BIVDA Joint Meeting with South Devon and Torbay CCG
Pomona House, Oak View Close, Torquay, TQ2 7FF
Minutes, 25 May 2014
Attendance List
Dr Jo Roberts
CCG
Hannah Ruelins
CCG
Lucy Wessels
CCG
Simon Knowles
CCG
Rebecca Perkins
CCG
Tony Maggs
FT /POCT team
David Bearman
Chariman at CO-OP
Pharmacy/ Plymouth PCT
Paula Varndell
South West Peninsula
AHSN
Kevin Muckian
Pharmacist
Mark Stone
Pharmacist
Doris-Ann Williams
Rebecca Bellars
John Bagshaw
Raj Debray
Diane Walker
Steve Holland
Evi Siaterli
David Wills
Wajid Shafique
Mandy Campbell
Andy Taylor
BIVDA
BIVDA
bioMerieux
ThermoFisher
ThermoFisher
Becton Dickinson
Cepheid
Alere
Alere
HORIBA
HORIBA
1. Introduction and Welcome
Jo Roberts
JR gave us a brief introduction on the direction of the meeting, and the potential questions that
should be asked, as follows:
What can we do to enhance the role of pharmacies for:
1. Medicines optimisation
2. Management of Long Term Conditions (LTCs) – e.g. could pharmacies undertake a generic
health check of the patient
3. Public Health
4. Changing perceptions of a patient, where should they go as the first point of contact could
this be pharmacy, not GPs.
JR pointed out that 47% of GPs are older than 50, and they undertake 30% of the workload. He also
stated that 50% of practice nurses are over the age of 55. Both groups will be considering retirement
soon, so the way the system currently operates may have to change. JR also noted that there is a
surplus of pharmacists qualifying from university. JR stated Bruce Keogh is currently looking at the
GP agenda.
2. Introductions
Each delegate gave a brief introduction of themselves and their position.
3. Resume of ‘Now or Never’ Pharmacist
Mark Stone
MS offered a presentation on the changing role for community pharmacy within primary care. He
referred to the Royal Pharmaceutical Society’s publication ‘Now or Never; Shaping Pharmacy for the
Future”.
MS stated that the pharmacist used to be first port of call, rather than going to a GP. The
Department of Health have issued a call to action called, “Dispensing Health” for community
pharmacy, asking how the NHS looks for community pharmacy. View this here.
MS put forward a number of facts, stating that now is the time for shaping community pharmacy. He
stated:
 There are 1900 prescriptions a minute in England; to cope DH want e-prescribing
 There are huge number of pharmacy graduates coming through
 In the next decade there will be 1000 too many pharmacists
 8% of A&E department visits involve consultations for minor ailments – NHS spends £136million
annually on them
 80% of care is self care in the UK
 Average GP consultation per patient rose from 3.9 to 5.5 per year between 1995 – 2008
 Minor ailments treatment 18-20% GP workload
 If minor ailment consultations went to pharmacy GPs would save one hour per day
What can pharmacies look at?
 LTCs
 Minor Illness
4. Joining up Community Pharmacy and Diagnostics
JR stated that he thought potential tests could be as follows:
 Dipstick and Urine tests
 Strep tests
 CRP & PCT blood tests
JR felt that many minor illnesses could be looked at in a pharmacy setting, especially as many are
likely to be safe and will clear up with time, e.g. cough, cold, sore throat.
It was agreed that in many cases:
 the pharmacists could make an accurate diagnosis, but
 the tests give credibility to what the pharmacists have said
 Tests could be used to change expectations of patients
 Tests provide reassurance to patients, including the worried well
 Tests could help limit the number of antibiotics prescribed
 Tests are used in other countries successfully – and not taken up in the UK due to
rebates/funding problems
 Tests need to be used appropriately
 Tests will show help show who needs attention, and needs a further referral
Problems in Pharmacies
DB questioned which problems are brought into pharmacies? The pharmacists in the room stated
that pharmacists look at: chest infection, sinus infection, ear infection, bites, nail fungal infections,
rashes. Receptionists may have a role in organising potential patients.
