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More than 300,000 CPCS referrals in six months since launch

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Community pharmacies handled 127,070 CPCS referrals between February and April
Community pharmacies handled 127,070 CPCS referrals between February and April

More than 300,000 patients with a minor illness or in need of urgent medicines supply have been referred to community pharmacy through the CPCS since its launch six months ago.

As of May 18, 295,256 patients had been referred to a community pharmacist by NHS 111 under the Community Pharmacist Consultation Service (CPCS) – which launched on October 29 – NHS England and Improvement (NHSE&I) told C+D last month (May 22).

Of these, 128, 575 (44%) referrals were made for patients with minor illness needs, while 166,681 (56%) had called NHS 111 with an urgent medication request, according to data NHSE&I shared with C+D.

The total number of CPCS referrals goes up to 307,142 once NHS 111 online referrals are added to the mix. As many as 11,886 referrals have been made through the NHS 111 online service since it began to be trialled in October last year. Of these, 8,399, were made after the service was officially rolled out at the end of March.

COVID-19 and CPCS

Between February and April, when the COVID-19 pandemic started taking its toll on the UK, community pharmacies handled 127,070 CPCS referrals.

While facing new challenges including difficulty sourcing personal protective equipment and increased demand for medicines home delivery, community pharmacies in England dealt with 55,441 minor illness concerns and 71,629 requests for urgent medicines supply. As of the end of April, the most common symptoms generating a CPCS referral included “sore throat and/or hoarse voice”, “lower back pain”, “headache” and “wrist, hand or finger pain or swelling”.

Commenting on the latest CPCS figures, the Pharmaceutical Services Negotiating Committee (PSNC) CEO Simon Dukes told C+D yesterday (June 2): “Throughout the COVID-19 pandemic, the CPCS has continued to support patients needing urgent supplies of prescription medicines or help to manage minor conditions.

“This has been a phenomenally busy period for all pharmacies. Helping large numbers of patients to manage minor conditions or to access vital medicines without needing to see a GP or another healthcare professional has been just one of many critical roles played by the sector.” 

An NHS spokesperson told C+D yesterday that the CPCS is “delivering benefits for tens of thousands of patients and has been playing a particularly important role as the NHS responds to the greatest health emergency in its 72-year history”.

Phone consultations

NHSE&I told C+D that it updated the NHS Pathways algorithms on March 24 to ensure that patients with COVID-19 symptoms were directed to the NHS 111 COVID Clinical Assessment Service and not to pharmacies. This allowed call handlers to continue to send patients with non-COVID-19 symptoms to pharmacies where clinically appropriate, the national commissioner said.

NHS 111 call operators highlight to patients the importance of contacting the pharmacy by phone as part of the CPCS referral process, NHSE&I said, adding that this message was “strengthened” in early March.

Chief pharmaceutical officer for England Keith Ridge said in a letter to pharmacies on March 19 that they should consider contacting the patient via phone once a CPCS referral has been received. If appropriate, the referral can then be completed over the phone, according to the letter.

Pharmacies who registered to offer the CPCS service as of or after March 23 were not made live for the service. However, the registration process resumed on June 1 and “once a pharmacy registration has been processed this will be communicated”, NHSE&I said in a COVID-19 primary care bulletin published last month (May 18).

Meanwhile, CPCS referrals from GP practices to community pharmacy – which are being piloted across England and were expected to be rolled out nationally “as early as April”, according to the Community Pharmacy Contractual Framework – were not extended due to COVID-19. This followed negotiations between the Department of Health and Social Care and PSNC.

38 Comments
Question: 
Have you dealt with many CPCS referrals during the pandemic?

Shahan Mir, Community pharmacist

The CPCS is actually a great demonstration of the use of a pharmacist's expertie and skillset. It is best utilised in those longer opening quiet pharmacies to effectively manage workload. They do however need to recruit more Pharmacists to NHS111.

Leon The Apothecary, Student

Would the ability to self-refer be useful? Offer an emergency supply but you will have to record a PharmOutcomes form?

I wonder how many referrals there would be if every pharmacy stopped doing any emergency supplies or "loaning" and instead referred the patient to 111?

C A, Community pharmacist

A hell of a lot more

For years pharmacies wanted a commissioned service to cover emergency supplies. Unfortunately, an in-house system was never going to be agreed due to lack of trust and the potential for pharmacies to over claim. So using 111 + pharmaoutcomes seemed the only real solution.

I have never seen it being the 5 minute service the poster below suggests. The point he makes about all emergency supplies should go through 111 is technically a valid one though. Although I can't see patients and pharmacists wanting to go from a system that takes a few minutes to one that involves a phone call to 111, pharmaoutomes referral processing and then paperwork to NHSBSA. But finances may dictate that we have to utilise it more.

Leon The Apothecary, Student

I have to agree, push people to use the system, and if the system isn't capable, the people will have a lot more pushback to facilitate change.

Mr Anon, Community pharmacist

I have found the CPCS laughable as a replacement for MURs. Since it launched, we have done 10 in total. Yes, you read that correctly. We have had 10 in total since launch, 3 of which we could not claim for because the patients, for whatever reason, didn't want to engage with the initial phone call we made. 

Was the CPCS an adequate replacement for MURs? Yes for the NHS budget, not for community pharmacy's revenue stream. Where did that extra money go? Looks like it went to the GPs for funding salaries for practice pharmacists...

