The subject of out of hours care is often in the news. The increasing demand, the increasing costs and the increasing pressure on A&E services are often complemented by a falling patient perception and increasing frustration with long waits. It is interesting to sit in discussions and never hear the words ‘community pharmacy’ mentioned. It always surprises me – so I was pleased to see some of the key proposals written in the NHS Alliance Manifesto.
Specialists (consultants) and generalists (such as GPs or nurses or pharmacists with out-of-hours contracts) should work together to construct joint Rotas to cover 24 hour service provision
It is because the NHS Alliance knows that community pharmacy often has longer opening hours than general practice, including weekends and bank holidays. They know that there are more than 800 pharmacies that open for 100 hours a week and that there are specialist out-of-hours contracts in place for specified services such as palliative care. They talk about community assets and recognise that we have all of these premises staffed by healthcare professionals available for extended hours and don’t make better use of them. They also know that in a time of austerity, you should build on what you have rather than creating something new and expensive, but ensure that primary care is the frontline for managing urgent care.
The answer starts with ‘minor ailment schemes’. I must admit that I hate this title with a passion so will immediately rename this as ‘acute care services’, although I could equally call it ‘urgent care services’ to keep aligned to the NHS Alliance language. So within the acute care services the community pharmacy is equipped and commissioned to manage a range of conditions that are likely to present acutely or urgently.
The program is based on ‘ATR’ – advise, treat, refer. The pharmacist is able to offer advice, offer treatment through OTC, PGD or independent prescriber status, or refer directly to another out of hours service or to the GP during opening hours. This service aims to pick up patients who are unable to get an appointment with their GP or present out-of-hours and would usually call the on-call team or go to A&E. The service could link with local GP practices and the emergency 111 or other information services.
The important thing is that the networks of pharmacies are already there. Several services are already in place and all they need is some redesign and support. These services fit in with the ‘talk to your pharmacist’ campaigns and seem a sensible solution to tackling increasing demand and building the community asset.
Many pharmacies are conveniently located throughout the neighbourhood and have reasonable facilities including a treatment/counselling room. In certain locations it might be reasonable to offer additional training in minor injuries to the pharmacist or even employ a nurse to deal with cuts, grazes, sprains and other injuries. The cost of equipping a pharmacy as an extended walk in centre may be considerably lower than commissioning completely new premises.
Then we should consider specialist medicines supply. I have already mentioned the palliative care networks of pharmacies who are available 24/7 to supply medicines from a palliative care list. But as primary care takes on more specialist services, the need for specialist medicines out-of-hours will increase. This service may become more important to support GPs who wish to put together a care package in short time to keep patients at home.
So, the next time you sit at a meeting discussing out-of-hours look around for the pharmacist and see how local pharmacists can contribute to integrated solutions. Before you build or create new services, with new premises, consider what you already have and look at ways of improving that.