Community pharmacies incentivised to refer frequent users of reliever inhalers to general practice

The new referral incentive will be part of the Pharmacy Quality Scheme for 2022/2023.
Hand holding inhaler

NHS England is incentivising community pharmacy teams to refer patients considered to be overusing short-acting bronchodilator inhalers to their GP for an asthma review.

The referral incentive forms part of the 2022/2023 Pharmacy Quality Scheme (PQS), through which community pharmacies can claim a portion of the £75m available in funding by meeting a set of domains.

Guidance on the domains for 2022/2023, published on 10 October 2022, includes a new target for respiratory care, which is aimed to incentivise pharmacy teams to “show evidence that patients with asthma, for whom three or more short-acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a six-month period have … been referred to an appropriate healthcare professional for an asthma review”.

The guidance adds that the pharmacy contractor “will normally be referring the patient to their GP, GP practice-based respiratory nurse specialist/asthma nurse or practice-based pharmacist for a routine appointment”.

While the scheme begins on 10 October 2022, evidence for meeting the target will be required by March 2023.

The incentive follows a recommendation made in the 2015 National Review of Asthma Deaths, which said that all asthma patients “who have been prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment if required”.

However, the NHS England guidance for 2022/2023 said that, for the purposes of the PQS domain, “this has been reduced to all patients prescribed three or more short-acting bronchodilator inhalers in the previous six months” after further research had showed that patients referred at this point “had improved outcomes and a better quality of life”.

The incentive for community pharmacy also aligns with a similar target set for general practice as part of the Network Contract Directed Enhanced Service to review patients prescribed 6 or more inhalers in the previous 12 months.

Jon Foster, policy manager at charity Asthma and Lung UK, said the new incentive was “great news”.

“The overuse of reliever inhalers is a serious issue and usually indicates that someone’s asthma is uncontrolled,” he added.

“Reliever inhaler overuse can put people with asthma at an increased risk of asthma attacks, hospitalisations and even death. With the UK’s death rate for lung conditions higher than anywhere else in Western Europe, incentives that promote better asthma control should be welcomed.

“However, when patients are changed from one inhaler to another it’s really important that they get good support from a healthcare professional, including an inhaler technique check so that they know exactly how to use their new inhaler.”

In February 2022, an analysis by Asthma and Lung UK found that “the UK has the worst death rate for lung conditions such as asthma and chronic obstructive pulmonary disease than anywhere else in western Europe”.

Other respiratory targets include checking that all children aged 5–15 years prescribed a press and breathe pressurised MDI for asthma have a spacer device, where appropriate; and that all patients aged 5 years and above dispensed an inhaler for asthma between 10 October 2022 and the day of the declaration have a personalised asthma action plan.

Last updated
The Pharmaceutical Journal, PJ, October 2022, Vol 309, No 7966;309(7966)::DOI:10.1211/PJ.2022.1.161145

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