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NHS England to roll out Boots sore throat scheme

Boots' Malcolm Harrison: I hope service brings opportunity to collaborate with industry partners

A sore throat ‘test and treat’ service first piloted by Boots in 2014 has been adopted onto an NHS England programme to be rolled out across the country.

The scheme, designed to prevent antibiotic resistance and reduce GP workload, will see community pharmacists conduct on-the-spot throat swab tests to determine whether patients need antibiotic treatment.

A pilot of the scheme ran across 20 Boots stores in London between October 2014 and April 2015, and another 15 branches in Leicestershire between January 2015 and April 2015.

A review of the pilot conducted by University College of London Hospitals and published in the Journal of Antimicrobial Chemotherapy in July, revealed that two-thirds of patients who would have seen their GP for their sore throat did not need to do so.

Boots estimates that an additional 800,000 patients could potentially be seen in community pharmacy rather than general practice if the service is rolled out nationwide, saving the NHS “millions”, it said last Saturday (November 12).

However, the review's authors admitted their calculations of savings did “not take into account the cost of delivery of the service within community pharmacies”.

Under the pilot, pharmacists trained to recognise bacterial infection in adults offered patients a swab test if they were displaying symptoms of a sore throat. Patients who tested positive for Streptococcus group A – typical bacteria associated with throat infections – were offered antibiotics.

Patients paid £7.50 for the test and a further £10 if antibiotics were supplied, with fees “calculated based on the cost of materials and staff resource to deliver the service”, Boots said when the pilot review was published.

Cost of delivery not known

C+D has asked Boots and NHS England to clarify whether these costs will remain when the scheme is rolled-out more widely, but is yet to receive a response.

It is also unclear if community pharmacies will be paid to deliver the service and whether they will receive similar monetary incentives for reducing antibiotic prescribing as GPs currently do.

Malcolm Harrison, senior manager project and contract development at Boots, and now fellow of the NHS England programme said: “I hope that the appointment brings more opportunity to work collaboratively with industry partners and other pharmacies."

Mr Harrison added that the scheme could provide "large-scale coverage" and "make sure that patients have a new access point of care to relieve burden on GPs, while also making sure that antibiotics are only given when needed.”

NHS Innovation Accelerator

The sore throat scheme is one of eight schemes selected for this year's NHS Innovation Accelerator (NIA) programme, which is designed to fast-track new treatments and technologies into the health service.

Announcing the new schemes last week (November 9), NHS England said that last year 17 “innovations” were rolled-out across "over" 380 NHS organisations – including smartphone app OWise, which allows patients to record in real time their experience of cancer therapies.

The projects selected to join this year’s programme were focused on three challenges: prevention, early intervention and long-term condition management, NHS England said.

The NIA is led by NHS England and delivered in partnership with 15 academic health science networks, 11 of which provide "financial contributions", including bursaries for fellows and to support the costs of programmes, NHS England said.

RPS welcomes service

Chair of the Royal Pharmaceutical Society's English pharmacy board Sandra Gidley described the news as a “win-win all round”.

“I’m delighted NHS England have fast-tracked this use of point-of-care diagnostics. It’s exactly the kind of direct patient care the RPS wants to see community pharmacists providing across the country as a matter of course.

"New technologies like this have the potential to enable patients to get quicker, accurate tests whilst still having that all-important conversation with a health professional to give appropriate advice and treatment," she added.

“Ideally we would like to see a national minor ailments service that encompasses this kind of treatment."

Listen to C+D's podcast with Professor Brendan Gilmore to find out if an antibiotic "apocalypse" is on the way

21 Comments
Question: 
What do you think about the sore throat scheme?

anatoly sikorski, Communications

Interesting comment with reference to Boots Mystery shopper participating in this process and recording results. Mmmmmmmmm wouldn't put it past them, poor staff.

Jonny Johal, Pharmacy Area manager/ Operations Manager

I suggest NHS England to think twice about thias project ... there is a serious risk that sore throat statistics will be distorted as a result of this. It will be open to abuse, and Boots will be motivated to 'improve' their profits, as the recent controversies in the Guardian newspaper showed, and the GPhC will refuse to investigate.

A Long Serving Pharmacist, Community pharmacist

I'm all for reducing the pressure on GPs and A&E departments. BUT what about the pressure on already overstretched pharmacists? The funding for these type of services goes straight to the contractor but the burden of extra work falls on the front line pharmacists.

Kevin Western, Community pharmacist

The story seems to be changing. is this only going to happen in Boots shops? if so the DoH, RPS and Ash Soni have just spent the last few days advertising for Boots - hope they get their fee... or is it all Pharmacies/ some Pharmacies as long as their ccg are willing to commission it - thats a no then... 

What exactly is going on?

Jaz Kaur, Pharmacy

Will this new service be assessed by their recently introduced "Mystery Shopper Review" whereby employee's are supposedly filmed carrying out duties.????   IF so , I look forward to  them sharing with all on youtube.

Kevin Western, Community pharmacist

Chair of the Royal Pharmaceutical Society's English pharmacy board Sandra Gidley described the news as a “win-win all round”.

MMM hardly win win if we arent going to get paid tho never a factor that has worried the RPS in the past i suppose...

