Think Pharmacy Minor Ailments Service March 2015

Welcome

Housekeeping

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

Thanks to our sponsors Lundbeck UK and Teva UK

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

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

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

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

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

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

GP Perspective Dr Mark Green

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

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 £147.09 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.

Example mapping of prescribing: fever & pain in children

Example mapping of prescribing: hayfever

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.

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

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.

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’

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

NHS Contract – Next Steps Sarah Boyd-Short Commissioning Support Manager – Contracts & Delivery 0151 651 0011 (ext 1790) sarahboyd2@nhs.net

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 [                ] Email:  [                    ] 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:  [                   ] Email:      [                    ] Provider Representative Title [                  ] Email:   [                    ] Tel:   [                    ]

Conditions and Treatments Nicola Bradley

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

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

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

Level 1 Clinical Knowledge Summaries http://cks.nice.org.uk/ Summary of Product Characteristics www.medicines.org.uk Patient.co.uk http://www.patient.co.uk/doctor/

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

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

Level 2 Adapted from those used in: West Cheshire, East Cheshire, Vale Royal, and South Cheshire NICE Good Practice Guidance GPG2 (September 2013) https://www.nice.org.uk/guidance/mpg2/resources Competency framework: For health professionals using Patient Group Directions

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.

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

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.

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

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

Uncomplicated UTI in Women Diagnosis of UTI - Quick Reference Guide for Primary Care https://www.gov.uk/government/publications/urinary-tract-infection-diagnosis CPPE - Antibacterial resistance - a global threat to public health: the role of the pharmacy team

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

Delivering the Service Nick Thayer Well Pharmacy Eastern Cheshire

Pinnacle Health Partnership LLP PharmOutcomes Kevin Noble Pinnacle Health Partnership LLP

Contact Details Sarah Boyd-Short 0151 651 0011 (ext 1790) sarahboyd2@nhs.net Nicola Bradley 0151 643 5319 nbradley1@nhs.net Melanie Carrol 0752 305 6986 melanie.cpcw@gmail.com

Any Questions?