Gridlock. Cover. 24m. 438m

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1 ANALYSIS IN DEPTH INFORMATION With emergency care under immense pressure, could signposting patients to pharmacy be the key to success? Rob Dabrowski investigates. Gridlock ADVICE BY PHONE 24m CALLS COMMUNITY PHARMACY 438m VISITS 20 - January February 2014

2 emergency services A&E at The number of people visiting A&E has accelerated over recent years, leaving emergency services congested. In the last four years alone, there s been an 11 percent rise, taking the total number of patients to 22 million a year, Health & Social Care Information Centre statistics show. With an ageing population the average life expectancy has increased by three years in the last decade to 82.8 for women and 78.8 for men the pressure on emergency services has been building. The situation came to a head last year, when the Government commissioned Sir Bruce Keogh, England s National Medical Director, to conduct a comprehensive system review.» Can pharmacies ease congestion? GP PRACTICES 340m CONSULTATIONS THE PUBLIC NEEDS TO KNOW THAT THE FIRST PORT OF CALL IS PHARMACY January February

3 THIS IS NOT AS SIMPLE AS PHARMACISTS TAKING ON EXTRA ROLES, IT S ABOUT HOW WE WORK WITHIN THE SYSTEM» Transforming Urgent and Emergency Care Services in England was released in November. Accompanying its publication was a letter to the Health Secretary Jeremy Hunt, in which Sir Bruce wrote that there is widespread anxiety that emergency services are under intense, growing and unsustainable pressure. He matter-of-factly states: Let me be clear that there is no simple solution. However, while there are too many variables and too much structural complexity for a quick-fix solution, the report voices hope that services will be able to cope with future demand. Key to this is an increasingly prominent role for community pharmacy, which is set to be integral to the plans. It is already the 340M GP CONSULTATIONS 20% could have been dealt with by community pharmacy most accessible and widely used healthcare resource, with a total of 438 million people visiting for health reasons in England every year, compared to 340 million GP visits and 22 million people heading to A&E departments. However, with 40 percent of those who attend A&E discharged requiring no treatment, signposting many of these people to pharmacy may be the answer. The report says: Community pharmacies are an under-used resource: many are now open 100 hours a week with a qualified pharmacist on hand to advise on common illness, medication queries and other problems. We can capitalise on the untapped potential and convenience that greater utilisation of the skills and expertise of the pharmacy workforce can offer. In the third chapter of the report, the proposals for improving urgent and emergency care are set out. The driving force behind the vision for the future is a highly responsive service that delivers care as close to home as possible. Mike Holden, NPA Chief Executive, believes pharmacists can help in this respect. A lot of people are turning up at A&E and trying to book appointments with doctors, when they don t need to; they could be seen by pharmacists, he says. It is important to get people to go to pharmacies and one way we can do that is through promoting self care. The benefit here is that the advice and the treatment is very accessible. This is a sentiment that is echoed throughout Sir Bruce s report, which states: Pharmacists have a wealth of knowledge and experience. They can advise on common ailments, medication and prescription concerns and many have consultation rooms. We intend to ensure that these are utilised more effectively. But is the report just empty rhetoric? It s not the first time that policy papers and research have highlighted the untapped potential of pharmacy. Keith Ridge, England s Chief Pharmaceutical Officer, 22M ATTENDANCES AT A&E 40% are discharged with no treatment 20+80R 40+60R 20% 40% 24M CALLS TO EMERGENCY CARE TELEPHONE SERVICE only 4% resolved and closed on the phone 4+96R 50+50R 4% 50% 7M AMBULANCE JOURNEYS 50% could be resolved at the scene 22 - January February 2014

4 emergency services believes the report offers a genuine chance. From a development point of view, this is fantastic to see and it is a real opportunity for community pharmacy, he says. I think this is the first time that community pharmacy has been recognised in this way, as being right at the front line of the NHS. He goes on to state: In my view, this is not as simple as pharmacists taking on extra roles; it s about how we work within the system. One issue is working closely with other practitioners and ensuring that we have the right infrastructure in place. Pharmacy minor ailments services are in place across Scotland, Northern Ireland and increasingly Wales, but, at present, their allocation across England is patchy. If we had a national minor ailments service in England, it would save people an awful lot of time, says Mike. Scotland has this service and it has been very successful in reducing the burden on other healthcare providers, as well as increasing access for the public. There has not yet been the will to do it in England on a national basis. It is being increasingly talked about, but it is slow to move forward and we need to accelerate progress for the benefit of all. The scheme has recently been praised in the Scottish Parliament, when it was 50+50R 1m M EMERGENCY HOSPITAL ADMISSIONS 1m considered avoidable KEY AIMS Keogh s five key aims for future emergency services structure are to: Provide better support for people to self care Help people with urgent care needs to get the right advice in the right place, first time Provide highly responsive urgent care services outside of hospital so people no longer choose to queue in A&E Ensure that people with more serious or lifethreatening emergency care needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and a good recovery Connect all urgent and emergency care services together so the overall system becomes more than just the sum of its parts revealed that in , over two million treatments were prescribed at a cost of just over 19m, which was commended for representing excellent value and easing pressure on emergency services and GPs. Noel Wicks, NPA Board Member and Managing Director of Right Medicine Pharmacy in Scotland, believes the scheme has been a major asset, along with two other resources a PGD for urgent care and direct referrals, meaning pharmacists can bypass NHS24 and book appointments for patients directly and get advice from doctors over the phone. When you compare how it is now in Scotland to how it used to be, I feel more integrated than I used to, he says. We have been empowered to use our professional judgement to help with, and help avoid, emergency situations. I don t think it is unrealistic to say that these tools allow us to save about 20 people a day from making GP appointments, or from seeking care elsewhere. This suite of tools is getting us into the land of instant access it has really opened up my eyes to what we can deliver, he continues. I m sure that pharmacists across the whole of the UK would be very happy to use these tools to deliver much better access and unclog A&E of common ailments. Keith tells inpharmacy that, due to the nature of commissioning in England, it s not as simple as following Scotland and introducing the scheme on a nationwide scale. It s a very different NHS, he says. Not to knock the great progress that has been made in Scotland over the past 10 years or so, I m very pleased at what Scotland has achieved and is achieving, but it is different because it is a managed service in Scotland. In England we are operating in an environment of commissioning choice and competition, which doesn t always suit pharmacy interests. Where local population needs show the importance of a common ailments service through pharmacies, this has been commissioned. But some areas may think that they don t need that service and will choose to use their money in a different way. In Hackney, which has commissioned the service, it is known as Pharmacy First, in a bid to communicate the message that pharmacy should be the initial port of call for» January February

