Academic pharmacist Joseph Bush scrutinises claims that a pharmacy minor ailments service could save the NHS large sums of money
Treating common illnesses at pharmacies "could save NHS £1 billion". Apparently. Or is it £1.1bn? What's the point in quibbling over £0.1bn? Well, £0.1bn is £100 million so we're not talking about an insignificant amount of cash. Having said that, to provide a little context, £1bn is less than 1 per cent of the NHS budget in England (and I'm presuming that the figures are based on introducing minor ailments schemes throughout England, although nowhere is this explicitly stated).
This media coverage was stimulated by a press release from the Royal Pharmaceutical Society, large chunks of which were reported parrot fashion by the media. To the best of my knowledge, nobody has sought to verify the reliability of the £1.1bn figure, which is odd because it's a bold claim and clearly one that is of interest outside of the pharmacy village.
The figure is derived from the MINA Study, which was funded by Pharmacy Research UK. This is an excellent piece of research in an area where we are lacking evidence of effectiveness and cost-effectiveness. However, the £1.1bn figure does not appear anywhere in the published report and it is not entirely clear how this figure has been derived.
Nobody has sought to verify the reliability of the £1.1bn figure, which is odd because it's a bold claim and clearly one that is of interest outside of the pharmacy village
The press release states that the study demonstrated "over 650,000 visits to A&E and over 18 million GP consultations every year" could be diverted to community pharmacy, generating more than £1bn in cost savings. These numbers appear to be based on a combination of study results and wider NHS data.
The release states the study demonstrated that 3 per cent of all A&E consultations and 5.5 per cent of all GP consultations are for minor ailments that could have been managed in community pharmacies. The only problem is that these figures do not appear anywhere in the published report. Results in the report actually suggest that 5.3 per cent of 550 A&E consultations (for adults, in one emergency department in one undefined geographic area of the UK) and 13.2 per cent of 494 GP consultations (for adults, in two practices in Grampian, Scotland) could have been managed in community pharmacy.
It is unclear which datasets have been used to arrive at the figures of "over 650,000" A&E visits and "over 18 million" GP consultations. Hospital Episode Statistics data for 2012-13 (the latest figures available) suggest that there were 18.3 million visits to A&E departments (3 per cent of 18.3 million = 549,000) while the number of GP consultations per annum is not known but was estimated at 340 million in August 2013 (5.5 per cent of 340 million = 18.7 million).
What is clearly derived from the MINA Study are the cost figures used in the calculation – £147.09 per A&E consultation, £82.34 per GP consultation and £29.30 per pharmacy consultation (although the report does not detail how these figures were derived, so we are unable to assess the validity of these figures). If the differences in cost between A&E and pharmacy (£117.79) and between GP and pharmacy (£53.04) are multiplied by 549,000 for A&E and 18.7 million for GP, we arrive at a figure of £1,056,514,710 (or £1.1bn).
A true picture?
How representative of participants in wider minor ailments schemes were the participants in the MINA Study? Participants in the MINA Study were all adults. Almost half of participants in a minor ailments scheme in central Birmingham were aged 14 years or under. Would the cost figures differ if children were included? Furthermore, the characteristics and morbidities of people attending A&E in an ethnically diverse, socio-economically deprived urban environment such as Birmingham may differ wildly from those in the areas studied.
Given the known links between deprivation and illness, it is possible that the proportion of A&E attendees in Birmingham who could have been managed in community pharmacy is lower than that in the MINA Study. Conversely, perhaps the higher levels of deprivation in Birmingham would lead to an increased proportion of inappropriate A&E consultations – consultations that could have been managed in community pharmacy – owing to deprivation-related issues such as lower educational achievement, poor levels of English literacy etc. At the risk of coming over all Doris Day – perhaps, perhaps, perhaps.
While extrapolating from one non-randomised study of just over 1,000 people – based in two small, atypical geographical locations – to the entire country of England may be politically expedient, the validity of the final result may not be a true representation of the national picture (especially when much of the research was conducted in Scotland). This is not to say that the figure is incorrect – it might be entirely accurate – but it should be subjected to critical scrutiny and treated with an appropriate degree of caution.
Joseph Bush is a senior lecturer in pharmacy practice at Aston Pharmacy School. More from Joseph Bush: