C+D recently reported that more than 90% of pharmacies in England have signed up to the new CPCS. Patients access the service through NHS 111 referrals for either the urgent provision of medicines or the treatment of minor illness. In the first two months of the service, more than 114,000 referrals were made, of which more than 50,000 were for patients with minor illnesses.
Where patients are referred for the treatment of a minor illness, they will usually visit the pharmacy for a face-to-face consultation during which the pharmacist is likely to consult the patient’s summary care record – with their consent, of course.
During the consultation, pharmacists must ensure that any red flags that may suggest a more serious underlying medical condition requiring onward referral are identified. This is a reference to red flag symptoms, contained within the clinical knowledge summaries produced by the National Institute for health and Care Excellence (Nice).
There are around 350 summaries listed on the Nice website, covering a wide range of conditions – from Achilles tendinopathy to whooping cough – so it may take pharmacists some time to familiarise themselves with this guidance.
While many pharmacists will feel confident advising patients, they should be aware of the risks of misdiagnosis or missing a red flag. For example, how many pharmacists feel confident that they would spot a red flag for cauda equina syndrome. And what would be the consequence of missing one?
Pharmacists carrying out the CPCS risk a claim for compensation if an error is made as part of a diagnosis that leads to patient harm. Any compensation claim should be covered by professional indemnity insurance, but premiums may rise if insurers believe the risk of claims is increasing. The General Pharmaceutical Council may also undertake a fitness-to-practise investigation if it believes that an individual is not practising with the requisite skill and care.
A healthcare practitioner who causes the death of a patient through gross negligence may face prosecution for manslaughter, but this is rare. In a review carried out following the Bawa-Garba case, the General Medical Council estimated that on average one doctor a year is investigated and prosecuted for gross negligence manslaughter.
While, to date, no pharmacist has been convicted of gross negligence manslaughter, the pharmacist’s role is becoming more clinical in nature and more autonomous, in the sense that pharmacists are moving away from “just” dispensing prescriptions written by others. With this, there is a greater risk of an error occurring that may be considered “truly and exceptionally bad” and so amounts to gross negligence.
Although pharmacists will no doubt welcome the service, and are being encouraged by leadership organisations to embrace a more clinical role, they do need to ensure that they and their teams have the appropriate knowledge and training to perform the service safely and effectively. For those who are not sure, there are training sessions and courses available.
It is expected that the CPCS referral pathway will be widened at the end of this year to allow GPs to make referrals. This is likely to increase the number of referrals significantly, given the pressure on GPs. Now would be a good time to make sure that the whole pharmacy team has the necessary skills, because it will be too late if a red flag is missed. And the consequences could be serious, for both the patient and the pharmacist.
Noel Wardle is a partner and head of healthcare regulation at Charles Russell Speechlys LLP