Minor ailments service = major success

While it looks like a minor ailments scheme is set to be rolled out in Wales, pharmacists in England are left disappointed, as Scotland’s MAS heads for a 10 year anniversary and continues to thrive…

“COMMUNITY pharmacy is the most cost-effective place to treat patients for minor ailments when compared to hospital or GP settings,” said Professor Harry McQuillan, Chief Executive Officer at Community Pharmacy Scotland (CPS), when commenting about a Royal Pharmaceutical Society commissioned study on minor ailments, led by Aberdeen University.
“In fact pharmacy treatment costs the NHS less than half that of a GP consultation. When compared to A&E, community pharmacy management of minor conditions costs just one-fifth against a hospital visit. The study also showed that the outcome for patients is similar no matter in what sector they are treated,” he says.
According to the study, costs per consultation in pharmacy are around £29.30 compared to GPs (£82.34) and emergency departments (£147.09).
CPS would like to see increased access to the Minor Ailments Service (MAS) and an increase range of ailments that could be treated, such as urinary tract infections.

On MAS
The MAS was introduced in Scotland in July 2006; one-year later 556,840 people were registered for the service and by March 2015 this had increased to 913,483.
During the last financial year (April 2014 to March 2015) nearly 2.1 million items were prescribed on MAS at a gross ingredient cost of £5 million and £14.8 million payment for pharmacy remuneration, with the average cost per item over the 14 Health Boards in Scotland ranging from £2.08 to £2.71.
As consultations in pharmacy save £53.04 compared to going to the GP, this represents a total saving of £106 million.

How it works
MAS allows eligible people to register with a pharmacy of their choice. They can present with symptoms and the pharmacist can provide advice, treatment or a referral to another health care professional according to the patients’ needs.
When a pharmacist decides that it is necessary to provide treatment, they generate a prescription electronically which is also printed out on form CP2. The paper form captures the patient’s declaration that they remain exempt from prescription charges. Pharmacies are reimbursed for the cost of the medicine and receive a capitation fee depending on the number of patients registered.
Prescribing should be in line with the information given in the local Health Board MAS formulary or the overarching NHS formulary.

Eligibility criteria
The following people are eligible to register:
* Those under 16 or under 19 and in full-time education
* Those 60 years or over
* Those with a valid maternity exemption certificate, medical exemption certificate, or war pension exemption certificate
* Those on Income Support, Income-based Jobseeker’s Allowance, Income-related Employment and Support Allowance, or Pension Credit Guarantee Credit
* Those named on, or who are entitled to, an NHS tax credit exemption certificate or a valid HC2 certificate.

The following are not eligible:
* Those not registered with a Scottish GP practice
* Temporary residents
* Patients in care homes

MAS aims 
* Improve access for patients to medicines
* Promote care through community pharmacy
* Transfer care from GPs and nurses to pharmacists where appropriate
* Help address health inequalities
* Assist the primary care team to achieve their 48 hour access commitment

Wales
Meanwhile in Wales Community Pharmacy Wales (CPW) has welcomed the publication of the evaluation of the common ailments service – ‘Choose Pharmacy’ — that has been running as a pathfinder scheme in Cynon Valley and Gwynedd since October 2013.
The evaluation concluded that: ”the impact and economic evaluation suggests a positive return on investment in Choose Pharmacy over the next five years based on the performance of the service in the two pathfinders”.
Russell Goodway, Chief Executive of Community Pharmacy Wales commented: “CPW supports the introduction of a national common ailments service in community pharmacies across Wales and welcomes this important evaluation of the initial Pathfinder stage of the service.
“The evaluation suggests that the service has been most effective where GP surgeries and pharmacies work closely together and where the service has been best understood by NHS Wales stakeholders. CPW is eager to support a Wales wide community pharmacy based common ailments service because we are convinced that it would make the best use of pharmacy skills and expertise and provide a real value for money service to NHS Wales.”
It is estimated that around 5 million GP consultations take place every year to deal with conditions that could be dealt with in a pharmacy, and while national rollout would cost £11 million, benefits would be accrued as a result of a reduction in GP appointments, savings £43 million over a five-year period.
In addition to the two Pathfinder areas an NHS common ailments service has been running in the Torfaen area since 2006. The introduction of a national common ailments service is a Welsh Labour manifesto commitment.

England
However in England, provision of minor ailments schemes remains patchy and recent negotiations for a national service failed to reach an agreement.
“I am very disappointed that we were not able to agree a national minor ailments advice service as part of the 2015/16 settlement. I hope that the joint business cases we and the NHS have agreed to work on for possible future services will help to speed things up for future services so that we can see faster development of services that we know we will benefit pharmacies, the health service, and most importantly, patients,” commented Gary Warner, Chair of Pharmaceutical Services Negotiating Committee’s Service Development Subcommittee.
The sentiment was echoed by PSNC’s CEO, Sue Sharpe: “There is a big distinction between schemes that use the professional skills of the pharmacist to advise patients on symptoms and treatment, and those that supply medicines to patients who would otherwise book a GP appointment simply to get a prescription. We believe that a service using community pharmacists’ advice can make substantial inroads into the 50 million GP appointments for minor ailments each year. But the scheme needs to be properly funded and the advice properly recorded. Our negotiations were based on a shared understanding that community pharmacists would be funded to provide professional advice, supplying a medicine only where necessary. The last-minute decision not to commission the service represents a massive missed opportunity for the NHS.”
There are currently 70 individually commissioned MAS across England and 48 LPCs out of 77 LPCs (not including the Isle of Man) have one or more MAS commissioned in their area. Fifty-four of these services have been commissioned by CCGS and 16 by Area Teams. The schemes vary in the ailments they cover as well as the fees and reimbursement arrangements.

Clarity required
It seems clear that minor ailment schemes are beneficial for the NHS as they save much needed GP time and provide patients with ready access to professional services when and where they need them. Yet, the failure to roll out a national scheme in England is baffling, not to mention incredibly frustrating for the profession, and it’s certainly confusing for patients. Here’s hoping that NHS England sees sense, and maybe with the RPS in their corner bending politicans’ ears, PSNC might yet succeed in delivery a much needed national minor ailments service in England.