The jury's out on the community pharmacist consultation service
The community pharmacy consultation service (CPCS) has seen mixed success since it was launched. How can we help it achieve its full potential, asks GP pharmacist Shilpa Patel
I must admit that our surgery has not wholeheartedly embraced the CPCS. We attended initial training a few years ago and made a few referrals. This resulted in both good and bad experiences and we have since dipped in and out.
There is an investment and impact fund incentive for GP practices to utilise the service, so it landed on our agenda again recently and new resources were allocated.
Does this sound familiar? Or has your team realised the service’s potential and been able to achieve the ultimate goal of improving patient experience and freeing up GP appointments?
I recently raised the question on LinkedIn and received some valuable feedback.
The CPCS was originally set up as a portal for NHS 111 to refer patients to pharmacies as a link between the two sectors, allowing patients speedy access to urgent treatment. Since it was launched, an average of 10,500 patients a week have been referred to it following a call to NHS 111.
In November 2020, the service was extended to accept referrals from general practices. But three years later, my community pharmacy colleagues tell me they are not seeing many referrals from their colleagues in practices.
But I see value for everyone. Firstly, for the community pharmacist who has been offering free advice and support to patients with minor illnesses for many years. Via this service, they only need to do a small amount of additional work to be paid £14 for each completed referral.
In addition, this introduces the opportunity for the sector to play a bigger role than ever within the urgent care system.
So, why does it feel like many community pharmacies are not encouraging and promoting the service? Why does it seem as if essential processes to regularly check for incoming referrals are not being followed?
Secondly, practices are facing a GP shortage crisis, resulting in long waiting times. Why are GPs not utilising the additional appointments CPCS can offer our patients?
Is it because general practice does not understand the service? Or because GPs and patients do not value pharmacists' knowledge? Is it because the process is too complicated? If so, then why isn't it simplified?
Thirdly, and most importantly, there are rewards for our patients. As of January 2023, one in five patients (20.3%) had to wait between two and seven days for a GP appointment.
Community pharmacies are more accessible and patients can be seen any time of the day and at the weekend in many cases. The service means that patients can be seen immediately and be given the support and advice they need by a highly qualified clinician.
We have learned from setting up pharmacist-led clinics in general practice that many patients trust pharmacists. And often those that are newly introduced to the concept will change their view once they’ve had a consultation with the pharmacist.
As a GP pharmacist, I feel ideally placed to educate the general practice team and build on the strong links established with my community pharmacy colleagues.
Finally, the service tackles NHS spending issues. Not only does it save the cost of a GP appointment, but also prescribing budget spend by enabling deprescribing of over-the-counter medications and empowering patient self-care.
With all of these benefits, why have we not seen more referrals? What are the main obstacles?
In my experience, the referral from a surgery can be quite time-consuming for the receptionist or member of the triage team. The first problem is the requirement to obtain consent for every referral to the pharmacy.
This is where we often give up. If the patient query comes in via phone, the receptionist can ask for consent immediately. However, most of our queries are submitted via our online consultation triage service.
I have yet to understand why consent is needed as patients have already nominated the pharmacy for sending a prescription, but that’s another matter.
We recently asked our online administrators to set up a consent request via the form as part of the information gathering process. In addition to the issue of streamlining IT systems, there are a minority of patients who insist on seeing a GP. At this point, patients need to be educated.
Workforce capacity within community pharmacy is another challenge. It does feel like we may be shifting the workload from one incredibly busy sector to another without tackling or supporting the underlying challenges.
We have referred patients to the CPCS and patients said they were not been contacted, or patients have told us they attended the pharmacy and no one knew anything about the referral. This, of course, results in a lack of trust and a fear of future referrals being missed.
Perhaps we need some improvement in visibility, to be assured that the patient will be seen or be contacted. Or perhaps I have not completely understood the service process and there is a way to track the patient journey.
I suppose the CPCS is neither a success or a failure. As it is still so new, it needs time to evolve and improve. I want to help this evolution and improvement.
My focus for this year is to improve links between community pharmacy and general practice. We can learn from mistakes due to a lack of understanding, trust, training or time.
Where the service is embedded and referrals are coming through to pharmacies, CPCS has delivered positive outcomes for both patients and GP surgeries and appointments are definitely being saved.
By starting this debate, I hope to inspire community and GP pharmacists to engage in this service, encourage everyone to adopt a growth mindset and allow the service to develop into its full potential.
Shilpa Patel is the lead prescribing pharmacist and a GP partner at WellBN in East Sussex