Realising the potential of community pharmacy
How can we maximise the public’s experience when interacting with community pharmacists?
With a specific focus on:
  • polypharmacy
  • improved health outcomes in the local population
  • shared decision making tools
  • generating significant savings for local NHS organisations through reducing wastage and preventing avoidable emergency hospital admissions.  

Ideas (Advanced diagnostics, genomics and precision medicine)

Innovation 'Elevator Pitch':
Evaluation of near patient testing within community pharmacy to help reduce inappropriate antibiotic prescribing associated with respiratory and urinary tract infections.
Overview of Innovation:
Inappropriate antibiotic prescribing can lead to higher rates of antimicrobial resistance. Taking steps to reduce the number of inappropriate antibiotics prescribed will help delay the emergence of resistant organisms and prevent harm by reducing the incidents of Clostridium Difficile. 

GP practices are often the first port of call for infections such as such as sore throats. It is estimated that 50-95% of sore throats in adults and 70% in children are caused by respiratory viruses which could potentially be managed safely within community pharmacy without the need for antibiotics.

Patients presenting with sore throats to GP practices fall into three groups namely, those with clear bacterial infection, those with viral infection and those where there is a degree of diagnostic uncertainty. In the latter group, a near patient test to aid diagnosis may help reduce diagnostic uncertainty and may prevent inappropriate antibiotic prescribing. 

Near patient testing is well established in general practice e.g. urine test strips for urinary tract infections. Recently, other devices have been introduced which look at CRP, Strep A, RSV, Flu.  These devices have been shown to aid diagnosis rates. 

However, conducting near patient tests in GP practice does not help address the current workload and capacity issues experienced by GPs. It is therefore proposed that such tests could be conducted in the Community Pharmacy.

Patients with diagnostic uncertainty could be referred by the GP to their community pharmacist to have a diagnostic test and dependent upon the results have the most appropriate treatment dispensed. Community pharmacists could supply antibiotics in line with local formularies if the test results were positive or self advice / over the counter medicines if the results were negative. 

By developing and evaluating this care pathway, we aim to evaluate whether this helps reduce overall antibiotic prescribing in primary care. We would also evaluate patient satisfaction, the impact of GP workload as well as pharmacy satisfaction with near patient testing. 

Initially we would like to evaluate one device but this patient pathway could be applied to other near patient tests. If successful, ear patient tests could be incorporated in common ailment schemes whereby patients approach their "pharmacy first" rather than their GP practice for sore throats or urinary tract infections. This would help reduce demand on GP services.  

Stage of Development:
Trial stage - Trial stage to prove that the idea actually works as intended
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Advanced diagnostics, genomics and precision medicine / Wellness and prevention of illness / Education, training and future workforce / Patient and medicines safety / Person centred care
Benefit to NHS:
The NHS would benefit on a number of fronts. 

1. Reduce inappropriate antibiotic volume. This will help delay the emergence of of antimicrobial resistance which in turn help prevent incidents of C Difficile and related multi-resistant infections in the future. 

2. A reduction of unplanned admissions associated with C Diff will help reduce pressure of the acute sector. Similarly, any reduction in hospital admissions will help the NHS save money. 

3. Introduction of a new care pathway involving near patient testing within community pharmacy will help reduce workload pressure on GP practices. A recent survey of GP surgeries has shown that GP waiting times have increased from an average of 9 days in April 2014  to 13 days in APril 2015. Near patient tests can take from a couple of minutes to 10 minutes. By doing these tests during a  GP consultation will add time which could be potentially be avoided if done elsewhere.

4. New ways of working between GPs and community pharmacists are part of the Five Year Forward View. A clear and robust pathway will help utilise existing capacity in community pharmacy to support other primary acre contractors such as GPs. This also strengths the links between community pharmacy and GP practices and will foster closer working between the two primary care contractors. 

Return on Investment (£ Value): 
Return on Investment (Timescale): 
Ease of scalability: 
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Manir Hussain 20/05/2016 - 18:18 Archived Login or Register to post comments

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