Agenda item

The Health & Social Care Sub-Committee is presented with an update on the readiness of pharmacies in Croydon to deliver the Pharmacy First scheme announced by the Government on 1 February 2024. The Sub-Committee is asked to:

1.    Note the update provided on the Pharmacy First scheme.

2.    Consider whether its conclusions on the information provided and whether there are any areas in need of further scrutiny.

The Sub-Committee considered a report set out on pages 15 to 18 of the agenda which provided an update on the Pharmacy First Scheme that was recently rolled out nationally by the Government and NHS England which aimed to give patients quick and accessible care while easing the pressure on GP services.

-          Councillor Yvette Hopley – Cabinet Member for Health and Adult Social Care

-          Councillor Margaret Bird – Deputy Cabinet Member for Health and Adult Social Care

-          Matthew Kershaw – Chief Executive at Croydon Health Services and Place-based Leader for Health

-          Rachel Flowers – Director of Public Health

-          Annette McPartland – Corporate Director of Adult Social Care & Health

Mathew Kershaw, Chief Executive at Croydon Health Services and Place-based Leader for Health, introduced the report. It was explained that the main objective of the Pharmacy First scheme was to open up the option for residents to access pharmaceutical advice as opposed to attending primary care or in some cases emergency department in hospitals. It was further added that it was a national initiative. It was stressed that Croydon had very good coverage compared to other authorities, with around 68 community pharmacies signed up for the programme. It was explained that this translated into around 96% coverage across the Borough. It was further explained that in many cases these services had been previously available in many pharmacies, however, the Pharmacy First scheme aimed to bring more structure and consistency to the offered services.

The first question asked by the Sub-Committee considered any unintended consequences of rolling out the Pharmacy First scheme, and asked whether the scheme required the participating pharmacies to have a designated private area for examination and conversations between pharmacists and patients. Mr Kershaw responded that so far, they had not observed any unintended consequences, however, it was stressed that the scheme was rolled out very recently. It was also highlighted that pharmacists were trained healthcare professionals and before the scheme was launched, they were already able to provide the same level of support. Therefore, they did not expect any unintended consequences to arise. Nonetheless, it was stressed that they would continue to monitor the scheme. In terms of pharmacy facilities, it was agreed that designated spaces allowing privacy were very important. Confirmation could not be given as to whether each pharmacy had adequate space, however, this would be expected to be available when a pharmacy signed up to participate in the scheme.

A supplementary question was asked by the Sub-Committee Member regarding the referrals and whether a patient could be refused care by a GP practice if they did not want to seek help in a pharmacy beforehand. It was explained that a patient cannot be forced to seek care elsewhere, and their needs would be assessed at the GP practice. It was stressed that this kind of appointment would often not require an engagement with a GP, but then a different healthcare practitioner would be assigned.

Subsequently, the Sub-Committee asked a question about what was being done by the Council to advertise this scheme. It was stressed that this type of care was often provided by many pharmacists and a considerable proportion of the population already knew that they could seek help there. It was explained that to increase awareness, Croydon Health Service NHS Trust (CHS) would continue to publicise it alongside the ongoing national campaign. It was also stressed that all possible routes of promotion would be considered, including direct work with communities. It was questioned whether the awareness raising work had already started. It was explained that work on this had only recently commenced and there would be more publicity rolled out in the near future.

The next question asked by the Sub-Committee considered the effect of pharmacists working from home on the scheme. It was explained that as all different health-care providers, including pharmacies had been exploring different ways of working and providing support. However, it was stressed that the premise of Pharmacy First scheme was different, as it was expected that in the great majority it would be expected that patients received care in-person and in the timeliest manner possible.

Subsequently, the Sub-Committee Member asked a question on data regarding the number of people accessing care through the scheme and whether there were any capacity concerns. It was explained that there were some early estimates, which were in the reach of 1500 visits over the first six to eight weeks across all the participating pharmacies. Assurance was offered that at this stage there were no capacity issues arising, and they were not expected to arise in the future.

