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CCG decision to axe minor ailments scheme means ‘patients will suffer’

O'Briens in Fleetwood Health Centre was one of the first pharmacies to offer the service (credit: © 2018 Google, image capture: March 2017)
O'Briens in Fleetwood Health Centre was one of the first pharmacies to offer the service (credit: © 2018 Google, image capture: March 2017)

A clinical commissioning group's (CCG) decision to scrap a minor ailments service will lead to a “massive influx of patients” to primary care, a contractor has warned.

Fylde and Wyre clinical commissioning group (CCG) announced last month (June 7) that it would stop its ‘Pharmacy+’ minor ailments service on July 1, following national guidance from NHS England to “curb prescribing” of over-the-counter (OTC) medicines for 35 conditions.

Aisling O’Brien, director of O’Brien’s Pharmacy group – which has three pharmacies in the Fylde and Wyre area in the north-west of England – said the CCG’s decision will result in an “astronomical” amount of patients going to GP practices or walk-in clinics.

“Over the last 12 months, across three of my sites in the area, we have done over 5,000 consultations,” she told C+D. Without the service, “86% of those patients said they would have gone to a GP”, she added.

Ms O’Brien said the effect on patient care would be “quite significant”, as they would be left to “suffer in silence”. They “will not pay for medicines [because] they haven’t got the money to”, she added.

Scheme “naturally came to a close”

Speaking at the time of the announcement, Dr Tony Naughton, clinical chief officer at the CCG, said the service had been “very successful”, but argued it was not intended to be permanent.

“Having received the national guidance, it meant most of the items available via Pharmacy+ were no longer available on prescription, so naturally it came to a close,” he added.

Lloydspharmacy ‘disappointed’

Lloydspharmacy – which operates six branches in Fylde and Wyre – said it was “disappointing” that the minor ailments scheme had been withdrawn.

Anna Ruthven, national development manager of commissioned services at Lloydspharmacy’s parent company Celesio, said: “This service will have contributed to the awareness of community pharmacy and established some new relationships with our pharmacists.”

PSNC response

The Pharmaceutical Services Negotiating Committee (PSNC) said the decommissioning of minor ailments services “could have a negative impact on some people, particularly those on low incomes”.

“We would like to see services commissioned that enable community pharmacies to do more to support self-care,” a spokesperson added.

Does your pharmacy still offer a minor ailments scheme?

Peter Sainsburys, Community pharmacist

Encouraging people to go and buy cheaper products will save billions.

"Why should I pay for 32 paracetamols when I can get them free on prescription?" the customers says, "I can't afford to pay for paracetamols", despite having 200 Benson and Hedges in the trolley, and holding his Mercedes key fob in his hand.

I once even had a customer ask for 10 paracetamols on emergency supply, despite being able to buy 16 in the shop for about 29p. When people are used to getting something for free, it's a habit that's hard to break.

Ebers Papyrus, Pharmaceutical Adviser

I'm aware of numerous minor ailments schemes and none of them have paracetamol listed or any painkillers for that matter.

The list of conditions range from UTIs, Impetigo, Eye infections, Hayfever, Migraine (Sumatriptan), Thrush, Constipation ....

The schemes are however setup to fail from the start, the paperwork is duplicated and two computer entries are needed (PMR and Pharmoutcomes). Payment takes months to appear, so in many cases its just easier for the patient to purchase the item where possible. General practice aren't signposting to pharmacy as they lose faith in patchy uptake poor marketing and inconsistent service due to accreditation hurdles. The minor ailments should be a national scheme and GPs reception computer systems should directly refer patient enquiries for those conditions to pharmacy unless the patient is exluded and is being referred back to the surgery. If surgeries are restricted from issuing prescriptions for those conditions then it would clearly free up time. Overtime more products would be available via this referral thus easing more pressure, efficiency improved for the patient and saving NHS money. It's not rocket science is it, but we really need to ask why the CCGs and GMC impose barriers to this service???

