For a while, Betsi Cadwaladr University Health Board (BCULHB) and Andrew Evans, Wales’ chief pharmaceutical officer, have been interested in getting community pharmacists more involved in managing acute minor illness.
Nearly 18 months ago, the team at Fferyllwyr Llyn Cyf pharmacies and the pharmacy team at BCULHB thought about launching a minor illness service from community pharmacy, led by independent prescribing pharmacists, that could be rolled out across the health board.
The service aims to increase access to diagnosis, treatment and advice for local patients and temporary residents, make better use of the skills of community pharmacists, and reduce the demand on local GP surgeries.
The challenge was to develop a service that could be replicated across many pharmacies, and not just in one pharmacy working with one GP surgery. We knew from the outset that the service would be heavily scrutinised as the conditions we hoped to manage had traditionally been treated by GPs.
I have been on the task and finish group, led by pharmacist Adam Mackridge from the pharmacy and medicines management team at BCULHB, from the beginning. One of our early priorities was to decide on the level of training required by the pharmacists involved; they should first train as independent prescribers (IP). But the IP courses on offer differ in content – some have a greater focus on minor illness and clinical examination skills than others – so we also decided that pharmacists would need specific minor illness training.
BCULHB worked with Bangor University to develop a minor illness course specifically for delivering this service. We also set up a transitional service for pharmacists, so that before launching the service from a community pharmacy, the pharmacists involved would have the opportunity to spend 12 days at a GP surgery seeing patients with minor illnesses with the support of the GP.
In September 2019, after weeks of writing standard operating procedures, developing internal procedures and creating a consultation record template, we launched the service and I saw my first patient.
Patients are seen in the consultation room after referral from the GP or coming directly to the pharmacy. I gather their history and examine them before establishing a diagnosis. I then provide advice or, where necessary, write a script using my personal prescription pad. I have my own personal formulary and all the medicines I prescribe come from this list.
We decided to do a soft launch of the service, without too much advertising, to give us time to alter the day-to-day running of the pharmacy and allow us to become familiar with the process involved.
Nine weeks into the service, we have carried out 157 consultations. Patients have been treated for conditions ranging from urinary tract infections, chest infections and exacerbations of chronic obstructive pulmonary disorder to infected bites and constipation.
We already had the Choose Pharmacy common ailments service and the sore throat test-and-treat service well established, and our new acute conditions service builds on their success. It widens the range of conditions we can see in community pharmacy and ensures that the pharmacists involved have the right training to gather a patient’s history, use diagnostic tools and prescribe the appropriate medicines.
At the moment, we document each consultation on paper, which I then forward to the patient’s GP. We do not have the summary care record in Wales, so if I need to view records I must liaise with the GP practice, with the consent of the patient, to have paper copies sent over. This is not ideal so, over the coming months, we will develop an electronic solution that allows community pharmacists to use the same system as the North Wales GP Out of Hours Service to document consultations and send them to the GP.
It has been an exciting but challenging few weeks: I have had to adapt to a significant change in my daily activities. I am now less involved in the day-to-day running of the dispensary, and our support staff, who have had additional training, now take a lot of this on.
Over the next few weeks, we want to see even more patients and work with the local surgeries to strengthen their pathways to community pharmacy.
Steffan John, superintendent pharmacist, Fferyllwyr Llyn Cyf, Blaenau Ffestiniog, North Wales