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The three types of patients to expect from NHS 111 referral service

Mike Maguire and Andre Yeung spoke to C+D at the Pharmacy Show
Mike Maguire and Andre Yeung spoke to C+D at the Pharmacy Show

Successfully delivering the NHS 111 referral service will hinge on understanding the “three segments” of patients pharmacies could receive, says an NHS England network lead.

North-east England local professional network chair Andre Yeung and Marton Pharmacy's Mike Maguire were the architects of the Digital Minor Illness Referral Service pilot that inspired the new national Community Pharmacist Consultation Service (CPCS). They spoke to C+D at the Pharmacy Show on Monday (October 7) to offer advice for pharmacists looking to implement the CPCS successfully.

The service launches across England on October 29, and will see pharmacies receive £14 for each consultation resulting from a referral from NHS 111 for minor illnesses and urgent medicines supply, although some pharmacy staff have expressed concern that they do not have the time or staff capacity to deliver the service.

Mr Yeung pointed out that the service is “not just about solving the problems that come your way”. Instead, pharmacy teams should understand the “three segments” of patients they may see.

“You’re going to get some patients sent through that you can definitely manage in a community pharmacy,” Mr Yeung explained. “You’re going to get some people that you definitely need to escalate to another location; for example, a GP practice.

“But then there’s a group of people in the middle where they actually need a bit of management, a bit of safety-netting, some advice – and actually they can always come back to see the pharmacist if things don’t get better or get worse.”

Watch the video to find out:

  • Why pharmacists should “put themselves in the shoes” of the NHS 111 call handlers
  • Why the £14 fee per consultation “feels right”
  • How the service has worked out in its north-east England pilot area.

25 Comments
Question: 
Is your pharmacy prepared to deliver the CPCS?

Gabriela Peterlin, Locum pharmacist

Who will serve walk in customers in the meantime? 

Edward H Rowan, Locum pharmacist

Three types of people who will be referred:

1. Those who expect a consultation with a dermatologist and some POM cream for infection / psoriasis / unknown rash.  Free. Right now.

2. Those who tell us that 111 have faxed us a prescription for Pregabalin and they said it'd be ready at the pharmacy. Free. Right now.

3. Those who've got a runny nose / sore throat and are grateful that we're open so they don't have to queue up at A&E for four hours to be told by a nurse to buy some Strepsils when they can get them from us. Free. Right now. 

How High?, Community pharmacist

Word.....

 

Joan Richardson, Locum pharmacist

I read the competency checklist and then headed over to the CPPE website for the recommended training modules only to discover that they are "under development"! 

Lucky Ex-Locum, Superintendent Pharmacist

Why is is supposed to be me 'putting myself in the shoes of the NHS 111 call handler'?? How about they put themselves in MY shoes? If it wasn't for the £900 quid sweetener, there is no way I would consider this foolish service. £14 will not even come close to covering the time which I will take dealing with one of these referrals which will then take me away from all of the other duties I have - if I am not available every single second we are open to talk to a walk-in patient at the drop of a hat, I will lose custom - just imagine if Mr Smith wants to talk piles with me but I'm in a half hour consultation following a 111 referral - he's going to go to Whizzbang Pharmacy down the road, speak to their pharmacist and then in the future go there instead of to me.

This is a badly thought out, badly remunerated service which will ultimately fail. Perhaps that's what the Government wants to happen so that it can blame Pharmacy.

V K P, Community pharmacist

it is not just badly thought out. 

for the pathetic fee they want us to also complete this checklist https://www.nhsbsa.nhs.uk/sites/default/files/2019-09/CPCS%20self-assessment%20framework%20Final%20V1.pdf

where is the protected learnign time to meet all the criteria on the checklist.  they are asking for clincal diagnosis as part of the consultation that to for £14??? take the piece of s**t service and give it to the GPs and their nurses. lets see how far you get with them. the BMA will not even meet them on the same table for £14. 

Chemical Mistry, Information Technology

Yeh of little faith !! reminds me of the saying " Led by Donkeys"

Benie I, Locum pharmacist

Why the £14 fee per consultation “feels right”

 

One of the most ridiculous statements I've seen on here encapsulates all your problems.

 

What if I said £40 feels right ? Can we run with that instead ?

V K P, Community pharmacist

What time/ motion analysis were carried out to cost the joke at £14?