5 IF WE HAD A NATIONAL MINOR AILMENTS SERVICE, IT WOULD SAVE PEOPLE AN AWFUL LOT OF TIME VISITING PHARMACIES» those suffering from common ailments. In 2013, the NPA s Ask Your Pharmacist Week also mirrored the Pharmacy First message, by encouraging people to seek pharmacy advice and treatment for winter ailments. The NPA, through Pharmacy Voice, is now working on the campaign to signpost the public to pharmacies first, Treat Yourself Better Without Antibiotics (see page 25 for more details). Hiten Patel, NPA and Pharmacy Voice Board Member and owner of a pharmacy in West Ealing, London, has been involved in the campaign. He says: We need to enhance the service that we provide with regards to self care. The public needs to know that the first port of call is pharmacy. People tend to think, when they get a cold or the flu, that they should go to their GP and obtain antibiotics, even if that s not the best thing for them. We need those people to visit pharmacists instead, so that GPs can be freed up to deal with more critical conditions. For this crucial change to take place, the public needs to understand that, in many circumstances, their local community pharmacy is the best option. Hiten says: We need better recognition than we receive at present. If there is a particular initiative being run, but no one seems to know about it, then that needs to be publicised nationally. Keith says that the recent Ask Your Pharmacist Week and Treat Yourself Better Without Antibiotics are a great step in the right direction and adds that he applauds the work. He continues: Community pharmacy is right at the front line of the NHS. There is a need for a significant level of engagement and I d expect that to have an impact on the implementation of this review. But raising public awareness is one thing and changing the public s perception and actions is another. Dr Sandra Wheatley, a social psychologist, says: Getting people to 12+88R1+99R 12% of the public use pharmacies for health advice 1% of the public use pharmacies for urgent advice change their behaviour can be a very tricky thing. For example, when supermarkets started selling stamps, it took people a long time to buy them there, even though it was often more convenient than the post office, but it did catch on in the end. There has to be a driving force behind something like this if people are going to change, then they will change because doing so makes their life easier. Visiting pharmacists first for certain conditions means better access for patients, and it saves the NHS money, so as long as people are made aware of the possibility, then they ve got nothing to lose by changing their behaviour. While there is unlikely to be an immediate shift in the public s perception of where they should go for the treatment of common ailments and their ability to self care, an increasing role for pharmacists is a long-term solution, not a short-term fix. It is not about this winter, says Keith. We ve been working with pharmacists and commissioners to look at what needs to be done. If you think about the scale of this, it is a major and complex task this is obviously going to take a while to implement. I m not going to sit here and say that in five years we will see a lot of major changes, but if there aren t major changes in that period, then I think we will have a major problem. Mike refers to NHS England s new Improving Care Through Community Pharmacy A Call to Action, which confirms PHARMACIES ARE USED, on average, 14 times a year per person THE MOST COMMON frequency of pharmacy visit is once a month THE MOST COMMON reason to visit a pharmacy is to get prescriptions that the current health system is unsustainable with services under pressure and recognises that community pharmacy should play a stronger role in public health and integrated out-of-hospital services, to deliver better health outcomes and reduce health inequalities. NPA Members can contribute to this call to action and help shape the future of community pharmacy (see below for details). The final chapter of Sir Bruce s report also recognises the system-wide transformation as a major undertaking in which traditional barriers and vested interests need to be broken down. Sir Bruce s team is now working with local commissioners to develop five-year strategic and two-year operational plans, and is set to release a progress report this spring. NPA support NPA Members can download a series of self care advice pathways to help give bespoke advice and exercise professional judgement on those occasions where the information provided in the Patient Information Leaflet is insufficient to cover a customer s specific circumstances. For more information, visit npa.co.uk Have your say To voice your opinions on NHS England s Call to Action, independentsvoice@npa.co.uk 24 - January February 2014