Patient Record
SK brought up the question of the patient’s record, and follow-up meetings. Other information
needs to be recorded such as how many patients then end up going to GPs, after pharmacy
consultation. The clinical systems were discussed.
JR stated that practices are “federating” a lot in primary care – sharing backroom functions. This is
due to both economies of scale and the government’s policy of 7 day week policy. The group was
informed that there is a system called Guru which is being mobilised, for GPs and sharing
information. If this pilot goes ahead, it may be necessary to have a similar system where Pharmacists
and GPs can see the record and can enter into it.
Quality Control
It was stated that no system from one company is the same as a system from another. Tests/systems
can show different information. They may be used to also show, patient ID, Local number, track
record. If there are errors with a test this may come up – and therefore should be placed on patient
record.
It was pointed out that pharmacies could pull up patient lists, and any good reputation gained would
mean that pharmacies could become beacons of excellence – although it was pointed out that
pharmacies are not homogenous.
It was stated that it is not in a company’s interest to put an instrument where people can’t use it
into a pharmacy – users are given training to a competent level.
Some tests will give you more information than you need, that may have to be acted upon. E.g.
finding out a patient is anaemic.
Funding
JR stated that the CCG may not be able to put up any money for this, and it would need a robust
business case. However, it does help that these issues are part of the national agenda.
DAW stated that this is potentially something which the Innovation team in NHS England may be
able to support. DAW will aim to discuss this with him.
Measuring Data
It was pointed out that there needs to be measurable data so that statistics will be meaningful and
can show any successes of the pilot. Including, Patient Experience, Appointments, antibiotic use, GP
appointments, A&E appointments
Logistics of size and space
 There is an issue of space, including consultation room, storage for reagents etc.
 The size of equipment was discussed, with a product from Cepheid shown.
 Should this project be undertaken in areas where there is high footfall, e.g. a supermarket
 Considerations of product type are essential, e.g. a device you record manually,
electronically, sensitivity and traceability etc.
 It was agreed that electronic would be preferable.
 POC testing in remote areas was discussed. Apparently NHS Health Checks in some
pharmacies has not taken place and pharmacists did not want to do it.
 Important to consider – EQA, IQC, Batch numbers, quality
POC Team
Although not represented themselves, TM will be feeding back to them.
5. Summary
Jo Roberts
1. Quality Control
a. Ensuring tests are appropriate / right quality
b. Ensure quality around pharmacies – right sites to do this
c. Test different settings /assumptions
d. Would patients pay / how much
2. What conditions
a. UTIs
3.
4.
5.
6.
7.
b. Sinusitis
c. Fungal Infections
d. Infections
e. Rashes
f. Conjunctivitis (agreed that this is easy to diagnose without a test)
Differentiating well from not well people, attracting patients, getting receptionists to direct
people
What do patients want
a. Expectations
b. Do they want antibiotics
c. Safety nets
Data
a. How to measure outcomes
b. Could there be huge variations
Follow – up
a. Patient Experiences
Objectives
a. These need to be clarified
i. Minor Illness
ii. Antimicrobial Resistance
iii. Patient Perceptions
6. AOB
PV – AHSN would be interested in working on the joint venture, especially regarding Long Term
Conditions, and extending role of Hospital Pharmacy Register.
It was questioned as to whether any other representation should be included in this joint venture,
around the room people put forward other groups, including:
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Public Health representation
Patient representation
Local POC team
Commissioner
Microbiologist
CCG needs to back the venture
An academic, e.g. from Exeter University.
Potential Exclusions
 Tourists
 Children
When
It was discussed that perhaps the scheme should go ahead in the Autumn, when the number of
tourists diminishes, and the seasonal winter illnesses are beginning.
Where this should be marketed?
 Pharmacies
 GP Surgeries
 A&E (£90 anytime anyone goes to A&E)
7. Thanks and Close