*This comment has been edited to comply with C+D's community principles*

Richard MacLeavy, Non Pharmacist Branch Manager

I'm not totally in agreement with Mr Yeung. He is right that this may open the door to further clinical services in the future but this is why the fee is so important and I think he is far too dismissive of that. If we undersell our service at £14 it is going to be extremely hard to negotiate a better rate for this or other services in the future as the NHS now see £14 as the value of a pharmacy consultation. Like Mr Yeung says it may pave the way for new services as presumably the NHS will then look at what they can put through community pharmacy as it would be a huge cost saving compared to GP services. However in the long term the £14 fee will not be sustainable for supporting the investment in premises, pharmacists and support staff to run a good quality and safe service particularly as volumes increase. 

How High?, Community pharmacist

No mate, they are selling us cheap again and we've been hearing "it'll open the door to....." for over 20 years. The crossroads? we're still stuck on red!

A.S. Singh, Community pharmacist

3 types of patients:

a) those wanting CD's

b) those wanting urgent medication when they have 6 months supply at home

c) those wanting OTC meds on prescription 'because it's free'

Lucky Ex-Locum, Superintendent Pharmacist

I can't actually see anything in this service that we don't already do. The first type of patient we treat with OTC products, same as now, the third type we refer to a gp same as now and the middle ones we use our judgement as to whether to supply or refer (always with the caveat of seeing the GP if things don't improve or get worse) same as now. I cannot for the life of me see the POINT of the service. It's not as if we are being granted any new powers - everything is covered by current legislation, it's just that people have to ring 111 first and go through all of that hassle to be referred when, to get exactly the same level of service, all they had to do was walk into a pharmacy, get the treatment or advice they need, walk out happy and we can get on with what we were doing without the mountain of paperwork we would have to fill in following a 111 referral.

Gabriela Peterlin, Locum pharmacist

There are very few of us sensible. Seriously, pharmacists agreeing to this ‘service’ are sheep.

Leon The Apothecary, Student

Ah, you've provided NUMAS before it seems!? Some of the stuff being referred through was...unique.

chris langtry-lynas, Community pharmacist

You forgot the ones that are referred to have their toenails cut. I joke not!

ABC DEF, Primary care pharmacist

I bet type c will be the majority. Everything's free in this country isn't it? Huh 

Leon The Apothecary, Student

"Feels Right."

Instead of subjective feelings, would it be better to consider funding as part of an evidence-based approach? As he says, it's not an important issue for him, but I rather suspect that for the majority of pharmacists who will be conducting these - it will be.

Benie I, Locum pharmacist

I'm sure hes been paid a healthy sum to 'develop' the service and will more to come as he comes up with more 'novel' ideas for the front line cannon fodder to trial.

Leon The Apothecary, Student

I'm sure developing the service felt right.

ABC DEF, Primary care pharmacist

5 reasons this will be a fail:

- No staff

- No capacity

- Pitful monetary return

- Patients not willing to pay for otc meds 

- 111 has not a clue how a pharmacy works

Perhaps all 111 call handlers should put themselves in the shoes of community pharmacists instead.

David Webb, Locum pharmacist

Perhaps all call handlers should be pharmacists. ...triage right there at the source...

How High?, Community pharmacist

I know some pharmacists that are. They still have to follow the script.......

Benie I, Locum pharmacist

I'm sure its will be a success. All the foundations are in place.

1. Minimum wage youngsters with minmal experience as support staff

2. Minimum wage experienced and compentent support staff that have never seen a pay rise

3. Pharmacists that are overworked already but haven't had a pay rise in roughly 10 years now earning similar rates or less than baby sitters but without the respect or job satisfaction.

4. NHS 111 have no clue or care as to how a pharmacy operates.

5. Expectant customers with no respect or care as to how a pharmacy operates.

As you can see all the building blocks for a successful service. Come all ye faithful, free stuff available at the pharmacy with no waiting time or queuing. NHS 111 said so........

C A, Community pharmacist

I never thought of it like that - a babby sitter costs £20/hr and a pharmacist costs £20/hr. Except one gets to deal with one or two rowdy children, one gets to deal with loads of rowdy "children", one spends most of their time sitting and one spends most of their time standing, and one if they have a particularly arduous or long shift might get a bonus for a job well done, and one doesn't...

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