Impact case study database

Background

Newcastle research showed that CPs 1) are an appropriate place to treat minor illnesses; 2) have the capacity and knowledge to manage minor illnesses; and 3) are often more accessible than GP services. In 2015, the CP minor illness scheme was rebranded as the Think Pharmacy First Minor Illness Scheme, which increased public awareness of the 11,700 CPs in England.

Flu vaccination in CPs: informing the contract change and demonstrating proof of concept

In July 2015, the Community Pharmacy Contractual Framework (CPCF) changed to allow CPs to deliver a national NHS seasonal flu vaccine service targeted at eligible at-risk patients (EV1). The contract changed because of Newcastle evidence that CPs were accessible, convenient and could target hard-to-reach groups, often more so than GPs: the 2015 briefing (EV2) cites R1 as evidence of the accessibility of CPs. Since the service began in 2015/16, there has been a rapid increase in the number of patients receiving a vaccination and the percentage of CPs involved (see graph, EV3). This demonstrated that CPs were able to handle the increased volume of patients.

Recognition in NHS and NICE policy

The value and capacity of CPs has been recognised by both PHE and NICE. A 2017 PHE document “Pharmacy: A Way Forward for Public Health” (EV4), citing R1 and R3, states “commissioners should consider using community pharmacies to help deliver public health services”. The 2018 NG102 NICE guideline (EV5), which cites R1, encourages more people to use CPs by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach.

Changing the NHS 111 algorithm to direct patients to CP

Having established the value and capacity of CPs, the next step was to change the framework of NHS 111 so that patients calling about a minor illness are directed to CPs, instead of to more urgent care centres such as EDs and GPs. A Newcastle University-led pilot (DMIRS) directly informed a change in the NHS 111 algorithm and call handler training so that, where appropriate, callers with minor ailments were referred digitally to a CP. The success of the trial led to DMIRS being rolled into the new national five-year CPCF in October 2019 (EV6, 7). The CPCF expands the role of CPs to embed them as the first port of call for minor illnesses and health advice across England. Page 7 states: “The piloting of DMIRS… has enabled us to introduce a well tried, tested, safe and sustainable service into the CPCF. It has also enabled us to demonstrate the value that community pharmacy can add.”

As at July 2020, an average of 5,511 patients per month calling NHS 111 have been recommended to CP (EV8), a total of 55,108 across England since October 2019. A large-scale evaluation of the service that ran throughout 2018 (EV9) found that 13,246 patient calls to NHS 111 were referred to CP. Of these, 47% of patients attended the CP and were successfully managed in this setting, saving over 6,000 appointments in GP or ED. A further 21% also attended CP, who escalated the patient to more urgent care, and 12% of patients were recovering or seeing another healthcare provider. Only 3% of patients did not attend CP, and in less than 1% of cases was the referral inappropriate.

Of note was the use of the service by patients from deprived areas: the highest number of calls and the highest number of patients referred to CP were from the five most deprived deciles (EV9). As noted in R1, CP accessibility was 99.8% in areas of the highest deprivation, confirming that those most in need of a CP were able to access one. Even in areas of low deprivation, a CP is often more accessible than a GP, both in terms of geography and opening times.

Impact on NHS 111 call handlers in the North East of England

In December 2017, the North East Ambulance Service (NEAS) NHS Foundation Trust call handling centre changed their algorithm to direct appropriate patients to CP for treatment; this presented an ideal opportunity to evaluate the effect on NHS 111 call handlers in practice. This pilot study was due to be repeated in other sites, but was halted by the COVID-19 outbreak. As of July 2020, 320 Health Advisors in NEAS had been trained on the new referral method, and as a result there has been a significant shift of patients from primary care to CP. From launch to end July 2020, a total of 43,191 patients have been sent to CP, of which around 46% were managed entirely in CP, saving around 20,000 referrals to a GP, Out of Hours Service or Urgent Treatment Centre in the North East alone (EV10).