What is the South Tyneside and Gateshead 'Think Pharmacy First Common Ailments Scheme'?
South Tyneside Green Party
In light of recent discovery of the plans drawn up by the Clinical Commissioning Group (CCG) to close Jarrow Walk In Centre and its GP Practice I decided to investigate one of the alternative routes patients are expected to follow. 'Think Pharmacy First' is being launched all over the country. In South Tyneside and Gateshead it is called 'Think Pharmacy First Common Ailments Scheme'. Another scheme soon to be signposted in our pharmacies is the 'Transfer of Care' (TofC) scheme which will enable pharmacists to liase with a Medicines Use Review (MUR), a New Medicines Service (NMS) or public health interventions. This is linked to PharmOutcomes and soon to be switched on.
Think Pharmacy First! What does it mean to patients? This is a Common Ailments Scheme for minor ailments only, which was launched in April. Instead of making an appointment to see our GP we are being asked to first, seek advice from a pharmacist, thus, reducing pressure on struggling GP practices, A and E units and Walk In Centres. They will be able to give a free prescription for a range of minor ailments. They will have access to Summary Care Records, (SCR) soon to be renamed 'Partial GP Records'. These contain sensitive personal information about gender, name, age, DOB, ethnicity, post code and key clinical information, including patient medication, known allergies and any adverse reactions to meds. They will not have access to full medical records. Clinicians will have a card which will be protected by a passcode and they will be responsible for its use by others in their team. The system will be able to mark every time it is used and what it has been used for and by whom (although it is possible to trick the system). GPs already use these cards to access our medical records. When this scheme is fully operational in the autumn, patient permission must be given for the Pharmacist to view the records, except where a patient is at risk of harm and unable to give permission. Then there is a way of over-riding protocols ‘in the patient’s best interest’. In the near future everyone with a card will be able to access sensitive information. Most people who work for the NHS have a limited access and are privy to restricted viewing.
This is a further step in the movement towards a totally paperless records system by 2018 where all clinicians, doctors, nurses, pharmacists, dentists, etc., will be able to access a central database. Although The 'Proof of Concept' report addressed the question of protocols and passwords required for clinicians to access this system I am unaware of any similar requisite for patient use. Is it possible to abuse such a system? Although there are protocols and passwords for clinicians to access this system I am unaware of any system of passwords or proof of identity to be offered by the patient who wishes to use this. Is it possible for an identity thief to use it? The 'Proof of Concept' report did not address this question.
Before they can take part in the scheme the pharmacist must complete a training program. They are also responsible for the in-house training of members of their team to be able to undertake a consultation with a patient. The team includes Pharmacy Technician, Dispensing Assistant or Pharmacy assistant. As part of this training questions have to be asked about training involving safeguarding vulnerable people and dealing with physical and mental problems. All staff involved in the delivery of the scheme must be trained and complete 'Every Contact is a Health Improvement Contact' and have training on relevant paperwork and protocols, which can be in house. The South Tyneside Pioneer 'Scene Setting' and 'Skills Session' training may be completed within the first year of service. A consultation form will be completed as a patient is given advice and/or treatment and/or onward signposting to alternative Health Care professionals. (I'm not sure yet of how the new TofC scheme fits in here!) Any products supplied must be entered on the 'Patient Medical Record' (Kept for 5 years) and the interaction recorded on PharmOutcomes. A PharmOutcomes Dataset must be fully completed for all patients. This includes Patient Details, Consultation Record, Supply Details, Accessibility and Person Conducting Consultation. Then aggregate data from PharmOutcomes must be transmitted to the Commissioner on a monthly basis. This seems to be contradictory as first it is recommended that 'Scene Setting' and 'Skills Session' must be completed in order to provide the service. Then it is recommended that these be completed within the first year. Does this mean that untrained people will be undertaking consultations?
After speaking to seven pharmacies in Jarrow I learnt that the system was not quite as joined-up as it could be. Opening hours vary from five days to seven days, with a single pharmacists on site all day who often only manages a 10 minute break to 'grab' some lunch, I wonder how feasible it is to expect this person to carry out in-house training of assistants and carry out consultations with patients. If a patient comes to harm due to something a Pharmacist does or does not do then they become liable. It is not clear if an assistant makes an error of judgement who is liable. Free prescriptions are only available if entitled and are on the list and do not apply to prescription only medicine or repeat prescriptions. Patients are not to be shown the list of available medications in case it is abused. This quote from a 'Think Pharmacy First' leaflet suggests that an adult accompanying a child must also be eligible for free prescriptions.
"To receive free medicines for a child on the Think Pharmacy First scheme, the parent or guardian must also be eligible for free prescriptions."
The chairman of the Local Pharmaceutical Committee (LPC) Mr David Carter, in his blog, describes the new service as 'a service where the public can access a vast range of medicines for an increasing range of conditions "quickly and conveniently" from community pharmacy instead of accessing other more expensive services (GP, Walk in Centres or Accident & Emergency departments).'
To comment on this I have to disagree with the term 'vast list'. There are ten ailments and approximately fifty different medicines. Most of them are paracetamol, ibuprofen and creams. Most people who attend a Walk In Centre do so because they can not see their own GP. They are often sent there by receptionists or 111 services. I understand that the Walk In Centre in Jarrow was initialised five years ago as a trial remedy for poor access to GPs . It has been a great success. The Health Minister, Jeremy Hunt, would be proud of it! It aspires to everything he subscribes to. The walk in centre and the GP practice are open seven days a week from 8am to 8pm. Why close it? Even Mr Hambleton (Chairman of CCG) said that it was not due to a money saving venture.
I realise that at present this is a minor ailments scheme (MAS) and at face value the medications involved seem fairly innocuous. However, having sensitive information about individuals accessible in a retail setting is not desirable for obvious reasons. Could errors be made regarding pain killers? How up to date are the SCRs going to be? Could this be extended in the future to other medications? Would a Pharmacist have to stand helplessly by as a person dies of anaphylaxis? Would medical records be open to alteration? There are those in the profession discussing whether patients can add or remove details from their records. Would the Medical Record still be deemed evidence in a legal battle if it had been changed? There are lots of questions which need addressing. The biggest question for me is whether this will help GP practices to cope with their load. Will it compensate for the loss of Jarrow Walk In Centre? I don't think it will. NHS Choice! Whose choice are we discussing? Not the choice of the Patients!
Lesley Kay Hanson
South Tyneside Green Party