 

Farhat Ahmed, Locum pharmacist

Dear Valeria, if you don't mind me saying, what you really need to put in figures is the following: a comparison of the number of CPCS referrals with the number of MUR'S conducted over a similar period and state whether the CPCS is a valid replacement for the MUR funding as this is how it was sold to pharmacists by PSNC

Benie I, Locum pharmacist

Strange how people seem to be longong for the return of MURs. I can only presume these must be contractors and multiple operators and not employees/locums who were forced to perform spurious ones to keep the cash rolling in.

N O, Pharmaceutical Adviser

Also, compare these figues to individual Pharmacy levels, to justify if replacing the MUR funding with CPCS has really worked for all the Pharmacies and not a select few.

mark straughton, Pharmaceutical Adviser

Overall I think it's an easy earner for pharmacies. To get paid over £10 (can't remember the exact number) to essentially do an emergency supply. Yes, know the downside is inefficiencies of the NHS with referrals i.e. those sending CPCS for UTIs and supplies of CDs but overall I think pharmacies could use it more. I think I'm correct in saying that this service can be accessed even if GP surgeries are open and there's no upper limit in the numbers each pharmacy can do, like there are for MURs.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

There is no upper limit, true, but since you have no control over CPCS referrals either, there is no lower limit. I have done, as a locum, precisely two since they started. It also isn't an easy earner because, to claim your 15 quid or whatever pittance it was (I forget now) there is far more work than just doing an emergency supply.

Benie I, Locum pharmacist

Strange that people seem to longing for the return of MURs. I presume it must be contractors and multiples not the poor saps forced to perform spurious ones on unsuspecting customers.

mark straughton, Pharmaceutical Adviser

Interesting that we have different views here. I've just done 2 this morning, on both occasions it was when they had 'ran out of their meds' and 'forgot to reorder'. Both regular medication. On both occasions they called 111 whilst in the shop, the referals pinged through a few mins later on pharmaoutcomes, generated a token then generated a label on the PMR. Once handed out completed an entry in the private rx register. In total it took about 5mins on each occassion (the longest part being the private rx entry). I'd much rather do that than engage in a useless MUR or go through the embarrassing process of the NMS.

As a side benefit I guess the surgery are happy than there's one less patient ringing up to 'harrass' them for a prescription immediately.

C A, Community pharmacist

How did the patients find out about 111?

mark straughton, Pharmaceutical Adviser

Sign post them (usually quite literally to a poster on the wall; in a lot of pharmacies)

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

What about the end of month claim process though? Is that as clonky as every other online claiming process (e.g. EPS) which seems to be designed to make it as difficult as possible to process a claim for ANYTHING.  I do agree with you about the relevance (or lack of) of MUR and NMS though.

Mr Anon, Community pharmacist

That's correct but the initiation of this is the problem. We can only do it AFTER a NHS 111 referall. And, if I remember correctly, the guidance documents specifically stated that we were not allowed to advertise this service to the public. So, what use is it to us if we can't promote it?

mark straughton, Pharmaceutical Adviser

You're entitled to 'refer' them to the service, not advertise. So the patient presents at the pharmacy or calls over the phone saying they've ran out of medication you can refer them to 111. The patient can ring 11 whilst in the shop 

Leon The Apothecary, Student

Can imagine a lot of staff not wanting to deal with the backlash of asking such a request of a patient.

C A, Community pharmacist

How quick is your 111? Any patients I've had in complain there is a long hold on 111

mark straughton, Pharmaceutical Adviser

Varies from a few minutes to hours. That's between the patient and the NHS, not the pharmacy.

Dave Downham, Manager

That's like quoting the capacity for Covid testing - that's not the crucial statistic. More pertinent - how many referrals resulted in a contact with the patient?

Watto 59, Community pharmacist

Less than half a dozen to answer the question

However

300,000 between approx 11,500 pharmacies over 6 months is approx 4 CPCS per pharmacy per month.... it is pathetic.   The almost Sysyphean labour  involved in completing the administration means this paltry number is probably a blessing to keeping sane.  No matter how hard PSNC try this turd will never be polished.

C A, Community pharmacist

That's £56 of pure profit per pharmacy! Compared to £900 odd from MURs. Is it a wonder why Pharmacies are going bust :(

mark straughton, Pharmaceutical Adviser

So how about a simple emergency supply of regular meds through the CPCS. It's straightforward and takes about 5mins of admin work and it's over £10 fees paid to the pharmacy?

Watto 59, Community pharmacist

5 minutes are you serious ?

mark straughton, Pharmaceutical Adviser

yes this is assuming it's a straightforward regular repeat med. I accept this takes much longer at times when you need to go onto NHS SCR etc. Also CPCS is largely done outside surgery hours when it's quieter and much of the paperwork can be done once the patient has left the pharmacy. This is compared with MURs which can take a good 20mins of the pharmacists time in the consultation room with patient

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Have you ever done one of these things?? Five minutes?? You have to be kidding!

mark straughton, Pharmaceutical Adviser

Yes, plenty. Receive the referral from pharmoutcomes. Complete the steps on pharmoutcomes which suggest a supply can be made, print a token of that info, make an entry on the PMR to generate a label, dispense the item, fill in private rx book. What else?

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