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Urgent and emergency care

Government to consult pharmacies on plans to ask patients in Wales to phone before attending A&E

The Welsh government hopes to begin testing a scheme encouraging patients to check whether they need to go to A&E by the end of September 2020.

Ambulance parking at A&E

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The “walk and phone” plans are designed to reduce pressure on hospitals during the winter season

Community pharmacy in Wales will be consulted by the government about plans to ask patients to “phone first” before attending A&E in an effort to curb demand during winter 2020/2021, it has said.

The government’s “‘phone and walk’ concept” — which is expected to be developed and tested by the end of September 2020 — was set out as part of draft plans to manage winter demand for urgent and emergency care during the COVID-19 pandemic by redirecting patients to other healthcare settings.

Pharmacy representatives in Wales said they support the proposals to ask patients to access care in the right place and would welcome referrals from A&E as “an extension” of those already received from out-of-hours services.

The draft winter preparedness plans, drawn up by the National Unscheduled Care Programme, also set a target for health and social care clusters — which include community pharmacies — to have vaccinated 60% of patients in at-risk groups against seasonal flu by the end of December 2020.

Previously, the Welsh government had asked that 75% of patients who are pregnant or aged 65 years and older, as well as 55% of those in clinical risk groups who are aged 6 months to 64 years, receive vaccinations over the course of the flu season.

The winter preparedness plans were published on 23 June 2020 alongside the NHS Wales COVID-19 operating framework for the second quarter — July, August and September — of 2020/2021.

These months provide “an opportunity to embed new approaches to unscheduled care which will help support COVID-19 and essential services in advance of winter pressures,” the framework said.

The targets included a “key deliverable” that said “a ‘phone first before attending [A&E]’ or ‘phone and walk’ concept targeted at patients who could be safely assessed elsewhere or through a planned approach will be developed and tested by the end of [quarter] 2”.

It adds that this would “support care in the right place and enable social distancing in emergency departments”.

A spokesperson for the Welsh government said it is “working alongside NHS Wales in the initial stages of exploring a ‘phone first’ concept and will be engaging with the public and other key stakeholders, including pharmacies and other primary and community services, over the coming weeks as part of this work.”

The document also says health boards “should deliver the ‘Choose Pharmacy’ system and common ailments service locally to enable patients to access an appropriate service for their minor ailments in a timely manner, and to receive NHS treatment from the community pharmacy, preventing the need for presentation at hospital”.

Vaughan Gething, the Welsh health minister, said in May 2019 that the Choose Pharmacy IT platform, which underpins the common ailments service, was available in 97% of pharmacies.

A spokesperson for Community Pharmacy Wales (CPW) said plans to ask patients “to access care in the right place was being developed over a long period of time and prior to COVID-19, and community pharmacies were already signed up to support this agenda”.

“In practical terms, community pharmacies already have patients referred to them from out-of-hours services to both the Common Ailments Service (CAS) and the emergency supply service in Wales,” they said, adding that “referrals for other reasons would be an extension of this”.

CPW added that pharmacists “are used to providing the [CAS] service during the winter alongside other demands for community pharmacy time, such as flu vaccination, so our anticipation is that even with the ongoing challenge of COVID-19 we believe we could cope within capacity”.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20208107

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