The Pennine Acute Hospitals NHS Trust in Greater Manchester has partnered with LloydsPharmacy to trial an innovative new pharmacy-led clinic at its busy North Manchester General accident and emergency department.
As A&E departments across the country face unprecedented demand and continuing pressures, with mounting patient numbers attending for all sorts of conditions and complaints, the LloydsPharmacy First Care Clinic pilot, has been developed to explore and understand how pharmacy can form part of the solution.
The service provides patients with free treatment by a clinically trained pharmacist for minor injuries and common ailments such as minor burns, scalds, neck sprains and earache. The clinic aims to see patients within 30 minutes of arrival and 15 minutes after triage.
The Pennine Acute Hospitals NHS Trust’s North Manchester General Hospital A&E unit sees over 100,000 patients each year. It is the best performing A&E in Greater Manchester and one of the best in the country for the four hour emergency access standard, due, in part, to the Trust’s willingness to innovate with initiatives such as the LloydsPharmacy First Care Clinic pilot, which aims to further improve outcomes for patients.
Dr Jimmy Stuart, Consultant and Clinical Director of Urgent Care at The Pennine Acute Hospitals NHS Trust, said: “Our A&E at North Manchester is one of the best performing sites in the country in relation to the national A&E access standards and waiting times. This is a result of hard work from our staff and a reflection of the innovations and improvements we are making in ensuring patients are treated, moved to a ward, or discharged in a timely manner when they are medically fit to do so. But this is an ongoing challenge as we try to cope with the huge numbers of people that turn up to our A&E departments;
“This is the first time LloydsPharmacy has partnered with a hospital to develop its pioneering First Care Clinic in an A&E department. Together we have developed care pathways for 21 minor ailments and injuries which can be treated by the LloydsPharmacy First Care Clinic and we’ll continue to build on these. We need to explore new initiatives and pathways such as working with pharmacists to see if they can become a part of the solution to the pressures facing A&E departments.
“The clinic enables us to refer appropriate patients to have their conditions efficiently and effectively treated; this could potentially free up the equivalent of two clinicians per shift who can concentrate on patients with more serious conditions. Pharmacy has an important role to play in bridging the gap between care in the community and secondary care, and is an important piece within the solution-jigsaw to the problems currently experienced by the NHS.”
Figures suggest that around one in four people who visit the A&E department at North Manchester General Hospital could be treated more quickly and more appropriately by a pharmacist or another local NHS service such as a walk in centre or GP practice. Nationally it has been found that one in seven people (15%) who go to A&E for treatment do not have urgent problems and could have been seen by a GP, according to data collected by the College of Emergency Medicine. The real figure could be even higher as Professor Sir Bruce Keogh, National Medical Director of the NHS, reports that two out of five people (40%) who go to A&E are discharged needing no treatment at all.
Steve Howard, Superintendent Pharmacist at LloydsPharmacy said: “At LloydsPharmacy we continually look at where we can use our clinical expertise and skills to provide pioneering and forward-thinking solutions that improve the patient experience.
“We have been trialing a minor ailment and injury clinic in three of our community pharmacies and with our initiative with The Pennine Acute Hospital NHS Trust we have developed this approach to meet the needs of an A&E unit. We have had extremely positive feedback from patients who have used the clinic so far, indicating a willingness and confidence in patients to consider using pharmacy as an alternative to A&E.
“We’re all aware of the pressures the NHS is experiencing and we believe pharmacy has an important role to play in easing those pressures, both in the community and in secondary care settings. Pharmacists are highly qualified health professionals who are capable of far more than dispensing medicines. We’re keen to demonstrate those capabilities so we can help a wider number of patients and better support local NHS services.”
Simon Stevens, the chief executive of the NHS in England, delivered his much anticipated Five Year Forward View reiterating how the organisation needs to change in order to meet future health challenges, which included a greater understanding that community pharmacies can help the public deal with common ailments, and recognising the enhanced role pharmacy can play in the future of the NHS.
Cormac Tobin, Managing Director at LloydsPharmacy concluded: “Pharmacy is a long-term partner of the NHS and this latest initiative is an example of how we can take a fresh approach to working together to meet the challenges of today, and the future.”
The patient pathway at the LloydsPharmacy First Care Clinic:
Under the First Care Clinic pilot scheme, patients attending the A&E department at North Manchester General Hospital will report to reception and be seen by a triage nurse in the usual way. Anyone over the age of 16 who is assessed as having a minor injury or illness will be offered the option of treatment by a pharmacist in the First Care Clinic. There is no obligation and patients can choose to remain in the queue for treatment by A&E colleagues, but those opting for the clinic will be seen almost immediately.
During the consultation, if the pharmacist assesses that the problem may in fact be more serious, they are able to refer the patient back to A&E or the relevant hospital department without them having to wait further. For example, if the pharmacist believes a patient with a sprain may also have a minor fracture they can refer them straight to the radiology department for an x-ray.
The First Care Clinic aims to treat minor injuries and ailments such as:
Athletes foot; Cold Sores; Cuts and grazes; Pressure Blisters; Earache; Conjunctivitis; Ringworm;
Fungal Nail; Hayfever and Allergies; Bites and Stings; Head Lice; Itchy Skin, Eczema, Dermatitis;
Scabies; Sinus Congestion; Threadworms; Verrucas; Neck sprain; Burns and Scalds; Oral Thrush;
Sore Throats; Tendonitis.
In Australia, there has been very little movement towards pharmacy-based clinical services in a formal manner, even though primary health care has been available for many years through the model of a free consultation accompanied by a patient purchase of a recommended medicine.
This model has limitations given that these days, OTC products have insufficient margin to carry the cost of free consultations.
There are gaps that are being created by GP’s who choose to refer rather than treat themselves.
This makes primary heath care unaffordable through GP’s and affordable through pharmacists.
There is a high level of interest from pharmacists generally, but little strategic leadership from within the profession.
i2P believes that either the pharmacy profession must sort itself out in the form of creating a peak body to truly represent all of pharmacy, or government will eventually impose its own variant.
The reality is that they have already done that through nominating the PGA to be the sole representative for CPA negotiations – and this has proven unpopular for the majority of registered pharmacists.
It’s time to end all the farcical behaviour – pharmacists can no longer afford the luxury of indecision.
Fortunately, the UK model described above looks like a sensible proposal, so as the evidence that accrues from the Lloydspharmacy model will eventually become available for adoption by Australian models.
The fact that it would take very little effort (other than ego management) for all pharmacy organisations to come together with a plan emulating Llolydspharmacy, which has great possibilities for all parties.
Pharmacy can no longer enjoy the performance of a politically disruptive PGA trying to be all things to all people and failing miserably.
Wouldn’t it be better to come together in a productive manner and contribute in such a way as to propel pharmacy forward in a direction agreeable to all – including our patients?
And as a footnote, Sigma has just announced that it has developed a modular clinical space suitable for most existing pharmacy clinical services, and includes options such as a “hands-free” sink and pathology trolley, and a patented seating area that converts to a pathology chair or bed.
Well done Sigma!
 Reference to come from North Manchester General Hospital
 NHS England Transforming urgent and emergency care services in England: Urgent and Emergency Care Review End of Phase 1 Report Page 6 http://www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1Report.FV.pdf