Minor ailment schemeswho benefits Anne Hinchliffe Consultant in
Minor ailment schemeswho benefits? Anne Hinchliffe Consultant in Pharmaceutical Public Health
Overview • The Community Pharmacy Contract • Minor ailment schemes • NPHS support for Pharmaceutical Needs Assessment (PNA)
Community Pharmacy Contract (2005) • To receive payment for NHS services a community pharmacy must be on the Pharmaceutical List • 3 levels of service – Essential – Enhanced – Advanced
Essential services • • Support for self-care Promotion of healthy lifestyles Dispensing Repeat dispensing Disposal of unwanted medicines Signposting Clinical governance
Enhanced services • National enhanced services • Locally commissioned enhanced services • Examples – Needle and syringe exchange – Supervised administration of methadone – Smoking cessation – Out-of-hours supply of palliative medicines – Emergency hormonal contraception – Chlamydia screening and treatment
Minor ailments • • • Athlete’s foot Bites and stings Constipation Contact dermatitis Cough Diarrhoea Dyspepsia Earache Hay fever • • • Headache Head lice Mouth ulcers Nasal symptoms Sore throat Teething Temperature Vaginal thrush Viral upper respiratory tract infection
Community pharmacy minor ailment schemes • Allows the community pharmacist to supply medicines, free of charge to the patient, to treat one or more minor ailment • National scheme in Scotland (July 2006) • Local schemes in Wales and England
Should Wales have a national minor ailment scheme? Should LHBs commission community pharmacy minor ailment schemes?
Lobbying and influencing Patients NPHS Royal Pharmaceutical Society of Great Britain Individual pharmacy contractors LHB staff Individual LHB board members Welsh Assembly Government Assembly members Community Pharmacy Wales and the PSNC Pharmacy multiples Drug companies and PAGB
Media Labour in favour of minor ailment schemes “Pharmacy based treatment schemes for minor ailments are high on Labour’s agenda for the NHS if the party wins a further term of office” April 2005
Media Minor ailment schemes on Government agenda in Wales” “A national minor ailments scheme for Wales may be on the horizon…. CPW was talking to the Welsh Assembly Government about the development of a national MAS” Nov 2007
Media PSNC wants pharmacy to be main provider for minor ailment care January 2008
Media Why don’t we have a universal minor ailment scheme? June 2008
Media Minor ailment schemes boost profits nationwide “Running a minor ailment scheme is more profitable than dispensing the same items on prescription and saves GP time” June 2008
Key questions • How big is this issue? • What are the barriers to self-care for minor ailments? • Do community pharmacy minor ailment schemes result in health gain for the population? • How much would it cost to implement a scheme?
Quiz Q 1. How many prescriptions are dispensed in Wales each year for over-the-counter medicines? a) 1 million b) 3 million c) 7 million
Prescribing of medicine available OTC by LHB, Apr-Oct 2007
Association between prescribing and deprivation • UK studies focusing on OTC medicines – Baines and Whynes (1997) – Timoney et al. (2003) – Evans (2001)
Quiz Q 2 What is the annual over-the-counter medicines market in Wales estimated to be worth? a) £ 5 million b) £ 50 million c) £ 100 million
Association between deprivation and OTC sales • Limited availability of OTC data at LHB level • UK studies – Boardman et al. (2005) – Bradley et al. (1998) – Johnson et al. (2001) – Mc. Intyre et al. (2003)
Is it all about money? • • • Financial incentive Reassurance Habit Low knowledge of self-care Consulting for other conditions Lack of confidence in pharmacy
Health gain • Patients are satisfied with MAS provided by community pharmacists • Reconsultation rates are similar to those of patients seen by GPs • Increased choice and more convenient provider • Little evidence on health gain • Impact on GP appointments
Financial implications • Treatment costs of pharmacy and GP consultations for minor ailments are similar Blenkinsopp and Noyce (2002) • Consultation costs are reduced with a pharmacist • Evidence on cost effectiveness of nurse led MAS was inconsistent • Difficulties in transferring GMS monies to community pharmacy
Financial implications CPW (2008) agreed rates: £ 143. 71 annual fee £ 3. 70 per consultation Assuming reimbursement of medication at drug tariff rate, no increase in volume and 50% conversion from prescribed to MAS Additional cost in Wales £ 9. 4 million/ yr (excl. VAT)
Summary of evidence • The majority of OTC medicines are purchased not prescribed • Even so, minor ailments constitute a significant workload for GPs • Some patients prefer to consult GPs for minor ailments for a range of reasons, not just financial • Some GPs and members of the public lack confidence in community pharmacy’s ability to manage minor ailments • Introduction of MAS across Wales would have a significant financial implication and uncertain health gains
NPHS role • To support those with decision making powers – Leadership – Developed a process to support LHBs make decisions about enhanced services (PNA) – Identified stages and agreed responsibilities – Provided practical support – Minimise duplication of effort
Lessons learnt • The need for PNA to inform commissioning of enhanced pharmacy services • The value of adopting a project management approach • Benefits from sharing information and experience • LHB pharmacists are good at analysing prescribing data but feel less confident in getting the patient/ public perspective • Need to consider other interventions to support self-care
Minor ailment schemeswho benefits?
- Slides: 28