“I’d like an appointment. I’ve had a sore throat since yesterday.”
My GP practice uses full telephone triage – if you want to see a GP, you have to speak to one first. Part of the reason why many GPs are triaging appointments is that, despite public information campaigns, the message that some conditions are best taken to a pharmacist just doesn’t seem to be getting through. I am constantly amazed by the number of young, otherwise healthy people who ring me after a few days of experiencing low back pain, a dry cough or a sore throat, having tried no OTC medicine.
It has been postulated that the demise of the multi-generational nuclear family has increased the need for patients to seek healthcare advice, when in the past they might have just asked Grandma or Mum. Whatever the reason, it isn’t sustainable to routinely use scarce GP time for minor illnesses. However, not all patients will be able to make a judgement as to whether their illness is minor. This is an area where pharmacists can have a key role.
A pilot project which ran from 2017 to 2019 involved NHS 111 directing patients with ‘low acuity conditions’ to a pharmacy consultation. These include things like sore eyes, mouth ulcers, vomiting, emergency contraception and ear wax. Following the success of this project, NHS England is piloting a new version of this Digital Minor Illness Referral Service (DMIRS), under which GPs will refer patients with these low acuity conditions to pharmacies.
The pilot will initially cover seven areas in England, but could be rolled out nationwide. The commissioner estimates that 6% of GP consultations (20.4 million a year) could be transferred to community pharmacists, which if correct, would help to take some of the strain off primary care.
In principle, this seems a sensible scheme. Patients will be directed to the correct healthcare professional, and if they have a good outcome then maybe in the future they will go straight to the pharmacy. There is the safety net of a pharmacist assessment; no triage system is 100% sensitive and specific.
Any patients whose condition turns out to be somewhat ‘higher acuity’ than first suspected can be directed back to their GP or A&E, if their symptoms have progressed or weren’t accurately described. If the pharmacist recommends medication, it can be bought over the counter or given via a minor ailments scheme.
This is my only reservation – many patients are reluctant to buy OTC products if they don’t pay for their prescriptions. A realisation that triage to a pharmacist may hit you in the pocket could lead to patients being reluctant to take part in the scheme. However, many GPs, myself included, already take a firm line on prescribing things like paracetamol. The latest NHS England guidance aimed at reducing prescribing of medicines that are available over the counter should further reduce such prescriptions from general practice, and therefore level the playing field in this regard.
The DMIRS is a welcome addition to the plethora of ways in which we can help direct patients to the most appropriate healthcare professional, and I look forward to it hopefully making its way down to my area.
Toni Hazell is a GP based in a practice in London