The NHS states that improving access to services is one of its main priorities. And so it should be, because one tends to have the feeling that the only way to get timely care is to pre-plan illness.
The difficulty with timely access services is precisely why a pharmacy-based minor ailments scheme is so blindingly obvious. The clear benefit to patients is something that has already occurred to the governments of Scotland and Northern Ireland and resulted in a plan for roll-out in Wales. These countries have quite properly taken a national view on service delivery, rather than encouraging the wasteful wheel re-invention associated with allowing clinical commissioning groups (CCGs) to apply piecemeal policies that lead to a waste of precious resources.
NHS England appears to have some difficulty understanding this growing problem and seeing the obvious solution. True, minor ailment schemes do exist, but it is left to individual CCGs to decide on whether or not this is the right thing for their local communities. This provides a shining example of the disconnect that exists between a truly national health service and the patchiness and variability associated with local decision-making.
Growing evidence supports the benefits of the minor ailments scheme. A study by Aberdeen University found that community pharmacy consultations cost half as much as a GP consultation and a fifth as much as a visit to Accident and Emergency. As Community Pharmacy Scotland CEO, Harry McQuillan put it, “community pharmacy is the most cost effective place to treat minor ailments.” Most recently, PwC found that the value of commissioned minor ailments services in England was nearly £50m.
In fairness, NHS England is encouraging CCGs to adopt a joined up approach to the Minor Ailment Scheme by April 2018, building on the experience of urgent and emergency care vanguard projects to achieve this at scale. Amen to that. But what we are seeing now is a number of CCGs decommissioning minor ailment schemes. CCGs say this is in response to a lack of uptake of the schemes. This is plainly counter-intuitive and out of kilter with the experience of other UK countries.
If there is a lack of uptake in England, this must be because of a lack of promotion of the schemes and a consequent lack of awareness and understanding amongst the patient population of the scheme and its benefits. This highlights, yet again, how pharmacy stands outside mainstream healthcare.
It is high time that community pharmacy is seen as - and promoted as - part of mainstream healthcare. If NHS England is truly serious about making greater use of pharmacy, it is time that this was reflected in their thinking and in delivery strategies.
The sector needs investment, not the removal of funding in pursuit of short-term goals. It is clear from the evidence that a national minor ailment service gives a positive return on investment. It is time that this was reflected in the attitude and approach of NHS England to the benefits pharmacy brings to improving the health of the nation.
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