The Community Pharmacist Consultation Service (CPCS) has been running as a national advanced service since October 2019 to relieve pressure on the National Health Service which aims to help with on the day demand in relation to minor illness and medicines.
The NHS Community Pharmacist Consultation Service CPCS (NHS CPCS) aims to meet the objectives of the NHS Long Term Plan to use community pharmacists’ skills to advise patients, and to build relationships with GP surgeries, primary care teams and wider NHS providers and to assist with urgent care system repeat prescription requests. Referrals from the GP referral pathway and urgent care systems and urgent treatment centres are digitally routed to community pharmacies so that patients can receive same-day appointments and have their queries resolved.
Based on the estimated annual number of minor ailment GP appointments, the service was expected to save the NHS up to £640 million per year . Three years later, the nation has weathered the Covid 19 pandemic, which had widespread effects and put further strain on already overstretched NHS staff.
The pandemic impact has resulted in higher numbers of GP appointments than initially anticipated. Nevertheless, this may offer an opportunity to proactively engage pharmacy teams in patient contact help ease strain across the wider NHS.
While working in a Northampton practice in 2019, Aggrey Mpofu – Head of Training and Development at Core Prescribing Solutions noted first-hand how busy the teams were. He introduced training for the reception and administration staff on how to correctly distinguish GP referrals from those for the community pharmacist.
Around a month after implementing this training, it was found that on average, half of the telephone calls received during morning triage calls were suitable for a NHS CPCS referral.
Challenges in primary care
It became clear that a key challenge for practice teams is having a trained on-site care coordinator who is responsible for this service and helps with appropriate referrals, some of this was to assist with urgent supply of medications.
GP practice system software providers such as Emis and Ardens have developed integrated CPCS protocols to create referrals to local pharmacies. Emis has a helpful YouTube video demonstrating the process.
Practice staff need in-depth training to take advantage of these innovations. Clinical pharmacists and pharmacy technicians supporting primary care teams can offer this education to practice staff and promote the benefits of reducing workloads for GPs and nurses.
Clinical pharmacists and pharmacy technicians can also help train a care coordinator to screen requests for appointments for minor conditions that can be covered by CPCS.
Challenges for community pharmacy
The challenge for the recipient community pharmacist is having a system to process the referrals within a day, as they need to be integrated into their already busy schedules.
In Aggrey’s spare time, he worked in a community pharmacy in Daventry, where he received NHS CPCS referrals from GP practices, NHS 111, and urgent care system and urgent treatment cetres. The pharmacy’s PharmAlarm service device notified him of referrals by lighting up blue and turning white when the referral was complete. However, a community pharmacy without this or similar technology can face a barrier to meeting referral demand on top of the multiple existing daily tasks.
Importance of training
To offer CPCS, each pharmacist must complete the appropriate required training. Some pharmacies may find this problematic, especially if they rely on locum staff, as lack of training could result in unmet referrals and weaken the relationship between the practice and the community pharmacy.
Community pharmacy experience of Community Pharmacist Consultation Service
A pharmacist and manager of a community pharmacy in the Gloucestershire area commented on the NHS Community pharmacist consultation service saying, “We offer this service regularly. It works well, but as always in pharmacy, finding time to do it is difficult.”
Another pharmacist in the Coventry area said, “The service works for urinary tract infections over minor illness referrals. The only downside is that there is no limit on consultation time and sometimes other patients have to wait for the pharmacist – this can sometimes take half an hour…”.
On the positive side, the pharmacist said that patients in his area respond well to the service and are not reluctant to purchase over-the-counter medications after a thorough consultation. However, a Southampton practice manager had a different opinion, stating:
GP Surgeries experience of Community Pharmacist Consultation Service
“We try to promote the service, but many patients in our area are on benefits and cannot afford the over-the-counter medications; some mothers cannot afford thrush cream or other urgent repeat prescriptions, for example.”
She then explained how reception staff screen patients using a clinical questionnaire template stored in their Emis system – red flag symptoms identified via the questionnaire prompt the staff member to contact the duty doctor for a triage consultation. This practice manager also said it would be helpful to consult the clinical pharmacists within GP practices on questions about minor illnesses that the practice team sends to doctors.
Integrated Care Boards – return on investment
A December 2022 report produced by the Buckinghamshire, Oxfordshire, and Berkshire West (BOB) Integrated Care Board showed some participation from Primary Care Networks (PCNs). While the report showed a total of 14.3% of target referrals between April 2022 and December 2022 made by the BOB PCN practices, this equates to approximately 60 days of potentially saved appointment time, which is a significant return on investment.
Although the figures in the BOB report show small participation, they are progressive and reassuring because of the resulting appointment time potentially saved via the GP referral pathway or through urgent care.
The Pharmacist and community pharmacy – the missing piece?
There is scope for further growth in CPCS participation. Could the prescribing qualification that came into effect in 2006 prove useful for improving patient access and helping with on the day patient demand assisting with urgent supply of medicines and minor illness via the CPCS programme?
Can the pharmacist, historically best known for dispensing prescriptions, over-the-counter medication and healthcare advice, prove to be the missing piece of the healthcare team, hidden in plain sight? Or can primary care clinical pharmacists and pharmacy technicians play key roles in the adoption, training and implementation of the CPCS scheme?
Future of CPCS
There is certainly scope for growth in CPCS if all stakeholders work together to improve access to healthcare, and to deal with on-the-day demand of minor illness related queries and urgent medication supply.