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Urgent and emergency care

A&E could refer patients to community pharmacy under new five-year contract

If ongoing pilots are successful, the Community Pharmacist Consultation Service could see patients referred from urgent treatment centres and A&E to community pharmacy

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The Community Pharmacist Consultation Service has been described as a potential “game changer”

Patients in A&E could be sent to see a community pharmacist instead of a doctor under a future expansion of the scheme that currently refers patients from NHS 111 and general practice.

The newly-named Community Pharmacist Consultation Service (CPCS), which combines the Digital Minor Illness Referral Service (DMIRS) and the NHS Urgent Medicines Supply Advanced Service (NUMSAS), will begin rolling out across England from October 2019.

Pilots of the service, funded by the Pharmacy Integration Fund (PhIF), are already underway with NHS 111 referring patients to community pharmacy in Devon, East Midlands and London.

And GPs in Cheshire and Merseyside; Cumbria and North East; Greater Manchester; Bristol, North Somerset and South Gloucestershire; West Yorkshire; and Lancashire and South Cumbria, are able to refer patients to a community pharmacist for a consultation.

According to the five-year community pharmacy contract, published on 22 July 2019, if the pilots are successful, referrals between general practice and pharmacy could be in place across the whole of England by 2020.

And it adds: “Referrals from NHS 111 online, Urgent Treatment Centres, and possibly A&E are further planned extensions if PhIF pilots are positively evaluated.”

Mike Hewittson, managing director of Beaminster Pharmacy in Dorset, told The Pharmaceutical Journal that the service “could become a game changer in the long run”.

“NHS England will probably find some way to mess the service up — and I hate being at the mercy of other providers for work — but I am at least hopeful that there is an opportunity for a useful service, with some meaningful income,” he added.

Deborah Crockford, chief officer of Community Pharmacy South Central, agreed that the service should be seen “as a positive”, with pharmacies adjusting their business model to cope with an influx of referrals, “if the funding is appropriate and consistant”.

“It can’t be that we get more and more referrals and less and less [money] for each one,” she said.

Community pharmacies offering the referral services in the pilot areas currently receive £14 per consultation.

However, the government said in the contract document that it would “review the payment model at the end of 2020/2021”.

“This review will take account of potential volume efficiencies, review fee structures, as well as the operation and optimisation of all elements of the referral process and service provision,” it said. “This will be informed by ongoing evaluation of the CPCS in operation.”

Richard Brown, chief officer of Avon local pharmaceutical committee, told The Pharmaceutical Journal that the CPCS service “is brilliant”.

“Why book somebody in for an expensive out-of-hours appointment when actually a consultation with a pharmacist out of hours would be what they need?” he asked, adding that he has already been talking to his urgent and emergency care sector about referrals to community pharmacy locally.

“In Bristol, they’re already very interested in how we could triage people out of minor injury units for common ailments,” he said. 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206851

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