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Urgent and emergency care

Pharmacists warned to look out for 'drug-seeking behaviour' in NUMSAS patients

Pharmacists receiving NUMSAS referrals from NHS 111 Online have been warned that they will not see the red flags on patients’ files.

Woman using NHS 111 Online

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Pharmacists have been warned to stay vigilant of patients with drug-seeking behaviour accessing NHS 111 Online

Community pharmacy representatives have warned pharmacists to look out for “drug-seeking behaviour” from patients accessing the NHS Urgent Medicine Supply Advanced Service (NUMSAS) through NHS 111 Online.

The warning comes after the NUMSAS pilot was expanded in Cheshire and Mersey and in Greater Manchester to provide access to the service through NHS 111 Online in July 2019.

In the first four weeks of operation, NUMSAS referrals from NHS 111 Online to community pharmacies in the Cheshire and Mersey area accounted for more than 20% of all referrals through NUMSAS.

However, in a newsletter dated 27 June 2019, Community Pharmacy Cheshire and Wirral (CPCW), which represents community pharmacies throughout Cheshire, Warrington and Wirral, highlighted that the NHS 111 Online system does not have any way to screen out patients with drug-seeking behaviour. This is unlike NHS 111 call handlers, who are able to see red flags noted on patients’ files.

A spokesperson for North West Ambulance Service (NWAS), which covers Cheshire, Merseyside and Greater Manchester, explained: “The NHS 111 service, as provided by NWAS, is designed with certain precautions put in place to address concerning patient behaviours, including those that may be drug seeking.

“When concerns are raised within or to 111, we are able to put special notes on the patient’s file, which will alert the call-taking staff when the patient contacts the service.

“In the event of a special patient note around drug-seeking behaviour being present, NWAS NHS 111 would not refer this patient to the NUMSAS service, instead we would refer or advise the patient to visit their own GP or an out-of-hours service.”

However, the online system does not have any way to screen out those with a special patient note and CPCW advised that when a patient presents in a pharmacy, staff members must request proof of identification to ensure they are talking to the person who has made the referral.

“This is no different to if the patient walked through the front doors without the service referral so please treat the referral as a request from the patient to be seen, not a request from the system to supply,” it said. 

Guidance from NHS England and NHS Improvement, published on 28 June 2019, added: “Receiving a referral for NUMSAS through 111 online is not in itself an authorisation to make a medication supply and should not impact on the pharmacist’s professional decision as to whether a supply is appropriate.”

NHS 111 Online is now live nationally and, according to the guidance, if the NUMSAS pathway pilot is successful in the North West, there are plans to roll it out nationally in the run up to winter 2019 to support urgent care services.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206943

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