Urgent and Emergency Care

I was invited to speak at the future of urgent and emergency care services. It is unusual for a pharmacist to be invited to this sort of event – well I wasn’t directly, but Dr Michael Dixon felt that I would answer the brief about pharmacy to compliment his opening. As expected, there wasn’t a single pharmacist in the audience. The first batch of speakers talked exclusively about new ways of working in A&E and urgent care centres – somehow I didn’t expect anyone to mention that pharmacists are employed in these services, as well as out of hours and General Practice to provide care for patients with common acute conditions, but as usual community pharmacy was not mentioned.

Feathers slightly ruffled from the start. I had to explain that there was slightly more than General Practice within Primary Care – General Practice is only one of the four independent contractor contracts within primary care – and they all provide urgent care for patients. I had to explain that within NHS England’s report they clearly suggested that a shift all the way down the line was needed with increased focus on self-care and community pharmacy to relieve the increasing pressures up stream. And, with more than 438million healthcare interventions in community pharmacy (2008/9 data) – this was more than any other profession added together. You do realise that the community pharmacy estate is huge – more premises and open longer than GPs and often more convenient for patients.

I mentioned data around the symptom checker – just to remind people that most members of the public who used the symptom checker were young and female. And that 44% still went for a consultation. There is a hint there, that putting symptom checkers in unsupported environments, like libraries might just increase demand on general practice and other services.

I offered a solution of putting NHS Choices symptom checker into community pharmacy, backed up with access to an assistant or technician that can support navigation and a pharmacist should further explanation or an intervention be necessary. Link this to the Healthy Living Pharmacy initiative with qualified health trainers and you could really start to change behaviour and attitudes towards better health.

I talked about minor ailment services – renaming them ‘common acute condition services’ and despite over 1,000 pharmacies being open 100 hours a week and many more open 80 hours a week, this service was commissioned in only 10% of pharmacies. There was service specification variability and access to medicines was generally poor. Access to medical records is still zilch, although access to the summary care record is on the horizon and will help in the future. As a side comment, if I had £1 for every patient that had been passed over to the GP for a prescription, I would have retired long ago! It is also sad that a pharmacist at 21.55 in the evening can’t book a patient into the GP next day or skype call to an out of hour’s service for support – so you can guess where those patients go.

I mentioned that the first minor injury training program, specifically for pharmacists was to be delivered this summer. Not requested by the NHS, I might add, but by pharmacists who, no doubt, will pay for their own training to deliver a higher level of service to their patients.

I was openly critical of the lack of working together in these services and suggested that it should be a basic requirement that GPs and Community Pharmacists work together to develop these services to the level that they need to be. In my opinion this is a serious flaw and limits the success of services. If the GP, Practice Nurse or receptionist simple enquired – “what did the pharmacist suggest” to patients with common acute conditions, perhaps we could turn this tanker around.

I questioned the use of NHS 111 where I am still not sure offers community pharmacy as a disposition. And the very few CCGs that underwrite the supply of medicines from a pharmacy in an emergency situation. There is no more of a heartsink moment in A&E when a patient turns up and says – “I am on holiday and I’ve forgotten my medicines and I’ll die without them”.

Those professions at the ‘bulk’ end of the scale –  General Practice, Community Pharmacy, Optometrists and Dentists must work together to create capacity and deliver more effective and more integrated care. We must share the load, and support more effective self-care to give those clever people at the top end of the system a little more space and time.


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