Francisco Alvarez believes passionately in pharmacists’ ability to take the pressure off GPs. Let’s hear it for Pharmacy First. The public health pharmacist of the year talks to Neil Trainis…
When it comes to stopping people with skin rashes, coughs and colds and cuts and bruises from clogging up hospitals and accident and emergency departments Francisco Alvarez appears to have come up with the answers.
The Pharmacy Business public health pharmacist of the year who has worked his resourceful and pragmatic approach to healthcare on the Isle of Wight, first at Regent Pharmacy and now as a consultant pharmacist at Sandown Health Centre, has pioneered an effective way of tackling what is known within healthcare circles as minor ailments.
To patients there is nothing ‘minor’ about constipation, haemorrhoids or athlete’s foot and to a government frantically looking for the NHS pressure release valve these conditions have become more major than minor. Francisco has faced it all head on. Two simple words sum up the way he has done so; Pharmacy First.
The scheme, which started on the island in 2014, allows residents to access advice and treatment for minor ailments without a prescription. Uncomplicated but brilliant. People with conditions such as earaches, coughs and colds, skin rashes, eye infections and diarrhoea can go straight to their pharmacist for a consultation rather than spend time chasing up a prescription from a GP.
The service has been a rip-roaring success. Patients do not worry about going without treatment or having to wait ages to see a GP or resort to out-of-hours care.
At Regent Pharmacy they knew they did not have to make an appointment to see Francisco or a member of his team. They knew they could talk to him about any health-related issue in confidence. Sandown Health Centre is now benefitting from the scheme.
“The beauty of the scheme is the ability to triage the patient. I’m the prescribing lead when it comes to new medicines or when patients have difficulties with their medicine. I must say where (Regent Pharmacy) has lost, Sandown has gained,” Francisco says.
“I worked on it to get it commissioned (at Regent Pharmacy). The demand is there but the capacity to meet that demand was not there.”
While the government in England has failed to get to grips with minor ailments, lagging woefully behind Scotland and Wales, it feels like the Isle of Wight has cracked it. Francisco vigorously believed in Pharmacy First, promoting it from Regent Pharmacy, taking it to local voluntary groups and meeting with local councillors to discuss its benefits. Thousands of residents on the island have used the service.
“It’s not about supplying a product but more about improving patients’ awareness of community pharmacists’ roles such as diagnosing and getting people to think of pharmacy as a first port of call,” he insists.
“I’d say we have 10 patients at least a day on the scheme. We triage without putting pressure on emergency services and other services on the island. The valued ones are children and elderly who want advice without having to turn to NHS 111.”
Francisco is asked how his local GPs reacted to Pharmacy First when it started. “I told them it was commissioned for them rather than a way for pharmacy to make money. Pharmacists get the blame for all sorts of things but we been very lucky here in that on the island, GPs have historically been supportive of pharmacists.
“I wanted to open awareness of Pharmacy First so people know it might be about a medication query but the basics are supporting the nurseries and schools. We promote services to local authorities.
“Imagine how many prescriptions there are for headlice. That’s a huge amount of pressure off GPs. We deal with skin rashes, cuts, bruises, things GPs shouldn’t have to handle.
“The other success of Pharmacy First is those who are exempt from prescription charges are eligible for it. There’s no appointment, we don’t allow them to wait more than five, 10 minutes max when it’s busy. There’s no age limit, anyone can access the scheme.”
It feels like Regent Pharmacy’s loss is Sandown Health Centre’s gain. “It was a very difficult choice to leave because what we created at Regent Pharmacy was unparalleled in terms of the relationships we created, maintaining that with GPs, nurses, care and nursing homes, hospital pharmacists. They all knew what we were doing,” he says.
“It was a tough decision to walk away from all of that but change happens in different ways. You need change. You constantly go out of your way to engage. To walk away from that was very difficult but I felt we did a great job and it’s not going to change.
“Regent Pharmacy is going to do even better but I needed a new challenge. I’m leading on electronic repeat dispensing (eRD) which has been harnessed ok on the Isle of Wight. The pressure on GPs is increasing. The number of prescriptions is increasing not decreasing but eRD is phenomenal.
“I train nurses who prescribe and healthcare assistants who lead health centres who don’t prescribe. It eliminates nurses taking up the time of GPs. Electronically, repeat dispensing is even more of a win.
“Cancelling an item is a lot better than having to send a letter to the surgery. It’s very seamless and it’s harnessing community pharmacy’s knowledge of the patient. We can support GPs’ workload and of course help the patient.
“We’ve got to educate patients about EPS (electronic prescription service) and eRD and iron out the creases. GPs have noticed a huge burden has been removed for them.”
Although Pharmacy First has worked well on the Isle of Wight with its 69,216 residential households (according to Isle of Wight Council, October 4, 2013) and 140,500-strong population, how would the scheme fare in cities with larger populations? Say, London with almost nine million people? Or Birmingham with over a million?
“I think there is a case for it (in big cities). There have been some negative reviews on the Isle of Wight where Pharmacy First was not being utilised properly. This is where the case for a national minor ailments scheme comes in,” Francisco says.
And there it was. Four words that have become almost a cry for help from health practitioners and patients in recent years. National minor ailments scheme. Will it ever happen in England?
“Whoever is running the show, we need a change of leadership. (The government) is looking to cut budgets but there needs to be a comprehensive review,” Francisco offers.
“NHS England doesn’t look at the figures and the trends or it takes them quite a while to get there as it did with the flu vaccinations. We need a change of leadership.”
Francisco is asked if he favours a change of government. “The way we work is very fragmented so it would be wrong to blame the political parties. But where would you go to find nationally protected services? Scotland. You don’t need to travel far.
“The workforce wants steady change and a different approach. We need a fresh pair of eyes, someone who understands patient needs. Did you know the NHS is the second biggest employer in the world? Who’s the biggest? The Chinese army. There, there’s a bit of humour for you.
“Whoever the party is, they need to be told what the NHS needs and what they need to do to support the NHS in the next 10-15 years. We need individuals who know what they are doing.
“The PSNC does a great job but they’re limited, they don’t have the leverage. They can make recommendations but NHS England doesn’t have to listen to them.
“That’s the problem. We need far more forward-thinking, ideas about how we can save money rather than cut budgets and using sticking plasters. We need health leaders with vision.”
Francisco might be described as a health leader with vision. The future of public health feels at least a little secure on the Isle of Wight. He is asked if he feels community pharmacy across England is threatened with extinction.
“It’s not items that matter, it’s the expertise of community pharmacists that matters to the community.
“This is where NHS England is short-sighted. There may be clustering but what are elderly people going to do for example if they can’t get to the pharmacy they use? I don’t have much faith in (NHS England’s) next decision unfortunately.”