“There is no such thing as a new idea … we keep on turning and making new combinations indefinitely; but they are the same old pieces of colored glass” wrote Mark Twain in his 1907 autobiography, The Chapters from the North American Review.
And Twain’s principle could be applied to health policy, too.
Take the NHS community pharmacist consultation service (CPCS) — this allows patients to be referred to community pharmacy for minor ailments or urgent medication supplies by NHS 111 call handlers.
It was announced as part of the new community pharmacy contract in July 2019 and, on 12 January 2020, the scheme’s achievements were celebrated in a press release sent out by the Department of Health and Social Care.
The statement said that 114,275 patients had been referred to a “new ‘pharmacy-first’ referral service” in its first ten weeks of operation. Matt Hancock, the health and social care secretary, was quoted saying: “This ‘pharmacy first’ approach makes life easier for patients and will help reduce pressure in the NHS. I want to see more patients with minor illnesses assessed close to home, saving them unnecessary trips to [hospital emergency departments] or the GP, and helping people get the care and advice they need quicker.”
In Scotland, pharmacy minor ailments schemes have been a fixture since 2006
The CPCS is a significant achievement for community pharmacy and it has done a great job in quickly stepping up to provide this service to more than 100,000 patients referred by NHS 111 over the festive period. As the service expands to include referrals from hospital emergency departments and GP surgeries, it will position pharmacy even more firmly as the front door of the NHS and provide a vital service for patients.
However, the government cannot claim that this is completely a new idea. The link with NHS 111 is new, but pharmacy minor ailments schemes have been a fixture in Scotland since 2006 for children, older patients and those on certain benefits. This will be expanded in 2020 to cover all patient groups in Scotland.
In England, the CPCS is essentially an amalgam of the NHS urgent medicine supply advanced scheme (NUMSAS) — introduced in 2016 — and the digital minor illness referral service, which was piloted in four areas from 2017 until 2019. Before these, there were many similar minor ailments schemes created locally after the white paper ‘Pharmacy in England: building on strengths — delivering the future’ by the then Department of Health in 2008 promised to roll them out across all pharmacies in England.
Funding for such services — commonly known as ‘Pharmacy First’ schemes — was withdrawn in most areas after NUMSAS was introduced and the NHS decided to pull back from providing “low-value” medicines for free. Then, an investigation by The Pharmaceutical Journal in 2018 found that around one in five pharmacy minor ailment services in England had been cut over the previous three years.
Policy makers may think they can get away with transporting us back a decade in a time machine, and then pretending nothing has happened, but this selective amnesia has real-life consequences when funding is suddenly cut and recycled into the latest “new” scheme. Just imagine how many patients could have been helped over Christmas if England had mature minor ailment schemes, which had been expanded incrementally to cover urgent medicines supplies over the past decade?
Yes, let’s celebrate the CPCS, but we shouldn’t be taken in by what is a slightly different configuration of the same coloured glass.
- This article was amended on 21 January 2020 to correct the name of the community pharmacist consultation service