1. Think Pharmacy Minor Ailments Service March 2015

2. Welcome

3. Housekeeping

4. Agenda Introduction Background GP Perspective
NHS Contract – Next Steps
Conditions and Treatments
Delivering the Service
PharmOutcomes Demonstration
Q&A

5. Thanks to our sponsors
Lundbeck UK and Teva UK

6. Speakers Jasmeen Islam Deputy Head of Medicines Management, NWCSU
Mark Green GP, St Hilary Brow Group Practice
Sarah Boyd-Short Commissioning Support Manager – Contracts & Delivery
Nicola Bradley Community Pharmacy Manager for the Wirral Minor Ailments Scheme
Nick Thayer Community Pharmacist, Well Pharmacies, Eastern Cheshire
Kevin Noble Pinnacle Health Partnership LLP

7. Introduction and Background
Melanie Carrol
Contractor support and Service Development Pharmacist
Community Pharmacy Cheshire and Wirral

8. How did we get here? West Wirral Minor Ailments Service
Opportunities to work together
Urgent Care Board Paper

9. Additional challenges
Merger of LPC’s
Merger of CCG’s
NHS contract

10. Working Group CCG Ian Stewart, Sarah Boyd-Short GP Hannah McKay
CSU Nicola Bradley, Jasmeen Islam
LPC Melanie Carrol
LPN Suzanne Austin
Others stakeholders when needed

11. Where are we now…… NHS Contract Service Specification
Level 1 Protocols
Level 2 PGD’s

12. GP Perspective
Dr Mark Green

13. Deputy Head of Medicines Management
Jasmeen Islam
Deputy Head of Medicines Management
NWCSU
March 2015
Background of my role
Team work
GP Clusters
LPN event

14. Community Pharmacy Manifesto
National Drivers
Five Year Forward View
Investing in building the public’s understanding that pharmacies can help them deal with coughs, colds and other minor ailments
Community Pharmacy Manifesto
5 pledges
Encourage patients to think ‘pharmacy first’, and use pharmacy to help relieve pressure on GPs and emergency departments
Community Pharmacy- helping provide better quality and resilient urgent care -NHSE
Better integrate pharmacy into the urgent and emergency care system
self-management of minor ailments
Need to embrace the opportunities under the 5yfv
Research from the Royal Pharmaceutical Society27 shows that common ailments cost the NHS an extra £1.1 billion a year when patients are treated at Emergency Departments or GP surgeries rather than at community pharmacies. Treatment results were equally good regardless of whether patients were treated at a pharmacy, Emergency Departments or GP practice. The cost of treating common ailments in community pharmacies was found to be £29.30 per patient. The cost of treating the same problems at Emergency Departments was found to be nearly five times higher at £ per patient and nearly three times higher at GP practices at £82.34 per patient. Overall, the study estimates that 3% of all A&E consultations and 5.5% of GP consultations for common ailments could be managed in community pharmacies. This equates to over 650,000 visits to A&E and over 18 million GP consultations every year that could be diverted with a total annual cost saving of over £1billion.
Policy makers agree that within five years healthcare delivery needs to change. Far more care needs to be provided local in primary care and we need a radical upgrade in prevention and public health.

15. Example mapping of prescribing: fever & pain in children

16. Example mapping of prescribing: hayfever

17. JSNA
There is currently one pharmacy for every 3,402 residents, which compares extremely favourably to the national average of one pharmacy for every 5,000 resident population.

18. than the cost of treating the patient in a pharmacy
Community pharmacists in England could help save the NHS up to £1bn a year if they were contracted to run a national minor ailments service, according to figures obtained by the Royal Pharmaceutical Society (RPS).
We also have new evidence, such as the recent Pharmacy Research UK publication, Community Pharmacy Management of Minor Illness showing that common ailments such as coughs and sore throats cost the NHS an extra £1.1 billion a year when patients are treated in Emergency Departments or GP surgeries rather than at community pharmacies with treatment results being equally good regardless of whether patients were treated at a pharmacy, Emergency Departments or general practice.
The cost of treating a patient with a minor ailment in an A&E department is
Twice as high
3.5 times as high
5 times as high
than the cost of treating the patient in a pharmacy

19. Statistics…
The cost of treating a patient with a minor ailment in an A&E department is five times higher than the cost of treating the patient in a pharmacy Coughs and sore throats cost the NHS an extra £1.1 billion a year when patients are treated in Emergency Departments or GP surgeries(source: RPS) Patient experience is high on the agenda nationally and locally
rather than at community pharmacies with treatment results being equally good regardless of whether patients were treated at a pharmacy, Emergency Departments or general practice.

