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Emergency supply and SCR issues: week one of NHS 111 referral service

NHS England: 8,649 pharmacies in England have signed up to receive referrals from NHS 111 so far
NHS England: 8,649 pharmacies in England have signed up to receive referrals from NHS 111 so far

One pharmacist is "surprised" at how few minor ailment referrals they have received from NHS 111, while another had SCR issues in the first week of the service, they have told C+D.

Almost three quarters (8,649) of the 11,600 pharmacies in England have so far signed up to deliver the Community Pharmacist Consultation Service (CPCS), which went live last week (October 29), and sees pharmacies receive £14 for each consultation they complete following an NHS 111 referral for minor illnesses and urgent medicines supply.

Pharmacists previously told C+D that they feared they would not have enough time or staff to deliver the service, which was introduced to make pharmacy the "first port of call" for low acuity conditions.

But how did the first week of referrals go?

Mostly emergency medicine referrals

Martin Bennett, managing director at Wicker Pharmacy in Sheffield, was "surprised" that his pharmacy did not receive any minor illness queries, having handled nine CPCS referrals – all for emergency medicines since the service launched.

But this figure is not unusual, he believes, as the pharmacy – which participated in the NHS Urgent Medicine Supply Advanced Service (NUMSAS) – used to receive 10 emergency supply requests a week through that pilot.

One CPCS referral concerned the supply of an inhaler, which a patient transferring between GP practices could not get prescribed in time, he told C+D this morning (November 4).

The challenge in that case, Mr Bennett said, was contacting the patient.

"After 24 hours, we had left a message on an answer machine and got no reply. So we closed the consultation," which then removes the request from PharmOutcomes, he explained.

But when the patient called back 20 minutes later, and after he unsuccessfully tried to retrieve the consultation request on PharmOutcomes, Mr Bennett had to contact NHS 111 to reopen the consultation to be able to help the patient.

Seeking permission to access SCR

Hull-based pharmacy manager Laura Buckley said her pharmacy has handled four CPCS referrals so far; three being for an emergency supply and one for a minor illness.

Those needing an emergency supply believed the NHS 111 operator had sent a prescription to the pharmacy, Ms Buckley claimed, which proved to be "time consuming" to then explain this was not the case once she spoke to the patient.

Seeking a patient's permission to access their summary care record (SCR) – a requirement under the CPCS – also proved time consuming when it came to handling an emergency supply request for a care home patient.

"I was speaking to a representative and I asked if there was any reason why the lady couldn’t give me permission [to access her SCR]. [When I was transferred to her] at first, she said no. After explaining the issue to her over the phone, I got permission to access her records, but that took about 35 minutes,” Ms Buckley explained.

"According to the SCR, one medication had been stopped, so I then couldn’t emergency supply it," she added.

However, the minor ailment referral was easier to deal with and was potentially life-saving, she explained.

"The minor ailment was a skin rash. Prior to examination the rash could have potentially been shingles. Thankfully in this case I identified it as contact dermatitis and treated it with an over-the-counter product."

"Straightforward supply"

A superintendent pharmacist based in east London who wished to remain anonymous also received a couple of CPCS referrals for emergency supplies and, as Ms Buckley experienced, found one patient was "misinformed", as he thought he could collect his medicine from the pharmacy.

"The second one was very straightforward," the pharmacist explained. The patient came in, participated in the consultation and the pharmacist was able to supply prednisolone to treat their asthma symptoms.

22 Comments
Question: 
Have you received many referrals from NHS 111 as part of the CPCS?

Johnathan Smith, Community pharmacist

I once needed an emergency supply of prednisolone, as I was on long term treatment and away from home with no prednisolone,

Joan Richardson, Locum pharmacist

One yesterday - patient was under the impression that 111 had sent a prescription and they were calling to check that the medication was ready for collection.  Seems to be typical situation!

Trying to access referral from PharmOutcomes was challenging - can't see it unless you enrol.  It tells you that you have one month to confirm all of the criteria from first attempt to enrol but would not let me in unless I confirmed everything.  Overcame that and could then see that the referral was for an emergency supply of medication but was unable to supply so tried to reject the referral to find the only option in the drop down box was "unable to contact patient" which was not the case!

This seems to have been rushed into operation without adequate time allowed for training.  First available face to face training in this area is 40 miles away in January.

D T, Community pharmacist

Depending on the reason for why you couldn't supply will determine what your actual action should have been in this instance.
If it was because it was clinically inappropriate or for a CD sch 2 or 3 then you should have advised the customer the reason you couldn't make the supply and then contact local OOH GP to make alternate arrangements for the patient as per the service spec. This still entitles you to the claim for the consultation fee.
If you didn't have stock of the item you should use the DoS to find the next closest pharmacy who provide the service and with the patients permission check if they have availability. If yes, the referral is forwarded via NHS mail and you can still claim for consultation fee, if no stock then you again refer to OOH GP for alternative arrangements again claiming for the consultation fee.

