Tedious process ‘deters general practitioners’ from referral program to community pharmacies


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A “bureaucratic” electronic referral system is preventing more GP practices from referring patients to the Community Pharmacist Consultation Service (CPCS) in England, a senior GP said.

The CPCS, in which patients are referred from general medicine to the community pharmacy for a same-day consultation with a pharmacist for minor illnesses, such as acne, constipation or vaginal discharge, has been deployed to the nationwide in November 2020, following a pilot that began in July 2019.

However, it has been little adopted by general practitioners. In October 2021, a report from the Royal Pharmaceutical Society (RPS) indicated that only 862 GP practices out of more than 6,500 were using the service.

However, financial incentives in the form of the ‘Winter access fund’, announced by NHS England on October 14, 2021, called for all practices to join the program by December 1, 2021 and may have increased that number since.

The “Winter Access Fund” offers firms £ 250 million to cope with winter pressures, with participation in the CPCS “a condition for a firm to benefit” from the fund.

Speaking at a meeting of the All-Party Parliamentary Group (APPG) on Pharmacy on December 1, 2021, Richard Vautrey, former Chairman of the British Medical Association (BMA) General Practitioners Committee, explained that the “bureaucratic process of CPCS referral system puts practices out of engagement in this arrangement ”.

The process requires generalist receptionists or “care hubs” to review a symptom checklist and, if applicable, electronically refer the patient to the pharmacy the patient has chosen.

“Sitting down with my practice staff who are doing this now, it potentially takes them ten minutes to work on the individual referrals,” said Vautrey.

“So when the patient calls [the GP surgery] – and it is clear from the patient’s first comment that this particular problem could be dealt with more appropriately by a community pharmacist – then it takes a long time to process this referral and then send it to the community pharmacist.

He explained that dismissals through the previously commissioned minor ailments program, which was phased out by March 2020, were “much simpler.”

“[The minor ailments scheme] was literally, “Yes, this problem can be treated by the pharmacist across the street or next door and that’s where you can go get it,” he continued.

The Minor Ailments Plan was introduced in 2008 and was designed to provide free NHS treatment for minor ailments, such as colds, allergies, and minor skin conditions, at pharmacies to avoid consulting a general practitioner.

Pharmaceutical journal revealed in 2018 that a fifth of minor ailments programs had closed in the previous three years, with the program later shutting down in London in March 2020.

Alastair Buxton, director of NHS services at the Pharmaceutical Services Negotiating Committee (PSNC), said that during PSNC’s regular discussions with the BMA’s GP committee, “we have heard that the [CPCS] in its current form is bureaucratic for general practitioners and can take significant administrative resources ”.

“It would be better if GPs could informally refer patients to a pharmacy, with all patients able to access the service simply by going directly to their local pharmacy. We will continue to seek such a walk-in approach to service in our discussions with the NHS England and Improvement and the Department of Health and Welfare. “

Thorrun Govind, Chairman of the English Pharmacy Board of RPS, said: “Streamlining CPCS referral pathways to make life easier for patients and staff was a key finding of our recent workshop with the Royal College of GPs, BMA and the pharmacy teams.

“With continued pressure across the health service, we hope that the workshop recommendations can be implemented with the NHS and other key partners to make CPCS a success. “

A report from the RPS and RCGP, released in November 2021, recommended that the GP referral system “fits into their current triage systems and pathways to ensure their teams don’t have to learn any systems or processes. additional / different IT ”.

He added that the government should develop an independent prescribing service for community pharmacists in England, to expand their role in the management of minor illnesses, in a model similar to the ‘Pharmacy First’ program in Scotland.

What is the “Community pharmacist consultation service”?

The ‘Community Pharmacist Consultation Service’ (CPCS) was launched in October 2019, replacing the pilots ‘NHS Advanced Urgent Medicine Supply Service’ and ‘Digital Referral Service for Minor Illnesses’.

In the initial phase of services, patients were referred from NHS 111 to the community pharmacy for free advice or a subsequent referral, with patients also able to pay for over-the-counter medicines.

In November 2020, the service was expanded to include referrals from general medicine. However, adoption by GPs has been slower than expected, with some local pharmaceutical committees receiving additional funding to increase referrals from GPs.

NHS England data showed 340,000 patients had been referred by NHS 111 as of June 2021, while general practitioners had referred 13,000 patients to community pharmacies since the service began.

The service also failed to meet the promised funding levels. He was expected to bring in around £ 4million in 2019/2020 and £ 9million in 2020/2021, with pharmacists paying £ 14 per consultation; however, low participation means that projected funding levels have not been met.

Data released on October 28, 2021 by the NHS Business Services Authority shows community pharmacies made just £ 1.9million from CPCS in 2019/2020 and £ 5.3million in 2020/2021.

Nonetheless, there may still be further opportunities to increase the number of referrals, as nine zones began piloting referrals from emergency treatment centers, such as emergency services, in November 2021.

Read more: Minor Ailments Learning Resources

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