04 October 2019 – Gov.Wales
By Vaughan Gething, Minister for Health and Social Services
I am pleased to reiterate the Welsh Government’s continuing support for the community pharmacy sector in Wales.
Community pharmacies make a significant contribution to improving the health and wellbeing of the communities in which they are situated.
This supports the Government’s long term plan for health and social care ‘A Healthier Wales’ which sets out the new models of seamless care we are developing. It builds on the strong foundations of local innovation being delivered through our maturing network of primary care clusters and community pharmacies have a fundamental role in getting this right.
As part of multi-professional teams working in our communities pharmacists provide a hugely valued service:
Helping those with ongoing conditions to manage these better, reviewing their medication and helping improve their quality of life:
• Dispensing advice and prescriptions in convenient and accessible locations
• Offering an increasing range of clinical services including influenza vaccinations, access to emergency contraception and treatment and advice through Wales’ national Common Ailments Service.
Our aim is to make community pharmacies the first port of call for many patients. Whether it is for coughs, colds, earache, hay fever, conjunctivitis or head lice, over 700 community pharmacies in Wales are providing free advice and treatment without the need for a prescription and without having to make an appointment with a GP.
These developments are supported by Wales’ Choose Pharmacy IT system which is now available in 98% of pharmacies right across Wales, supporting an expanding range of clinical services and underpinning the transformation of the community pharmacy sector in Wales from supply to service.
Since the launch of the Common Ailment Service in September 2013, over 100,000 consultations have been completed and over 80% of people accessing the service say they would have visited their GP, out-of-hours or A&E if it had not been available.
And, as well as freeing up GPs’ time emergency department consultations, the Common Ailment Service is providing more readily accessible advice and support at a time and place convenient to our local communities.
The Choose Pharmacy system and the Common Ailments Service are exemplars of innovation; innovation which is rightly attracting much interest from other countries who hope to emulate our success.
Success which was rightly reflected on a national level when Choose Pharmacy won the 2018 Clinical Pharmacy Congress award for Excellence in use of Technology in Pharmacy Practice and by the innovative Sore Throat Test-and-Treat service winning the Innovation and Technology category at the 2019 Antibiotic Guardian Awards. A clear demonstration that Wales is at the forefront of innovation in community pharmacy and in the fight against antimicrobial resistance.
Like all components of Choose Pharmacy, the Sore Throat Test-and-Treat pilot has been extremely successful. Starting in 58 pharmacies in November 2018, 3655 consultations have been recorded and there has been a great deal of positive feedback from beneficiaries.
Pharmacists assess patients’ symptoms including undertaking an examination of patients’ throats and a simple swab test for those with symptoms which suggest they have a bacterial infection. The results of this cutting edge point of care test are available in minutes and help the pharmacist and patient decide on the best treatment and advice to manage the symptoms. If a bacterial infection is present and the patient is likely to benefit from antibiotics, they can be supplied by the pharmacist, again without a prescription. However I am aware of concerns regarding the potential for inappropriate increases in antibiotic use; a key part of the service is therefore to raise awareness that bacterial infections often resolve without antibiotics; as a result some patients choose not to take antibiotics even if the throat swab shows positive results, knowing they can return to the pharmacy without appointment if symptoms persist.
Importantly the service ensures patients take antibiotics only when they are truly needed. Previous research suggests antibiotics are prescribed in over 60% of general practice consultations for acute sore throat. In the initial evaluation of the sore throat test-and-treat service antibiotics were supplied in just 21% of consultations. Small reductions in antibiotic prescribing were observed in the pilot areas when compared to areas in which the service was not available. The initial evaluation provides confidence the supply of antibiotics by appropriately trained pharmacists did not result in increased antibiotic consumption and may be associated with small reductions in their use. In celebrating this we need to be cautious as further work is required to confirm these early findings. This will form part of the ongoing evaluation as the service now expands.
Following the success of the pilot, the aim is for the test-and-treat service to be universally commissioned and consistently delivered.
Health Boards across Wales will begin implementation by commissioning the service to support winter pressures initiatives. All Health Boards have indicated they intend to commission it in a minimum of 50% of sites, with a phased implementation between October and December this year. The pharmacies engaged in this next phase of the pilot will be those who have embraced our transformation of the community pharmacy sector from supply to service and in who we are confident have the capacity and competence to maintain the exceptional standards observed in the initial pilot.
Health Education and Improvement Wales (HEIW) is working closely with health boards to offer clinical skills training sessions for all pharmacists identified by health boards for implementation of the service. Each health board has been allocated up to 40 places. These sessions will be delivered during October and November and the intention is that pharmacies will be commissioned in this timeframe. HEIW are also currently developing a plan for further training in 2020 to expand implementation, and to ensure workforce sustainability.
Implementation of a national service which requires additional clinical skills and knowledge must be co-ordinated and implemented in a way which ensures that pharmacists receive appropriate training and demonstrate competence to deliver the service to a consistently high standard. NHS Wales, HEIW and the Welsh Government are committed to implementing this service as quickly as possible whilst ensuring that it is robust, sustainable and delivers the outcomes we value most highly: improved access and reduced antibiotic use. The evaluation of the pilot identified the importance of the training provided in ensuring safe and effective service delivery and the most appropriate model for training. As such the current training programme has been informed by the experience of pharmacists already providing the service.
To ensure success of the Sore Throat Test-and-Treat service those pharmacies demonstrating consistent delivery of the Common Ailment Service have been prioritised for phase 1 implementation; this is to ensure that patients can routinely access the service when needed by patients. All health boards are committed to commissioning the Test-and-Treat Service and recognise its importance in supporting access to NHS services within primary care.
Health boards will continue to work with those pharmacies where delivery of the Common Ailment Service is currently less consistent to understand the challenges to service delivery and work with contractors and Community Pharmacy Wales so that pharmacies who wish to deliver the Common Ailment Service and Sore Throat Test-and-Treat Service are commissioned to do so. Ensuring that where pharmacy services are commissioned that they are consistently available is a priority for NHS Wales, particularly as we look to community pharmacy to become more involved in services such as Sore Throat Test-and-Treat to enable patients to access appropriate NHS care where and when they need it.
Whilst evaluation results from the pilot are very promising it is important the wider roll out of this service is managed well. As the season for sore throats has not yet arrived, the service has not been tested under a maximum demand situation. Analysis of data will continue for at least a further year to see how seasonal variations may affect the service. This will include investigating whether the service is associated with a reduction in sore throat consultation rates and antibiotic use across primary care.