Hope this helps

Joan Richardson, Locum pharmacist

Helps to some extent - however in this area OOH GP can only be contacted out of hours and phone just rings out at other times!

 

Tired Manager, Community pharmacist

I'm not surprised they wished to remain anonymous... prednisolone this week, zomorph next week

Benie I, Locum pharmacist

So far so good....

s8chy P, Pharmacy owner/ Proprietor

What is a pharmacist doing supplying Prednisolone as emergency supply?!!
I despair at this new breed of pharmacists, don't seem to know what they're doing.

S Y, Community pharmacist

I think the NHS 111 advisors need to re-enforce the message that the CPCS is basically having a consultation with a pharmacist. It's just like having a consultation with their GP or nurse. It should not be mistaken as 'Oh the pharmacists must provide you an emergency supply' or 'your requested medicines are ready to collect when you go and meet the pharmacist'.

They also really need to tell patients to turn up for their consultation on time as agreed with the pharmacists upon the initial contact. Sometimes, when you've had booked appointments for other services throughout the day, it can be difficult to fit in these sudden referrals already....

Leon The Apothecary, Student

This was something that we thought when we first saw NUMAS. It appears further learning still needs to take place.

Colin Keenan, Locum pharmacist

1st consultation completed successfully in about 35 mins. SCR tab on pharmoutcomes not functioning properly (quicker to use NHS portal) . Four unhappy patients waiting for prescriptions to be checked by me. At least there was a computer system in the consultation room ( I understand to be compulsory by April 1st 2020). Working in a pharmacy with only one computer system in the dispensary next. How is that going to work? I've heard that some pharmacists are telling patients to ring 111 when they enter the pharmacy for advice to generate a consultation! Looks like target s are being set already!

Leon The Apothecary, Student

Pharmacies with one PMR system in their dispensaries is a struggle. Many a time I've seen these places with a queue to use the PMR. Sometimes I think Pharmacy premises need to be objectively looked at with and really considered

"Is this place appropriate to prepare medicines in?"

Lucky Ex-Locum, Superintendent Pharmacist

For 14 quid. It just isn't worth the hassle.

Benie I, Locum pharmacist

And not a penny of it to the pharmacist chasing his/her tail to provide the service. 

P T, Community pharmacist

I've had two local independants close down near us and it's hardly a surprise with dreadul services like this coming into place. The time spent offering the service is not adequetly reimbursed but even if it was the amount of time that could be spent on a single consultation means less time spent doing all the rest of the pharmacy jobs. Do they think we just stand around twiddling our thumbs all day with nothing to do? All the admin work after the consultation also seems like a massive headache. I personally would've been much happier just to do minor ailment and E/S on a non referral basis as was before, checking the SCR as and when. They should've made a better replacement for MURs than this, this is terrible. 

Stuart Reeve, Community pharmacist

CPRS. All that effort and preparation. Waiting, waiting and still waiting. Nothing! However, I believe this is the way forward for pharmacy. To add I mean the theory of CPRS not the actual process. 

 

 

 

Leon The Apothecary, Student

I agree, putting Pharmacists into a primary consultation role compared to a checking role that can, and in my opinion, should be delegated to a lower grade of staff. However, there is a lot of fundamental change that needs to happen within the pharmacy, and its systems for that to be successful.

An entirely new model. I would challenge someone with the resources to attempt to create a pharmacy, from scratch, with a new vision in mind. A pharmacy that uses automation and technology to it's fullest. Where the mundane and routine is done with computers rather than people. 

D Change, Community pharmacist

Bang on exactly what is needed.

N O, Pharmaceutical Adviser

""" supply prednisolone to treat their asthma symptoms.""

Few Questions:

1. Was it on his repeat medicines list on the SCR?

2. If not then was the Pharmacist a Independent Prescriber.

3. If none of the above then on what basis was Prednisolone supplied?

The answers would greatly help us if faced with such situations.

S Y, Community pharmacist

Some asthmatic patients could be on a long term steroid course, and the patient in this case could have just run out of tablets... I think the word 'treat' used in this article is rather misleading! As if this particular patient had had an acute asthma exacerbation, I would expect the NHS 111 advisor to escalate the case and refer them to A&E or an out-of-hour doctor/asthmatic nurse (depending on the severity). This healthcare professional who may then prescribe a course of steroid to 'treat' it....

Leon The Apothecary, Student

I think it would be really useful if C&D could reach out to NHS111 in regards to that situation. There's a great deal of learning to be obtained regardless of the reasoning.

C A, Community pharmacist

It would be on the SCR, though I would have thought it to more likely be on the acutes, unless it was a standby medication (which is unlikely given that we aren't talking about COPD).

I doubt the pharmacist was an Independrnt Prescriber.

It would be supplied on the basis of an emergency supply by the sound of it. 

sam Simon, Community pharmacist

Emergency supply of prednisolone?

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