BY RICHARD BROWN
The NHS England Digital Minor Illness Referral Service (DMIRS) is one of the most important changes to community pharmacy since the advent of the 2005 pharmacy contract. Every day, community pharmacy sees hundreds of thousands of people where self-care advice is the appropriate outcome. Pharmacists working in community settings are highly skilled in responding to the symptoms of the communities they serve. They are competent in identifying red flag warning signs and where appropriate referring to another healthcare practitioner. However, it must be noted that most of these consultations are concluded satisfactorily with advice, an OTC product and safe netting where required.
Eight appointments a day
The service looks to build on the long-standing work carried out in community pharmacy by referring patients from either NHS111 or from the local GP practice. Each year it is estimated that 20.4 million (6%) of GP appointments could be referred to community pharmacy, which translates to approximately eight appointments per day per pharmacy. This transfer of acute, self-limiting illness to pharmacy will free up surgeries to spend time with the more complex patients, the ones that unless seen that day could well end up in out of hours or worse, admitted to hospital. The NHS111 referral scheme, initially trialled in the North East, saw over 5,000 patients being seen over a fourmonth period saving approximately 11 weeks of GP time.
Consistency a challenges
The conditions that the pharmacies are expected to manage include sore throats, rashes, constipation, coughs and colds. In essence, the conditions we already manage successfully day in and day out. The challenge we face is to ensure consistent delivery of the service across the whole week from all of our pharmacies signed up to the service. This means the entire pharmacy team needs to be aware of the service and how to identify people presenting in the pharmacy. The risk is that a patient presents, and the pharmacy manage them through the historic responding to symptoms pathway and hence lose the ability to record the intervention.
Adequate training is vital
We need to ensure that all pharmacies can access NHSmail to collect and referrals along with PharmOutcomes, Sonar, NICE Clinical Knowledge Summaries and the Summary Care Record at all times during the day and in particular evenings and weekends. The service itself is not complicated. However, ensuring the team is adequately prepared is crucial. The VirtualOutcomes online training course includes all the service information as well as checklists to ensure you complete all actions prior to go live and then ongoing whilst delivering the service.
Important to maintain local ties
So, what now for community pharmacy? Whilst you are waiting to go live with the service, it is important to be building strong working relationships with your local surgery as it will be vital that the clinical team in the surgery trust how the service works and how you will support them in jointly managing the clinical risk for a patient.
For some surgeries, it will be a huge leap of faith to ask a patient to leave the surgery and present in the pharmacy. This, therefore, means that the correct record keeping and surgery feedback is essential to deliver the service and build mutual professional trust. Each Local Pharmaceutical Committee needs to be discussing the service with their NHS England team, Clinical Commissioning Group, Integrated Urgent and Emergency Care team and NHS111 provider. This is required, especially the support offered to NHS111 as the call handlers will need to be confident in the service and that the patient will be handled correctly.
The big picture
It is also important for pharmacy to be aware of the bigger picture. Primary Care Networks will require patient’s to be seen at the most appropriate setting, in a time frame aligned to their needs. Community pharmacy must be a valued partner of a PCN and DMIRS offers a simple, easy to implement service that every PCN in England should utilise to maximise available care to their population.
Finally, as with any change, there will be nervousness, however the sector has a huge opportunity to demonstrate to the NHS the value community pharmacy brings to the care it offers local communities.
Get this right and there is a bright future for community pharmacy, get it wrong and fail to deliver and we only have ourselves to blame.
The author is roving judge for Pharmacy Business Awards and director at online training course provider VirtualOutcomes.co.uk.
This piece also appears in the July issue of Pharmacy Business.