A Minor Ailment Scheme – Streamlining What We Have Always Done

The PGA has submitted a proposal to government for the provision of a minor ailments program.
While pharmacists have provided this type of service for many years, a more streamlined and integrated version might well serve the community better.
The Australian Self Medication Industry (ASMI) commissioned a study in 2008 and found that 15 percent of all GP consultations involved minor ailments and that 7 percent were for minor ailments only.

The cost to government for these services were estimated at $260 million.

The same survey got a 71 percent YES answer to the question:
Would you be willing to use your pharmacist as your first point of contact for your health concerns?

So the possibility of a government supported first contact scheme look promising in terms of cost savings and improved efficiencies.
The fact that the 6CPA saw a number of items leave the PBS list because they were available over the counter at a cheaper price initially caused some concern because of the possibility of patients accepting prescriptions for more unsuitable molecules, particularly the codeine-containing analgesics.
A pharmacy minor ailments program has the capacity to take up any molecule not having a prescription written by a doctor.
The scheme also has the effect of triaging patients, leaving GP’s to treat more complex conditions.
I2P decided to look at a minor ailments system already in use and found a version in Scotland, a country well advanced in supporting pharmacy into self care and primary health care systems.

The Scottish system is limited to patients (including children), the Australian equivalent being concession card holders (Scottish equivalent patients get their medicines free).
Scottish patients can go to a pharmacy for advice and a non-prescription drug and get both free of charge.
Other patients have to pay normal pharmacy retail price.

To access the system a patient must first register with a GP surgery that itself is registered in Scotland, have an existing entitlement for free medicine and do not reside in a nursing or residential care home.
Registration with your pharmacy of choice is also a requisite.

Pharmacists are required to see patients without having to make an appointment and the consultation must always be with a registered pharmacist.
The pharmacist will either make any recommended medicine available free of charge.
Registration can be made at any time and basic information such as date of birth, gender and residential postcode will be asked for and a patient signature on the registration form for NHS purposes.

The pharmacist will also check whether you pay for your prescriptions may ask for proof of exemption, for example a maternity or medical exemption certificate or HC2 certificate.

The pharmacist will also prepare a separate form for each family member, including children..
Registration is for one community pharmacy only, but provision exists to register for a new pharmacy if required.
The patient may still have to visit their GP if the pharmacist requires it, or the medicine required is only available on a doctor’s prescription.
The minor ailment scheme allows for free advice and medicines for:

acne, athlete’s foot, back ache, cold sores, constipation, cough, diarrhoea, earache,

headache, head lice, indigestion, mouth ulcers, nasal congestion, pain, period pain,

thrush, eczema and allergies, haemorrhoids (piles), hay fever, sore throat, threadworms, warts and verrucae

If your pharmacist feels that it is better for you to see your GP then they may refer you directly or tell you to make an appointment with your GP

Patients are free to continue visiting their GP in preference to a pharmacist and they can visit any pharmacy with a doctor’s prescription or a private purchase.
However, only one pharmacy of choice is permitted for each minor ailment patient.

A complaints system is in place and a special patient website is available for patient reference.at www.scotconsumer.org.uk/hris.

While the Scottish system has limitations on some pharmacist discretionary activities it does have the benefit of promoting pharmacy as the first choice for minor ailment supplies (rather than a supermarket).
This is a valuable reinforcement process.
It also forces collaboration with GP’s and allows GP influence for the type of medications that can be supplied under the system.
A loss of freedom in one sense, but overall more benefit for pharmacy, cheaper service for patients and a freeing up of GP’s to concentrate on more complex patients.
It may also impact on the number of pharmacists employed, which is also a positive.
With the escalation of the average age of patients, complexity is set to overwhelm GP capacity.
Pharmacy will at least be in line to catch any future overflow.

While Australian pharmacy organises itself with funding of minor ailments, don’t forget that there is a private market that has existed for a long time, and it also needs revitalising.
i2P has published a lot of material on establishing clinical spaces, marketing a clinical service, charging for a clinical service and training clinical assistants to assist in delivery of services.
Delivering your own version of a minor ailments program does not require rocket science – just a bit of imagination and the drive to see it through.

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