The ever-expanding role of a pharmacist means new pilot schemes are popping up in community pharmacies throughout the UK, delivering care in areas that the profession has not traditionally been involved in.
But how are these services faring? C+D speaks to the pharmacists leading three pilots to see how they are getting on.
London hepatitis C pilot
Eight pharmacies in London took part in piloting a service that launched in November 2017, testing intravenous drug users, who use needle exchange services in community pharmacies, for hepatitis C. The theory was that pharmacies are an accessible place for these patients, as it is often hard for them to reach treatment in GP practices.
In this first phase, run by hepatitis C treatment organisation the London Joint Working Group, pharmacists offered these patients a saliva test via a mouth swab, and referred those who tested positive for hepatitis C to secondary care for formal diagnosis and treatment.
Half of the patients who were seen during the three-month period tested positive for the virus.
In phase two of the pilot, which launched in July 2018 in nine pharmacies, pharmacists offered patients a more accurate blood test, which assesses if the virus is active. The second phase proved even more successful than the first, according to Rekha Shah, pharmacy immunisations lead for Kensington, Chelsea and Westminster local pharmaceutical committee (LPC). “We’re excited,” she says.
Patients know whether they are positive within 10 minutes of testing, Ms Shah says. The "best thing" about the service is then treating those who test positive, she says.
The pilot even caught the attention of Steve Brine MP, who visited a pharmacy offering the service when he was pharmacy minister. Two months after his visit, he told MPs in parliament he was “impatient” to see the pilot “scaled out”. However, Ms Shah says it will be challenging to provide the service on a wider scale.
She told Mr Brine during his visit that the pilot is funded by a “tiny local authority pot of money”, and rolling out a similar service across the capital would be difficult, because “there isn’t the framework [to do so] within the pharmacy contract”.
“Out of 33 boroughs in London, we only managed to get seven of them to agree to be a part of this, so getting it right across London in the first place is quite difficult”. However, because the first phase proved that pharmacies are well placed to help patients with hepatitis, “we thought it might generate more interest from local authorities and commissioners”, she says.
Other areas are starting to show interest, she points out. Another hepatitis pilot service is launching in pharmacies in Birmingham and Manchester, while two London authorities now plan to commission the service.
Watch Ms Shah’s reaction after Mr Brine's visit to Portmans Pharmacy in the video below:
Ear, nose, throat and eye service
Another pharmacy pilot service that saw early success is the ear, nose, throat and eye service in Staffordshire and Shropshire. It was initially trialled in 10 pharmacies in December 2017, before adding another 15 the following year – and more are in the pipeline.
The service offers care for ear, nose, throat and eye conditions. Pharmacists can give advice, recommend over-the-counter medication, prescribe antibiotics under a patient group direction where necessary, or signpost to secondary care.
The scheme, which started with £28,000 of funding from NHS England, received a further £218,000 a year later. It has also diversified the service so that 15 pharmacies taking part will also deliver a service for respiratory and skin conditions. This month, NHS England said it would be rolled out to a further 50 pharmacies in Staffordshire and Shropshire.
Most of the funding will go towards training – the scheme provides pharmacists with a full-day course where they learn consultation skills and history-taking, and have a practical session using otoscopes.
Pharmacies receive an initial payment of £500 to help towards training costs, then a further £25 per consultation.
Gill Hall, South Staffordshire LPC service development officer, says the additional funding means pharmacists in the pilot “can see many more patients”.
The initial phase was limited to 640 consultations in total. “Now we’ve got the money to do 3,000 ear, nose throat and eye consultations, and 4,000 for respiratory and skin.”
The extended pilot has been running since October, with a review planned to analyse the results this month, Ms Hall says. So far it has showed signs of taking pressure off GPs. “Our follow-up questionnaire showed how many patients didn’t go on to [consult] another healthcare professional,” she says.
At the moment, there is only funding to train two pharmacists at each of the participating pharmacies, but Ms Hall hopes the project will expand soon.
It would be nice if there was at least one pharmacy in every locality providing the service, she says.
Dorset mental health service
A pilot in Dorset is operating on a smaller scale, but aims to support some of the most vulnerable patients.
The objective of the service – funded by Public Health Dorset – is to encourage patients with mental illnesses to take their medicines daily, says Amanda Moores, chief officer of Dorset LPC. It aims to improve their treatment by ensuring medicines adherence, in a patient group who often struggle to take their medicines, as well as providing advice and support.
As part of the service, patients have an initial consultation with the pharmacist, where they answer 13 questions on how they manage their medicines and what support they need. The patient is then encouraged to visit the pharmacy to take their medicines, so the pharmacist can ensure they are taking them correctly.
Each time the pharmacist sees the patient they record the interaction via PharmOutcomes, where they can also update a local mental health trust on patient progress.
The pilot is running in two areas in Dorset, with a review planned for April. The pharmacies taking part receive £400 for training, then £300 for the first week of support. Pharmacists are encouraged to spend up to an hour preparing for and conducting a consultation with a patient if needed.
Ms Moores says the approachable environment of a pharmacy makes it an ideal place to treat patients with mental illnesses.
“There should be no reason why a pharmacy cannot deliver this service. The only thing they really need to have is a consultation room.”
But she admits that providing the service has been far from plain sailing.
A local mental health team refers patients to the pharmacy. But Ms Moores says getting these referrals is challenging, as it is a “huge commitment” for patients to come in every day for support to take their medicines, when they previously may not have been taking them at all.
“I would love to tell you that we have had lots of patients coming into this service. We haven’t, we’ve had one.”
However, though they might not have large numbers attending, she says the impact the service has had on that one patient has been “amazing”.
“They now go to their pharmacy every single day for their medicines, and we are at a point where that person is being supported to go and get a job – something they have not been able to do for many, many years.”
These three initiatives prove that, if given the opportunity, community pharmacists can combine sensitivity to a local need – whether it’s hepatitis C or mental health issues – with engagement with commissioners. Though small in size, they have delivered promising results, displaying how it is possible to fairly fund the extra workload required, while making an even greater contribution to the health of their local communities.