1. NHS Fife Pharmacy First Service
VHK, Education Centre 24 October 2017

2. Opening remarks
William John – Public Health Pharmacist
Antimicrobial stewardship
Niketa Platt - Senior Pharmacist – Antimicrobials, VHK
UTI PGD in practice
Amanda Dellar – Pharmacy Champion (Dunfermline)
Diagnosis and management of UTI in women
Dr Joanna Coy – GP, St Brycedale Surgery, Kirkcaldy
Look ahead to the new impetigo PGD service
William John
Presentation and management of impetigo (inc case studies)
Pauline Buchanan, Dermatology Nurse Practitioner
Summing up and next steps

3. Background
Following the 2015 National Review of Primary Care Out of Hours Services; one recommendation was the use of PGDs by community pharmacies to provide specific services to ease pressure on both Out of Hours Services and GP practices. For example early in 2016;
NHS Forth Valley commenced a UTI PGD and an Impetigo PGD
NHS Border commenced a UTI PGD
In December 2016 UTI PGD pilot commenced in five NHS Fife CPs, followed by a further five CPs in January 2017

4. Pharmacy First – Aims and Learning Objectives
Aim - allow pharmacists to confidently provide advice and treatment to patients accessing the Pharmacy First service
Learning Objectives
Provide appropriate advice and treatment to patients accessing the Pharmacy First service
Identify patients who need onward referral to other NHS services
Provide services with appropriate assurances to antibiotic stewardship

5. Pharmacy First
This is a new CP Service which aims to build capacity in Primary Care by extending the scope of community pharmacists in the management of common clinical conditions
The service seeks to counter the challenges of access to GP services and relieve pressure on OOH services
National funding to commence for Winter period 2017/18 confirmed to roll out the following services in all CPs via PGD
uncomplicated UTI in women aged 16-65
mild impetigo in patients aged 2 years of age and over

6. Pharmacy First

7. New Pharmacy First Service Impetigo PGD – inclusion criteria
Minor staphylococcal infection of skin (impetigo)
Patient aged 2 years of age or over
Minor skin infection limited to a few lesions in one area of the body
The rash consists of vesicles that weep and then dry to form yellow-brown crusts

8. New Pharmacy First Service Impetigo PGD – exclusion criteria
Multiple site skin infection.
Children under 2 years of age.
Had impetigo within the last 3 months.
Known hypersensitivity to any component of the medicine.
Presenting with any underlying skin conditions on the same area of the body as impetigo
Concerns regarding patient compliance with topical medication.

9. Patient assessment proforma (Appendix 1
Patient assessment proforma (Appendix 1.) and Notification of supply/referral form (Appendix 2)

10. Notification of supply/referral form (Appendix 2)
Patients GP must be informed of consultation and any treatment given
Patients who do not fit the PGD criteria and cannot be managed by OTC treatment/advice must be referred by the most appropriate route for further assessment and advice
Pharmacists must facilitate the referral process by means of professional to professional support where OOH referral is required
May also consider use of SBAR tool (now on PCR)

11. Appendix 3 – Impetigo – Patient information leaflet
For treatment and self care tips
Where possible remove scabs by bathing in warm water before applying the cream
Take precautions to minimize spread e.g.
do not share towels
wash hands frequently
avoid touching the lesions

12. Fife Formulary Choice – mild impetigo (section 13.10.1)
Fusidic acid or Hydrogen peroxide cream (Crystacide®) topically TDS
For further information see section

13. The next steps......... What you need to do next
Each pharmacist to complete Pharmacy First e-learning module via Turas
Each pharmacist to sign both PGDs (mid November)
Each community pharmacy to sign Service Level Agreement (SLA) for both services
When you need to do it by
Final SLA to go to Community Pharmacy Fife then to each contractor/Area Managers
Pharmacy First expected to commence in all CPs by 27 November 2017

14. Pharmacy First e-learning module via Turas (2-3 hours to complete)
Click onto website
Register or sign in
Pharmacy First has 5 parts plus assessment
UTI (1 hour)
Skin conditions including impetigo (45 mins)
Antimicrobial Stewardship (30 mins)
Referral including SBAR tool (20 mins)
Information Gathering (15 mins)
Assessment (60-80 True/False questions)

15. Proposed remuneration
One off opt in fee
Fee per consultation
For each treatment supplied
For onward referral to GP/PCES (NB. For women between only)
Claim form to be submitted monthly
CPUS to be used used to write prescription for fusidic acid cream to include patient CHI where possible (use GP prescriber code as cost centre – like urgent supply scripts)

16. Differences between current UTI PGD and new Pharmacy First Service
Change of remuneration
Different claim form
Joint SLA for UTI and impetigo service
Can be registered with any GP in Scotland
Anticipated minor changes to trimethoprim PGD at end of November

17. Contacts William John – Public Health Pharmacist William.John@nhs.net
Pharmacy Champions
Colin Cossar
Amanda Dellar
Joe Grady
Naseem Sadiq
Allan Shields
Alex Stuart

18. THANK YOU