Community Pharmacy Future project estimated to save £470m if rolled out across England
Three services piloted through community pharmacy could save the NHS £470m per year if they were implemented across England, according to the results of the Community Pharmacy Future (CPF) project.
Keith Ridge, chief pharmaceutical officer for England, described the pilot as “impressive” and said that the work contributed positively to the evidence base, which is “important” to commissioners. Furthermore, he recommended that the results feed into NHS England’s current “Call to action” consultation, which closes on 18 March 2014.
Four of the biggest pharmacy multiples have been collaborating on the CPF project for two-and-a-half years (see Panel). The aim of the project was to develop and evaluate clinical services delivered through community pharmacy. Boots, Lloydspharmacy, the Co-operative Pharmacy and Rowlands Pharmacy presented the results last week (27 February 2014) to an audience at the King’s Fund in London.
David Wright, professor of pharmacy practice at the University of East Anglia, led the group that carried out the independent analysis of the data for the three services — which included a chronic obstructive pulmonary disease case-finder service, a COPD support service and a four-or-more medicines support service. He told the audience he is impressed with the quality of the data collection, which allowed the calculation of a cost per “quality-adjusted life year” (QALY), the measure of cost-effectiveness used by the National Institute for Health and Care Excellence.
The COPD case-finder service, which identified patients at risk of COPD, is predicted to save more money than it costs to set up, which means that the cost per QALY does not need to be calculated, explained Professor Wright. He added that there is clear evidence that it should be adopted by the NHS.
The COPD case-finder service was piloted in 21 pharmacies in the Wirral. Professor Wright explained that, for every person diagnosed with COPD, there are three cases that go undiagnosed, leading to disease progression and an estimated cost of £3.2bn to the NHS. Over nine months, 238 patients were screened and 135 were identified as being at moderate risk of COPD. Of these patients, 88 were active smokers and 54 went on to access smoking cessation services following their COPD risk being identified. Scaled up to the 11,000 community pharmacies in England, the service is predicted to result in gross savings to the NHS of £264m per year through earlier diagnosis of COPD and £215m through potential lifetime savings from patients stopping smoking.
COPD support service improved adherence
Also in the Wirral, the COPD support service involved 34 pharmacies, with 306 patients recruited but only around 200 completing the service. It aimed to improve patients’ understanding of their medicines, their adherence to treatment and their inhaler technique. As a result of the service, 136 patients changed their inhaler technique and 72 got smoking cessation advice, four of whom quit. There was a 97.5 per cent uptake of influenza vaccination.
Furthermore, there were fewer visits to the GP surgery, fewer accident and emergency admissions, and an improvement in patients’ quality of life and adherence to their medication. It was calculated that this could save £139m gross annually and £86m through potential lifetime savings from patients stopping smoking.
The third service, for patients over 65 years old and taking four or more medicines, recruited 620 patients through 25 pharmacies in Wigan. Pharmacists helped patients understand their medicines and used the STOPP/START prescription screening criteria to make recommendations to their GP. It was found that the number of falls among these patients halved following the service and medicines adherence improved. There were also more recommendations to stop medication than to start medication. The researchers calculated gross annual NHS savings of £36m per year in reduced prescribing costs and hospital admissions, and £34m per year through reducing falls resulting in fracture and hospital admission.
The researchers estimate that the cost per QALY for the two support services would fall under the £20,000 threshold for cost-effectiveness used by NICE.
Professor Wright said that the results have been submitted to the International Journal of Pharmacy Practice for peer review and publication.
Community Pharmacy Future project background
When the project was launched in 2011 there was concern about pharmacy revenue following category M cuts, said Kenny Black, managing director of Rowlands. “We needed to do something to change the funding for the pharmacy model,” he added. Otherwise, none of the four pharmacies could confidently predict that there would be any investment from their parent companies, he continued.
A steering group was established, which included all four pharmacies’ managing directors and representatives from the Department of Health, NHS Employers and the Pharmaceutical Services Negotiating Committee. “We wanted this to be something that would improve the entire pharmacy sector,” added Tricia Kennerley, director of healthcare public affairs at Alliance Boots. Services were also implemented in independent pharmacies and a supermarket, but these were not included in the main analysis.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11135309
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