The service would involve testing patients for AF – using a device that attaches to a smartphone – and then monitoring those diagnosed with the condition, Community Pharmacy North Yorkshire LPC chief executive officer Jack Davies told C+D today (March 6).

The electrocardiogram test conducted in a pharmacy’s consultation room would use an AliveCor heart monitor, which fits on the back of a smartphone, Mr Davies explained.

The service could “realise savings of up to £1.8m per year” for clinical commissioning groups (CCGs), the NHS and local authorities, by preventing “a large number of patients ending up at A&E after a stroke”, Mr Davies told C+D.

How would the service work?

Pharmacy technicians would flag patients on a community pharmacy’s database at risk of AF to dispensers; including those with hypertension, raised cholesterol levels, chronic obstructive pulmonary disease or diabetes, Mr Davies explained.

When the patient visited the pharmacy, the branch’s health champion would then offer them an electrocardiogram test using the AliveCor monitor. If the test is positive, the pharmacist would give the patient advice before directing them to their GP, forwarding their test results via NHSmail, he continued.

A GP could run further tests on the patient, potentially prescribing a medication that would require a new medicine service (NMS) review, he said, and "four follow-up interventions".

See the LPC’s flow chart of how the AF service works here.

Preventing trips to A&E

Mr Davies estimated that 67 patients in the Vale of York alone visit hospital every year due to AF, incurring costs of up to £33,000 each for a minimum three-day stay.

In contrast, the AF service would cost Vale of York CCG just £74,000 per year, Mr Davies claimed.

Mr Davies said community pharmacies across the region were well-placed to test patients for AF, and estimated around 57% of the local population – “just under 200,000 people” – visit a pharmacy regularly.

“Community pharmacies could make a major contribution to identifying AF patients, given their footfall,” he said.

Having already approached the Vale of York CCG, Mr Davies is taking the service to another CCG in the area, he told C+D.

NHS England: “Really innovative work”

NHS England’s deputy chief pharmaceutical officer Dr Bruce Warner heard about the service during a visit to Monkbar Pharmacy in York in January.

Great to see some really innovative work being planned around AF by the local LPC and CCG at Monkbar Pharmacy in York today.

— Bruce Warner (@BruceWarner) January 25, 2018

Mr Warner’s visit was also attended by Vale of York CCG senior pharmacist Faisal Majothi, lead pharmacist Laura Angus and atrial fibrillation adviser Dr Kathryn Griffiths (see photo). 

Main image left to right: Vale of York CCG senior pharmacists Faisal Majothi and lead pharmacist Laura Angus; NHS England deputy chief pharmaceutical officer Dr Bruce Warner; Community Pharmacy North Yorkshire chair Ian Dean; Vale of York CCG atrial fibrillation adviser Dr Kathryn Griffiths; Monkbar Pharmacy health champion Sarah Thomas and pharmacy manager Bekki Shone.