Urgent change needed
NHS 111 is becoming the focal point for urgent and emergency care triage in the NHS. It’s increasingly more prominent in the average working week of the pharmacy as the front end for out of hours GP services, NUMSAS and the DMIRS pilot.
Urgent Treatment Centres are mandated to be provided by every STP area by 1 December 2019. Opening a minimum of 12 hours a day, 365 days a year, they will cater for patients who would otherwise attend A&E.
Helpfully, NHS England has published various documents about what Urgent Treatment Centres (UTCs) will provide. There are 27 minimum standards, but I won’t bore you with them now, I know you’ve probably got a few things to do.
Alongside the minimum standards, NHSE also answers some frequently asked questions, including the rather obvious but crucial, ‘what sort of patients would be suitable for referral to an Urgent Treatment Centre?’
Examples of the types of patients suitable for a UTC include:
- Strains and sprains
- Suspected broken limbs
- Minor head injuries
- Cuts and grazes
- Bites and stings
- Minor scalds and burns
- Ear and throat infections
- Skin infections and rashes
- Eye problems
- Coughs and colds
- Feverish illness in adults and children
- Abdominal pain
- Vomiting and diarrhoea
- Emergency contraception
Notice anything odd? You didn’t realise you were an Urgent Treatment Centre did you? (Actually, I suspect you did). With the exception of the broken bones, I hope anyone reading this would expect to be able to provide appropriate care to patients presenting with anything on that list.
Unfortunately it’s not realistic to expect every pharmacy to be commissioned as an Urgent Treatment Centre, despite the competence and capabilities of the network to do so. Prescription volume still increases for no more pay and your resources are, quite rightly, focused on the safe and efficient supply of medicines to your patients – something which takes increasingly more time as the market conditions progressively worsen.
It is abundantly clear that this coming winter the message to the public from Government will be that NHS 111 is the answer to all your urgent care needs. In principle this could be a good thing. Referral to pharmacy for minor ailments has always been a potential end-point for a patient calling 111. However, as anyone who provides NUMSAS, and especially those pharmacies who are providing DMIRS in the pilot areas will testify, NHS 111 don’t do a particularly good job of referring patients to pharmacy. NHS 111 suffers from the same ailments as much of the rest of the health service: increasing demand, and banging its head against significant recruitment and retention issues.
Where does this leave pharmacy? Well, I don’t think anyone paying attention will be surprised if DMIRS becomes a new national advanced service when the new contract settlement is announced. The service will only provide a successful and meaningful contribution to the NHS (and pharmacy) if NHS 111 is able to do its job and refer patients successfully to pharmacy, something that in my experience with DMIRS and NUMSAS is unlikely.
Let’s go back to that list of 15 conditions – sorry 14, no broken bones – and think about the step before the streamlining or signposting part that the 111 call handler needs to perform to arrive at that conclusion. NHS England and the Government appear to have forgotten that pharmacy is already commissioned to provide that signposting and self care support service, they just don’t pay us for it.
Instead of increasing pressure on 111 and spending a huge amount of time and effort (and money) on designing and commissioning hundreds of Urgent Treatment Centres, wouldn’t it be a better use of everyone’s time and money, especially the patients’, if pharmacy was properly commissioned to provide care for at least 14 of those ‘urgent’ care needs?
Outsider is a community pharmacist
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