They say, ‘but I


PHARMACY FIRST IN FORTH VALLEY


– ONE YEAR ON NHS Forth Valley is reporting results from its version of the Pharmacy First initiative, which it says prove the scheme is ‘a big hit’.


With all 76 community pharmacies in the health board area taking part, 3,500 people were treated under the scheme from its launch in March 2016 to the start of April 2017.


The majority of consultations were for urinary tract infections (79 per cent) followed by impetigo (twelve per cent) and the remainder benefited from an existing scheme for pharmacists to prescribe and manage the treatment of people with COPD.


NHS Forth Valley now plans to extend the scope of its Pharmacy First programme to cover bacterial conjunctivitis, vaginal thrush, skin conditions such as eczema


want this now!’


JM: WHAT IS THE POTENTIAL OF COMMUNITY PHARMACY THAT PERHAPS THE EXTENDED MAS PILOT AND PHARMACY FIRST ARE DEMONSTRATING?


The movement of resource from secondary to primary care for a lot of reasons is probably not quite happening for me. There isn’t necessarily endless capacity – we are not sitting around all day in community pharmacy, we are very busy.


I think the potential really is there through the access we offer, through the skills that we have. I think the development of the new roles within primary care is recognition of the profession. Indeed, I know some health boards are adopting a mixed model of using community pharmacists to do some of the primary care pharmacist roles a couple of days a week. Some of the early indications are that that approach is working for patients. The challenges of workload are considerable but, hopefully, some of the automation initiatives and innovations around how we use our people, will address this. •


and contact dermatitis, and skin infections including cellulitis, insect bites and nail infections.


‘We are really pleased that the scheme has been successful as it not only helps takes pressure off busy GP services,’ said NHS Forth Valley’s Acting Pharmacy Director, Scott Hill, ‘but also makes it easier for people to access treatment as many pharmacies are open six days a week. Those based in supermarkets are also often open in the evenings and on Sundays.’


Community pharmacists carry out a consultation in the pharmacy with the patient, providing advice and treatment if required, under locally agreed patient group directions (PGDs), before submitting monthly claims reports to the NHS Board.


John Macgill is a Director of Ettrickburn, a communications consultancy specialising in Scottish health and care policy. www.ettrickburn.com


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