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Pharmacies to receive £14 per consultation for NHS GP referral pilot

Patients will be referred to a participating pharmacy via PharmOutcomes
Patients will be referred to a participating pharmacy via PharmOutcomes

Pharmacies will be paid £14 for every patient consultation completed following a digital referral from a GP in the next stage of NHS England’s DMIRS pilot.

NHS England announced last month that the next stage of its Digital Minor Illness Referral Service (DMIRS) pilot will see GPs refer patients with low acuity conditions – such as rashes, constipation and vaginal discharge – directly to community pharmacies via online triage systems.

The commissioning body has since told C+D that pharmacies will receive £14 for each consultation completed following a GP referral – the same amount received for completing referrals from NHS111.

The payments cover participating in the pilot, completing documentation, taking part in the evaluation and completing system training, NHS England explained last week (June 26).

NHS England’s director of primary care strategy Ed Waller reiterated at the National Pharmacy Association (NPA) conference that the first pilot sites – in the Cheshire, Merseyside, Lancashire, Cumbria and Greater Manchester areas – were due to go live in June. However, C+D understands that the majority of areas will go live in July.

The commissioning body estimates that 6% of all GP consultations – 20.4 million appointments per year – could be safely transferred to a community pharmacist if the service is rolled out nationally.

Important sector development

Cheshire and Wirral local pharmaceutical committee (LPC) chief executive Adam Irvine – who has several pharmacies in his area piloting the service this month – said setting up digital referral pathways between GP practices and pharmacies is “really important”.

“It is a positive way to get GPs and GP staff to refer to pharmacies for the things they know pharmacies can do well,” he told C+D.

“Once we have the pathways in place, we can expand what referrals we take in the future.”

While community pharmacists are “without doubt” very busy, the referral service is remunerated, “so there is support for pharmacies” to carry it out, Mr Irvine said.

Surge of phone calls?

One pharmacist involved in the pilot, who wished to remain anonymous, told C+D they are concerned there may be “a surge of phone calls at 9am” from patients looking to book their appointments, “as the surgeries are open [earlier] than us”.

However, Mr Irvine said the pilot service “shouldn’t be a hindrance” and pharmacies in his area have shown an interest in trialling it.

The LPC expects the pilot to involve “a reshaping of what pharmacies already have, rather than investing in new things”, he added.

Would you like to receive patient referrals direct from GPs?

Pharmacist Pharmacist, Community pharmacist

But will the patient get the treatment for free? Thats the main reason why patients attend the doctors. For free treatment!

ABC DEF, Primary care pharmacist

Spot on. The abuse and wastage we are seeing today are mostly due to people getting FREE scripts for whatever reasons on anything and everything without knowing how costly drugs actually are, provided they cared about that in the first place, which I don't think most care anyway. And this is why the current model is not sustainable and on brink of collapse.

Adrian Tebby, Community pharmacist

£14 is not enough for this service. DMIRS pilots referred from 111 are remunerated at £14 to reflect the workload of completing the service template (on PharmOutcomes or Sonar, depending on where you are).

But 111 DMIRS referrals have already been through the triage of NHS Pathways. GP DMIRS referrals won't have been - so the triage has to be done in the pharmacy, by the pharmacist, in the consultation room.  You can't use your trained counter staff to do it or you don't meet the SLA.

GP DMIRS is a very different service from 111 DMIRS and needs correctly remunerating and structuring.

(For clarity, I work for both Well and Devon LPC, but these are my personal views and should not be taken to represent the position of either organisation that I work for)

ABC DEF, Primary care pharmacist

Won't be long till you see patients being referred for hydrocortisone cream for the face/genitals, chloramphenicol eye drops in <2 and ointment for stye, avamys/fexofenadine, flixonase for polyps, beconase in <18, canestan in <16/>60 etc etc. I work alongside GPs in surgery and I'm confident in telling you that 99% of them have not a clue what one can buy otc and their indications and exclusions. If these are not made very clear to GPs this will only end up being a disaster! 

Ronald Trump, Pharmaceutical Adviser

So this means there will be enough money for 2 pharmacists in every store? One to do services and one to do all the other sh*t? Or will the multiples just put more pressure on the pharmacist and other staff, then cream off the profits? hmmm I wonder...

Sue Per, Locum pharmacist

Dream on....... They contractors will not pass on anything. As usual they will stretch and extract, and disingenously plead poverty. Us working at the coalface will have to demand it collectively!!! Need to stop entertaining those silly offers of £19.00 p/h after 4 years at university, and starting working life with a debt of 60-80K.


locum norfolk, Locum pharmacist

@Ronald Trump...not sure why your post has been recieved negatively?? you make some good points but the the strongest position the large contractors/multiples have over the masses of pharmacists is the fragmented nature of the whole profession and non existant cohesion in coming together... which is why negative changes with regard to future decisions over pharmacy are just rail roaded through regardless... the truth does hurt unfortunately and many pharmacist who remain are not making plans for the impending heartache..

N O, Pharmaceutical Adviser

For how long, no one knows. Also, MR cannot replace XL so very hard for people on 20mg, 30mg of XL and 20mg MR of branded generics. Last time when we asked the GPs to prescribe by generic, they simply changed to Branded generics that were lower in price. Now even for 10mg MR and for 60mg XL we have to return the script !!! SAD

Snake Plissken, Student

Absolutely agree. We had a smiliar issue that the M.I of the manufacturing companies were unable to answer. If someone was on an XL 30mg OD and you had M/R prep available, would you give 30mg M/R BD or split it i.e 20mg OM and 10mg ON? The pharmacokinetics of M/R preps inform that the tabs have roughly 12h half'life so would a 30mg BD prep make more sense? 

SPS have an interesting response in relation to Adalat products.

Anyhow, this new service being piloted seems interesting. However, need more details in relation to indeminty and whos going to cover it?? Also, the fee seems very low but has adeqaute training been proovided to areas providing this service? What is this training, signing off a few SOPs and a CPPE online package (which will seem rather insufficient)?? More details would be nice...

R A, Community pharmacist

Poor levels of remuneration given the risks the provider of such service has to accept! On second thought its the pharmacist who will assume the risk and the employer cares little what happens to the pharmacist.

N O, Pharmaceutical Adviser

Off topic. But, no where else to post. 

All Nifedepine products (including branded) are now out of stock. Does this mean we will see the first SSP case??

ABC DEF, Primary care pharmacist

Just swap it all to amlodipine if it's for bp or angina. 20-30mg nifedipine daily is deemed to have equivalent effect to amlodipine 5mg daily. If for Raynaud's then go with other CCBs nicardipine, amlodipine, or felodipine. Off-label use but still a solution.

Reeyah H, Community pharmacist

10mg MR tablets and 60mg XL tablets are available from AAH. Well, they were yesterday! 

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