1. Minor ailment schemes- who benefits?
Anne Hinchliffe
Consultant in Pharmaceutical Public Health

2. Overview The Community Pharmacy Contract Minor ailment schemes
NPHS support for Pharmaceutical Needs Assessment (PNA)
Over 700 community pharmacies in Wales
An estimated 100,000 people visit a community pharmacy in Wales each day.
Prescribed medicines in Wales cost >£400 million per year with prescribing of a medicine being the most common healthcare intervention
OTC sales in Wales are estimated to be worth around £100 million
Pharmacists have 5 years training before qualifying
Source of expert information on medicines
Readily accessible
More likely to have contact with hard to reach groups

3. Community Pharmacy Contract (2005)
To receive payment for NHS services a community pharmacy must be on the Pharmaceutical List
3 levels of service
Essential
Enhanced
Advanced

4. Essential services Support for self-care
Promotion of healthy lifestyles
Dispensing
Repeat dispensing
Disposal of unwanted medicines
Signposting
Clinical governance
Promotion of healthy lifestyles
Opportunistic advice to hard to reach groups
Verbal- may be backed up with written leaflets
Take part in up to 6 health promotion campaigns- under the directorship of the LHB each year

5. Enhanced services National enhanced services
Locally commissioned enhanced services
Examples
Needle and syringe exchange
Supervised administration of methadone
Smoking cessation
Out-of-hours supply of palliative medicines
Emergency hormonal contraception
Chlamydia screening and treatment

6. Minor ailments Athlete’s foot Bites and stings Constipation
Contact dermatitis
Cough
Diarrhoea
Dyspepsia
Earache
Hay fever
Headache
Head lice
Mouth ulcers
Nasal symptoms
Sore throat
Teething
Temperature
Vaginal thrush
Viral upper respiratory tract infection

7. Community pharmacy minor ailment schemes
Allows the community pharmacist to supply medicines, free of charge to the patient, to treat one or more minor ailment
National scheme in Scotland (July 2006)
Local schemes in Wales and England

8. Should Wales have a national minor ailment scheme
Should Wales have a national minor ailment scheme? Should LHBs commission community pharmacy minor ailment schemes?

9. Lobbying and influencing
Patients
Royal Pharmaceutical Society
of Great Britain
Pharmacy multiples
Individual pharmacy contractors
NPHS
LHB staff
Welsh Assembly Government
Individual
LHB board members
Assembly members
Community Pharmacy Wales
and the PSNC
Drug companies and
PAGB

10. Labour in favour of minor
Media
Labour in favour of minor
ailment schemes
“Pharmacy based treatment schemes for minor
ailments are high on Labour’s agenda for the
NHS if the party wins a further term of
office”
April 2005

11. Media Minor ailment schemes on Government agenda in Wales”
“A national minor ailments scheme for Wales
may be on the horizon…. CPW was talking to the
Welsh Assembly Government about
the development of a national MAS”
Nov 2007

12. Media PSNC wants pharmacy to be main provider for minor ailment care
January 2008

13. Why don’t we have a universal
Media
Why don’t we have a universal
minor ailment scheme?
June 2008

14. Media Minor ailment schemes boost profits nationwide
“Running a minor ailment scheme is more profitable than
dispensing the same items on prescription and saves
GP time”
June 2008

15. Key questions How big is this issue?
What are the barriers to self-care for minor ailments?
Do community pharmacy minor ailment schemes result in health gain for the population?
How much would it cost to implement a scheme?

16. Quiz Q1.
How many prescriptions are dispensed in Wales each year for over-the-counter medicines?
a) 1 million
b) 3 million
c) 7 million

17. Prescribing of medicine available OTC by LHB, Apr-Oct 2007

18. Association between prescribing and deprivation
UK studies focusing on OTC medicines
Baines and Whynes (1997)
Timoney et al. (2003)
Evans (2001)

19. Quiz Q2
What is the annual over-the-counter medicines market in Wales estimated to be worth?
£5 million
£50 million
£100 million

20. Association between deprivation and OTC sales
Limited availability of OTC data at LHB level
UK studies
Boardman et al.(2005)
Bradley et al.(1998)
Johnson et al.(2001)
McIntyre et al.(2003)

21. Is it all about money? Financial incentive Reassurance Habit
Low knowledge of self-care
Consulting for other conditions
Lack of confidence in pharmacy

22. Health gain
Patients are satisfied with MAS provided by community pharmacists
Reconsultation rates are similar to those of patients seen by GPs
Increased choice and more convenient provider
Little evidence on health gain
Impact on GP appointments

23. Financial implications
Treatment costs of pharmacy and GP consultations for minor ailments are similar Blenkinsopp and Noyce (2002)
Consultation costs are reduced with a pharmacist
Evidence on cost effectiveness of nurse led MAS was inconsistent
Difficulties in transferring GMS monies to community pharmacy

24. Financial implications
CPW (2008) agreed rates:
£ annual fee
£3.70 per consultation
Assuming reimbursement of medication at drug tariff rate, no increase in volume and 50% conversion from prescribed to MAS
Additional cost in Wales £9.4 million/ yr (excl.VAT)

25. Summary of evidence
The majority of OTC medicines are purchased not prescribed
Even so, minor ailments constitute a significant workload for GPs
Some patients prefer to consult GPs for minor ailments for a range of reasons, not just financial
Some GPs and members of the public lack confidence in community pharmacy’s ability to manage minor ailments
Introduction of MAS across Wales would have a significant financial implication and uncertain health gains

26. NPHS role To support those with decision making powers Leadership
Developed a process to support LHBs make decisions about enhanced services (PNA)
Identified stages and agreed responsibilities
Provided practical support
Minimise duplication of effort
Not a comprehensive assessment of all medicines and pharmaceutical related needs in the population
Assessment of need related to a specific pharmaceutical issue within a defined population
Based on models of HNA (epidemiological, qualitative, comparative) and utilising project management techniques
Used to support commissioning/ planning decisions for enhanced services

27. Lessons learnt
The need for PNA to inform commissioning of enhanced pharmacy services
The value of adopting a project management approach
Benefits from sharing information and experience
LHB pharmacists are good at analysing prescribing data but feel less confident in getting the patient/ public perspective
Need to consider other interventions to support self-care

28. Minor ailment schemes- who benefits?