20. Further Context
Nigel Mathers, the honorary secretary of the Royal College of General Practitioners:
‘“sensible” that community pharmacists, and not over-stretched GPs, should be the first port of call for common ailments.
Such a move .. would take pressure off the demand for a GP appointment and leave more time for doctors to deal with more complex consultations’

21. Future Travel… National Minor Ailment Service – much discussion…
National exploration of co-commissioning of community pharmacy services:
potential for future years
RCGP / RPS collaboration
RPS video – Minor Ailments

22. NHS Contract – Next Steps
Sarah Boyd-Short
Commissioning Support Manager – Contracts & Delivery
(ext 1790)

23. GOVERNANCE AND REGULATORY
Full Legal Name
Address
Is this the Principal Address
YES/NO
Is this the Registered Address
Company Number
Authorised Signature
Name and Title [                ]
  [                    ]
Tel:      [                     ]
Provider’s Information Governance Lead
Name [                ]
Provider’s Caldicott Guardian
Provider’s Senior Information Risk Owner
Provider’s Accountable Emergency Officer
Provider’s Safeguarding and Prevent Lead
Addresses for service of Notices
Provider:    [                ]
Address:  [                   ]
      [                    ]
Provider Representative
Title [                  ]
   [                    ]
Tel:   [                    ]

24. Conditions and Treatments
Nicola Bradley

25. Service Provision 2 distinct levels: Level 1 Service Renumeration:
Patient assessment - accredited pharmacist
Provision of P or GSL medicine or appliance
Advice on condition
Renumeration:
£4.50 per consultation
Formulary tariff for medicines provided

26. Service Specification
Level 2 Service
Patient assessment - accredited pharmacist
Provision of a Prescription Only Medicine
Patient Group Direction
Specified conditions
Specified Criteria
Communication to patient’s registered GP to advise treatment provided
Renumeration:
£8.20 per consultation
Formulary tariff for medicines provided

27. Level 1 24 Level 1 Treatment Protocols Adapted from those used in:
West Cheshire, East Cheshire, Vale Royal, and South Cheshire
Definition
Inclusion/Exclusion criteria
Treatment Choice
Counselling and Advice
Referral

28. Level 1 Clinical Knowledge Summaries http://cks.nice.org.uk/
Summary of Product Characteristics
Patient.co.uk

29. Level 1 Conditions Acne Vulgaris(mild) Acute Bacterial Conjunctivitis
Allergy
Athlete’s Foot
Cold Sores
Constipation
Cough
Cystitis
Dermatitis / Eczema (mild)
Diarrhoea
Genital Thrush
Haemorrhoids
Headache, Pain (including Dental Pain)
Hay fever (Seasonal Allergic Rhinitis)
Head lice
Indigestion and Heartburn
Mouth Ulcers
Nappy rash
Nasal Congestion
Oral candidiasis
Scabies
Sore throat
Threadworm
Warts and verrucae

30. Level 1 Treatment Protocols
Cough – Simple linctus
Cystitis – Lifestyle advice, analgesia
Dental Pain – Ibuprofen, Paracetamol
Head lice – Bug busting kit
Hedrin 4% (Second line)

31. Level 2 Adapted from those used in:
West Cheshire, East Cheshire, Vale Royal, and South Cheshire
NICE Good Practice Guidance GPG2 (September 2013)
Competency framework: For health professionals using Patient Group Directions

32. Patient Group Directions
Patient Group Directions (PGDs) provide a legal framework that allows some registered health professionals to supply and/or administer a specified medicine(s) to a pre‑defined group of patients, without them having to see a prescriber.

33. NICE Competency Framework: For health professionals using Patient Group Directions
Domains
Competency areas
The patient consultation
Knowledge
Options
Shared decision‑making
Safe and effective
Safe
Governance
Always improving
PGDs in context
Information
The healthcare system
Collaboration

34. NICE Competency Framework
Each competency area includes:
a statement that gives a general overview of what the competency area covers
a list of individual competencies, referenced to relevant good practice recommendations, where applicable.

35. NICE Competency Framework
Individual health professionals need to consider:
how they will use the competency framework
how each competency applies to their scope of practice and individual responsibilities
what evidence can be collected and documented to demonstrate competency e.g. case studies

36. Level 2 PGDs Acute Bacterial Conjunctivitis Fusidic Acid Eye Drops
Chloramphenicol Eye drops/ointment
Uncomplicated Urinary Tract Infection in Women Trimethoprim 200mg
Hay fever (allergic rhinitis) Beconase nasal spray
Impetigo Fucidic acid 2% Cream
Migraine Sumatriptan 50mg tablets
Oral candidiasis in infants <2 years Nystatin oral suspension

37. Uncomplicated UTI in Women
Diagnosis of UTI - Quick Reference Guide for Primary Care
CPPE - Antibacterial resistance - a global threat to public health: the role of the pharmacy team

38. Uncomplicated UTI in Women
Severe or ≥ 3 symptoms of UTI:
Urgency
Polyuria
Dysuria
Frequency
Suprapubic tenderness
NO vaginal discharge or irritation

39. Delivering the Service
Nick Thayer
Well Pharmacy
Eastern Cheshire

40. Pinnacle Health Partnership LLP
PharmOutcomes
Kevin Noble
Pinnacle Health Partnership LLP

41. Contact Details Sarah Boyd-Short
(ext 1790)
Nicola Bradley
Melanie Carrol

42. Any Questions?