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'Pharmacy Collect might lead to a better understanding of COVID tests'

"Despite how many of them there are, LFTs are still not always being used in the right way"

Public understanding of how and when different COVID tests should be used is poor. Pharmacists can give patients good advice at the same time as their free tests, says Toni Hazell

Abbreviations can be tricky things. If my patient has PID, is that a prolapsed intervertebral disc, or pelvic inflammatory disease? And when I document ABH in the notes, am I raising a concern about bowel cancer due to altered bowel habit, or documenting a brush with the law and a conviction for actual bodily harm?

I thought I’d learnt all the medical abbreviations that I’d ever need, but there is a new kid on the block. ‘Normal LFT’ no longer automatically signifies that the liver function is normal but might mean that my patient has done a lateral flow test (LFT) that has come back negative for COVID-19.

I’m sure that, like many people, I have dozens of lateral flow test kits hanging around at home. My secondary school-age child gets them sent home from school and I take them regularly for work. Friends who walk past testing stations on their way to work report that they have to avoid eye contact for fear of having another pack of test kits thrust into their hands.

But, despite how many of them there are, LFTs are still not always being used in the right way, so is it pleasing to hear that pharmacies are going to be able to distribute these test kits under the Pharmacy Collect service. Tests will be given out by pharmacies, to be done at home, and those collecting the kits will need to answer three questions: have you used these before; why do you need them; and what is the age of the person using the kits?

These questions are really important. Public understanding of COVID-19 is, in my opinion, pretty poor. The pandemic has seen the development of “Schrodinger’s cough” – a cough that is so bad that the coughing person rings their GP to ask for antibiotics, but is simultaneously definitely not bad enough for them to feel they need to self-isolate or take a test.

If I had a pound for every febrile coughing person who has rung me in the last year (and here I really need a facepalm emoji), I’d be retiring to a Caribbean island as soon as restrictions allow. Similarly, many patients have told me that they don’t need to take a test because they have a cough but no fever, or that “it’s definitely not a COVID cough, doctor”.

The latest frustration is those who ring up and say that they have a cough or fever, but that it’s fine because they’ve done a lateral flow test and it is negative – completely failing to understand that lateral flow tests are only for asymptomatic carriers. They are not sensitive enough to be used for people who have symptoms of COVID-19.

This message is clearly not getting out there with the distribution of test kits as it is at the moment, and so the involvement of healthcare professionals such as pharmacists in giving out the test kits will hopefully help to remedy this. I hope that those who get kits from pharmacies will read the advice sheet, which clearly states that kits are for those who don’t have symptoms, and that if the advice appears unclear to them then the pharmacist will be able to explain the three key messages:

  1. These are for asymptomatic people
  2. A positive result needs to be confirmed with a polymerase chain reaction (PCR) test
  3. A negative test doesn’t affect the need to follow whatever social distancing rules are in place at the time, because the test isn’t 100% accurate.

I am looking forward to the next relaxation of lockdown restrictions and undoubtedly LFTs are a key part of this return to normality. Pharmacists and other healthcare professionals have an important role to play in making sure that the public understands when they should and shouldn’t be used. Hopefully Pharmacy Collect can contribute to a greater public understanding.

Toni Hazell is a GP based in a practice in London

5 Comments

V K P, Community pharmacist

Yes Doctor, more free work. The pharmacy collect specifically stipulates that pharmacy are only expected to fulfil the supply function and nothing more. Any information required whether for understanding purpose or knowledge, there is a dedicated line for that. 119.  Please call them for the understanding whilst refraining for sending unpaid work to the pharmacy door again. How about the GPs contributing to the greater public understanding for once considering they are working virtually anyways, if at all, even when the public needed their GP the most but were faced with closed shutters.

TC PA, Community pharmacist

To be fair she has only repeated the requirements of the service as detailed on the PSNC site:

https://psnc.org.uk/our-news/c-19-test-distribution-service-providing-information-when-supplying-test-kits/

I don't read it as GPs sending people to pharmacies for information, I certainly haven't experienced any of that. She has just reiterated what we need to provide as detailed in the terms of service.

Yes, we are primarily a distribution service but we do have at least provide some information if asked. Unless you want to put your fingers in your ear and shout loudly if a patient asks any questions and then tell them the phone 119.

 

V K P, Community pharmacist

Q. Are the key points of advice to the person collecting the test kits required to be provided each time they collect test kits?
The key points must be provided to the person collecting test kits where they indicate this is the first time they are collecting test kits. On subsequent collections, pharmacy teams can use their discretion to determine whether all points need to covered, for example, having determined whether the person had any problems using the tests or any outstanding questions. It is important to remind people of the importance of reporting their results, whether positive or negative.

The important poin to remind is reporting of the results which is on the PSNC website under FAQs.

https://psnc.org.uk/services-commissioning/advanced-services/c-19-lateral-flow-device-distribution-service/

 

Reiteration should occur following complete awareness of the service specification. Rather than putting fingers in the ears, active reading would facilitate greater understanding of the requirements. What pharmacy need to provide is clearly written in the specification and on the PSNC website. Hence it is recommended to read the entire terms of service and maybe it will save the ears. There is nothing in the terms of service thats says the below:

If the advice appears unclear to them then the pharmacist will be able to explain the three key messages:

1) These are for asymptomatic people

2) A positive result needs to be confirmed with a polymerase chain reaction (PCR) test

3) A negative test doesn’t affect the need to follow whatever social distancing rules are in place at the time, because the test isn’t 100% accurate.

 

Finally, you do not read it as GPs sending people to pharmacies for information. If a GPs' understanding is such then  there is an inherent expectation that the pharmacies will be carrying out the free work. Hence not surprised that interpreting the message is difficult to comprehend for some. Enjoy the free work TC PA. 

TC PA, Community pharmacist

No extra free work for me VKP other than about 5 minutes to do the claiming on MYS portal, other than that the service is run by counter staff who are more than capable of reading advice off a card. Also bear in mind we do actually get a fee per kit and an initial set up (small as it is), so we are getting paid.

If you want to be pedantic about advice we need to provide to patients/customers let's compare what Dr Hazell has said and what the key points are we MUST provide as detailed in the terms and sample SOP.

Dr Hazell: These are for asymptomatic people

Key point: The tests help identify people who are positive for COVID-19 but do not have symptoms

Dr Hazell: A positive result needs to be confirmed with a polymerase chain reaction (PCR) test

Key point: A negative result does not guarantee someone does not have COVID-19. It is important to continue following Government guidelines and restrictions. 

Dr Hazell: A negative test doesn’t affect the need to follow whatever social distancing rules are in place at the time, because the test isn’t 100% accurate.

Key point: see above

The only difference I can see is the mention of PCR test, which would maybe add about 5 seconds to the advice we give out.

Don't get me wrong VKP, I agree with you in principle about doing work for free, I hate the fact that some pharmacies try to undercut others by providing everything for nothing. But on this occasion I disagree.

 

M. Rx(n), Student

Fair point, well articulated.

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