Shaun Steren, Pharmaceutical Adviser

https://www.theguardian.com/commentisfree/2016/nov/15/sore-throats-pharmacies-nhs

Highlights from a Guardian article published today:

"My head is in my hands. This is neither evidence based nor shown to be cost effective, and may actually make pressure on the NHS worse"

"The pilot study – which occurred in Boots stores (whose head office analysed the data) – was not a randomised controlled trial. It showed it was possible for pharmacies to assess people with sore throats and use a “point of care” rapid antigen test to determine who should get antibiotics. This might sound superficially sensible. But the National Institute for Health and Care Excellence (Nice) does not recommend this rapid antigen test because it has a poor sensitivity for picking up relevant bugs"

"It is already known – from randomised clinical trials – that this test does not help beyond normal care. Furthermore there has been no full cost-effectiveness analysis – let alone an independent cost-effectiveness analysis – of the Boots scheme. Without comparing the pilot to usual care, we have no way of knowing whether more or fewer antibiotics were prescribed. It is a travesty of evidence-based policymaking"

"This scheme may actually increase demand on the NHS, fragmenting services but without improving care. More than half of the patients in the study said that if the pilot had not been available, they would have either have done nothing or treated themselves without assistance. This, if it held true, meant that antibiotics were subsequently used just because the scheme was there. Isn’t that good? Not necessarily"

"The study concluded that if the pilot hadn’t been available then there could have been a “delay seeking medical treatment when it was needed”. But it didn’t show this, and not all bacterial throat infections need to be treated. In fact, antibiotics reduce the length of time of a sore throat by an average of 16 hours, with only a modest impact on complications such as ear infections. Balanced against common side-effects of antibiotics such as diarrhoea, as well as antibiotic resistance, there is often not a clear-cut reason to prescribe. This scheme expands the market for medicine, without clear benefits. Earlier is not always better" 

Shaun Steren, Pharmaceutical Adviser

Apart from this article being a rather splendid demolition job of an obviously idiotic idea, the article further expands on the theme of faux innovation. 

Government mandarins who have absolutely no technical expertise in, nor ground experience of, the very thing they control. Whether it be the useless GP health check scheme or dementia screening, they all involve  making already busy clinicians generate 'activity' in order to create the illusion of taxpayer value. 

It is also of interest to note the comments section below the article. Multiple posts by those who are obviously interested parties, ignoring every reasoned point and every piece of evidence, only to repeat the same meaningless mantra of pharmacists extended role. Note the complete failure in reasoning and absolute ignorance of evidence, reminds me of certain posters on here. Coincidence maybe.

Shaun Steren, Pharmaceutical Adviser

When do I receive my 200 page folder and branch target? 

Clive Hodgson, Community pharmacist

C&D... Could you find out who exactly was responsible for feeding the Press details of this scheme? 

S Pessina, Pharmacist Director

What utter nonsense. Boots roll out this crap with such hype to grap the headlines " aren't we good" ---actually you're not. Boots did same with simvastatin, clamydia testing, sildenafil etc etc----all hype and a flop. Poor pharmacist stuck in middle every time---oh dear.

Meera Sharma, Community pharmacist

Mr Harrison added that the scheme could provide "large-scale coverage" and "make sure that patients have a new access point of care to relieve burden on GPs, while also making sure that antibiotics are only given when needed.” - Really? I can already see the next headline - "Boots pressures its pharmacists to achieve 10 sore throat tests per week"! Honestly, NHS England need to scrutinise "joint working arrangements" that promise coverage and access. If it's a traget based reimbursement scheme, I think every pharmacist can see what's coming. I agree with all the comments on here, fair funding TO THE PHARMACIST NOT THE PHARMACY, or this scheme should be rejected. There has been enough goodwill provided by pharmacists for free over the last decade, it needs to stop.

Lucky Ex-Locum, Superintendent Pharmacist

People go to the GP to get paracetamol! They aren't going to pay £17.50 for this. 

Chris Mckendrick, Community pharmacist

Show me the money - new service, new money or forget it.

Hemant Patel, Community pharmacist

Is it 1st April or some weird sense of humour or lack of news stories? 

Clive Hodgson, Community pharmacist

I think someone badly jumped the gun with the press statements last week. Front pages of several papers, including the Telegraph, were implying that this service would be available from all Pharmacies imminently.

Would have been nice if we had been told of (and agreed to) the scheme first.

Barry Pharmacist, Community pharmacist

 

According to Pulse magazine .....

Boots funded a pilot of the scheme at 35 of its pharmacies in London and Leicestershire, with patients charged £7.50 for the throat swab test and a further £10 for a course of antibiotics.

Results from a six-month period showed that 367 people accessed the service out of a total of 2,087 that enquired about it.

So 10 patients treated per participating pharmacy over 6 months. That is 10 in 26 weeks, one every 17 days. Wow that is really going to be worthwile setting up. However Boots did have lots of enquiries (another 1,700 patients) but I'm thinking as they didn't want to pay £17.50 they decided to go elsewhere? 

Valentine Trodd, Community pharmacist

Might be some take-up in the 'well to do' areas, but on the coast no one will pay £17.50 when they can get it for nothing... like everything else!

Chaitanyakumar. Jayantilal. Patel, Community pharmacist

Forget the funding. We'll be waiting forever. Get your supplies from www.connect2pharma.co.uk and set up your own private service. Use the free publicity while it lasts.

 

Stephen Eggleston, Community pharmacist

New services are all well and good but where is the funding? Reducing workload pressures on GPs is all well and good, but what about workplace pressures on pharmacists?

Valentine Trodd, Community pharmacist

where is the funding?

Probably somewhere in the 'global sum'!

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