As at least
20% of a GP’s daily workload is taken up treating minor health problems, it can
be difficult for a doctor to find more time to focus on those patients with
complex conditions who really need their input. The solution, according to the
Department of Health, is to encourage people to take control of and
responsibility for their health through self-referral to the most appropriate
primary care team member.
For a number
of minor ailments, the first port of call is usually the community pharmacist,
who is trained to deal with minor illnesses and already spend a good proportion
of his or her time advising on these self-limiting conditions.
Minor health
complains are every day aches and ills that generally require little or no
medical intervention, such as hay fever, constipation, dyspepsia, minor skin
irritations, pain and inflammation, coughs and sore throats. A survey by the
Irish Pharmacy Union (IPU) confirmed that almost 60% of people regularly rely
on their pharmacist’s advice to solve their minor ailments.
By giving
appropriate advice and recommending effective over-the-counter (OTC) products,
community pharmacists have an important role to play in diverting minor
illnesses from the GP surgery. Pharmacists are also trained to distinguish
between minor illness and major disease so they can act as a filter for
referral where a GP consultation is needed.
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| Rory O’Donnell |
“All
community pharmacists, to one degree or another, provide this service to their
customers. Every pharmacy has a consultation room in Ireland, some of these
consultations require a one-to-one conversation in private and, for other
consultations it is just as appropriate to have them at the counter or to one
side of the counter. It just depends on the circumstances and on the patient,”
says Rory O’Donnell, who runs a busy pharmacy in Derrybeg, Co Donegal. He is
also President of the IPU.
Pharmacists
in Ireland provide approximately 15 million items of advice on minor health
problems each year – a number that is growing annually as more individuals
struggle with the cost of attending their GP, particularly for minor illnesses.
Now, more than ever, there is considerable scope to develop the current level
of professional services delivered by local pharmacists into a more
comprehensive and structured service to the community.
Both the IPU
and the Pharmaceutical Society of Ireland have long advocated for the
introduction of a National Minor Ailments Scheme in community pharmacies, as
currently exists in other countries including Scotland and the UK.
A minor
ailments scheme works by providing non-prescription medication, where
appropriate, to medical cardholders free of charge, without them having to go
to their GP for a prescription.
“Under the
current system, a medical cardholders with minor complains, such as a cold sore
or hay fever, has to make an appointment with their GP and sit around in the
waiting room so that their doctor can prescribe Zovirax or an antihistamine.
This is time consuming for both the patient and the doctor and is an
unnecessary drain on GP resources,” explains Rory. “A more progressive attitude
to community health care would see pharmacists providing these medicines with
appropriate advice on their use.”
At the IPU
National Pharmacy Conference in Galway recently, union officials called on the
Minister for Health James Reilly to actively engage with them on establishing a
National Minor Ailment Scheme. The Minister was reminded of the IPU survey
(2006), which revealed that 86% of medical cardholders are in support of this
initiative.
In March this
year, the Welsh Government announced plans to introduce a minor ailments
service in community pharmacies across Wales. The first services will be in
place by March 2013 with phased rollout beginning later that year.
 |
| Lesley Griffiths. |
“By visiting
pharmacists rather than GPs for minor ailments, patients will not need to make
an appointment, but they will still be able to get any necessary medicine
without charge. This will free up GP time for dealing with more complex
conditions, and may also decrease waiting times for appointments,” remarked
Welsh Health Minister Lesley Griffiths.
This
endeavour to promote a more appropriate use of GP and community pharmacy skills
has proved successful in Scotland and the UK. Under the Scottish system, which
was introduced in 2006, patients register voluntarily in a pharmacy of their
choice and the patient's GP is informed. This enables individual patient usage
to be monitored through the pharmacy. There is a potential patient safety
benefit and the risk for abuse of the scheme is removed, since patients can
only use one pharmacy.
Payment is on
a capitation basis determined by the number of patients registered, plus
reimbursement for the cost of medicines supplied.
After just
two years in operation, a review of the service found that there were 70,000
consultations per month in Scottish pharmacies that previously would have taken
place in GP surgeries, and the average cost of medicines prescribed by
pharmacists under the scheme was lower than those prescribed by GPs under the
same circumstances.
In the UK,
the public has been able to access free NHS treatment at local pharmacies in a
large number of Primary Care Trusts for some minor conditions since 2005. Key
features of existing minor ailment schemes is that the community pharmacist
supplies the medication for a set list of minor ailments from a limited
formulary and patients exempt from prescription charges receive these medicines
free of charge.
According to
research in the UK, this service has proved particularly beneficial in areas of
deprivation, since patients in socially disadvantaged areas are more likely to
receive OTC medicines on prescription than patients in more affluent areas.
Some members
of the medical community have voiced concerns that there may be a real
potential for excessive use of medicines where a health professional is both
prescriber and dispenser. However, when the ‘Care at the Chemist’ study,
conducted by the School of Pharmacy and Pharmaceutical Sciences at the
University of Manchester, evaluated a minor ailment service in a deprived area
of Merseyside, researchers found its introduction did not lead to an increase
in medicine costs.
Rory
O’Donnell points out that one of the biggest barriers to setting up a minor
ailments service in Ireland is the limit of non-prescription medicines that are
available to Irish patients through their pharmacy.
“This is only
opening up gradually for us here in Ireland – they’re way ahead in the UK where
there is a whole plethora of extra medicines available without prescription for
a wide variety of minor medical conditions. The availability of the morning
after pill without prescription from pharmacies was a welcome addition but,
needless to say, we would welcome and call for a greater extension of switches
like that - medicines such as fluconazole for thrush and sumatriptan for
migraine.”
But, he says,
in terms of the ability of Irish pharmacists to deliver this service, they are
absolutely capable and willing.
“I believe
that pharmacists have the skills, it’s part of our core competence already but
any extra training that may be required would certainly be provided,” he
suggests. “Firstly, we would have to agree the parameters of this service,
involving all key stakeholders at an early stage - protocols and standard
operating procedures for the scheme would need to be developed by a
multi-disciplinary working group.
“As well as
deciding on the list of formulary drugs, consideration would need to be given
to what guidelines and advice should be included in the formulary, such as
inclusion and exclusion criteria for treatment with the drug, and when to refer
to the GP.
“We’re ready
to engage at any time in that discussion. The package would have to be a
win-win for everybody: The patient would have greater access to healthcare
advice; it would reduce congestion in GP surgeries; the health service would
benefit by targeting resources and making savings, and of course, schemes such
as this promote the role of the community pharmacist not only as a medicines expert
but as professionals who are trained to recognise and treat minor ailments and
give healthcare advice.”
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