Peter Sainsburys, Community pharmacist

My first experience with the MAS was in an inner city pharmacy. A Somalian lady who couldn't speak English came to the counter with a friend to translate and about 6 young children. She had been told she could get free treatments here, so I asked what was wrong. Nothing she said, she just wanted as much free stuff as I was allowed to give her.

Pear Tree, Community pharmacist

Your description of a “Somalian woman with 6 children” seems to echo the language of certain sections of the right wing media against Sonalis and I’m deeply offended to be used by a health care professional. Imagine substtituting your description of that stereotype to a “uneducated, white, teen age girl with three children” or a “Intoxitated Jamaican woman who spoke broken English”. It would be nice if you had put aside all your prejudice and stereotype against certain communities and used neutral language without undermining your argument. 

Jonny Johal, Pharmacy Area manager/ Operations Manager

Yes, I had similar experiences. I refused supply, but other pharmacists ... ?

Peter Sainsburys, Community pharmacist

The idea of MAS is quite ingenious. Instead of having someone with a headache/sore throat or whatever going to see the GP, just send them to the pharmacist for free paracetamol, saving the NHS about £29 or whatever.

In practice, like most pharmacy ideas, it just doesn't work!

The devil was in the detail, there was extra paperwork and training to be done, and in the region where I ended up working most GPs didn't even know what it was, so it was doomed to failure.

Maybe some pharmacists would just supply, but if they submitted the paperwork it would be fraud as the MAS guidelines don't permit you to supply meds for patients to keep in their cabinet at home for future illnesses.

The MAS was nothing but exceptional value for money for the NHS, providing that the guidelines were actually followed properly.

It's a shame to see the service go, though, because it was a MUCH better idea than MURs and NMS (who thought those up?).

Jonny Johal, Pharmacy Area manager/ Operations Manager

Yes, I agree it is the scheme with the most potential ... but for it to work properly, we need a patient registration system and a new payment system (probably not payment by 'piece work'). This will open up the contractors vs professionals debate again!

Jonny Johal, Pharmacy Area manager/ Operations Manager

The minor ailment schemes I have been involved with in the past are all so open to abuse. I am not surprised that some CCGs realise that these schemes may not be value for money, or reaching the 'right audience'. I support either scrapping these or introducing tighter controls. 

Dave Downham, Manager

Surely the point is that MAS prevents the unwashed from troubling the overworked GPs by taking advantage of underutilised skills within pharmacy to deal with minor troubles? By removing this service - that's what we're supposed to be about - this makes it more likely that GP waiting rooms will be full of runny noses and sore throats which is non sensical. You could give 60 boxes of paracetamol away if it saves 1 GP appointment.

Joan Richardson, Locum pharmacist

Exactly - if GP's are being told to cut back on items of dubious effectiveness or readily available over the counter then those same items cannot be allowed in a minor ailments scheme.

voice of treason, Manager

The Pharmaceutical Services Negotiating Committee (PSNC)  needs to be renamed to The Pharmaceutical Services Committee (PSC). 

Zero Negotiating

Peter Sainsburys, Community pharmacist

They don't provide any pharmaceutical services either, so maybe we should just call them a committee? But that would be a bit much because most real committees actual do something.

Female Tech, Pharmacy technician

The scheme can't continue in its current format. It's no good telling doctors to stop prescribing for acute illness on one hand, but tell people they can get their freebies at the pharmacy on the other.

Caroline Jones, Community pharmacist

Totally agree....the purpose of this is to make people manage minor ailments themselves ! General practice may have an  influx initially but I suspect people will get them message when they don't come away with a prescription!

David Moore, Locum pharmacist

So the service had been very successful. Odd way to go about things.

Caroline Jones, Community pharmacist

Not really.......if general practice is being encouraged to not prescribe a prescription then it's logical not to allow it on the minor ailment there is still a cost to the NHS

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