The next question considered accessibility of pharmacies’ and whether there were dedicated staff to monitor the experience of patients attending pharmacies rather than GP practices. Also, the Sub-Committee raised anecdotal concerns about the tidiness and cleanliness of some pharmacies. It was explained that CHS was not aware of any work being done nationally around patient’s insight and there had been no work locally as the scheme had only been rolled out very recently. However, it was stressed that there would be work to gather patient feedback in the future.

In terms of facilities, it was stressed that it was very important to ensure that people were examined in appropriate spaces. However, it was explained that pharmacies would not do more complex examinations, therefore, the spaces they used did not require the same standard as GP practices or hospitals. It was also stressed that there were no identified GDPR concerns. It was highlighted that in terms of access, it was often easier for residents to visit a pharmacy than a GP practice. However, it was stressed that people would have a choice to seek care at a GP practice, if they wished to do so.

The Sub-Committee asked a supplementary question about the risk of a large pharmacy chain closing some of its pharmacies in the Borough and how this might impact upon the scheme. It was explained that CHS were not aware of any particular risk of pharmacy closure and it was expected that the scheme would have a positive effect on their business, as it would generate more footfall and potentially increase sales. Therefore, it was in the interest of pharmacies to provide a good experience for their customers.

The next question followed-up on the accessibility considerations, and asked whether the GP surgeries were aware that people had the freedom to choose how they accessed care, whether at a pharmacy or in their practices. It was explained that the GP practices and other relevant parties knew that it was not a mandatory scheme and people were allowed to receive care wherever they preferred to.

Subsequently, the Sub-Committee asked a question on the access to medical history records for pharmacists and how much testing in this area had been carried out before rolling out the scheme. Assurance was given that there was an information flow between GPs and pharmacies, and it that it had been robustly tested before the scheme was rolled out. It was also added that so far there had been no issues reported to CHS. It was also explained that the pharmacists would only provide treatment for less complex conditions, which were of less significance in terms of medical history. However, the NHS would like to ensure as strong and robust information flow as possible, and therefore, it would be continuously monitored and managed accordingly.

The next question asked by the Sub-Committee asked whether the tool for the GP triage was finalised. It was explained that it was about to be completed, and it agreed that it would be confirmed to the Sub-Committee once it had been completed.

The next question considered whether pharmacists had received any additional training in relation to the seven conditions they would be covering, particularly around ‘uncomplicated urinary tract infections in women’. It was explained that these conditions would not be new territory for the pharmacists, and they would have sufficient knowledge to provide treatment without additional training.  It was assured that if a pharmacist thought that a condition was more complicated and beyond their area of expertise, they would signpost the patient to a GP practice.

A supplementary question was asked about how residents could access information to confirm which pharmacies had signed up for the Pharmacy First scheme. In response to the question, it was explained that this could be included as part of the communication strategy, as this information was not currently available.

The next question asked by the Sub-Committee asked what the process would look like if someone was not registered with the GP.  It was explained that in order to receive help from a pharmacist an individual did not need to be registered with a GP. It was also explained that pharmacists did not prescribe medication, they only provided medical advice and dispensed medication that did not require a prescription.

Subsequently, the Sub-Committee asked a question about conditions that would require examination of more private body parts, including shingles, and how an examination would take place in a pharmacy. It was explained that it would be up to an individual to choose whether to go to a pharmacy or a GP practice with such conditions. It was also highlighted that a pharmacist could provide some medical advice and signpost the individual to a GP practice if the examination could not happen in conditions the patient was comfortable with.

The next question considered the mechanisms implemented to continuously monitor the scheme’s effectiveness and what data was going to be collated to ensure there were no disparities in terms of service provision. It was explained that CHS had already started collecting data to monitor how many people were using the scheme, what had been treated, and any issues arising. It was further explained that disparity was a challenging to monitor and manage, as it was a voluntary scheme and not universal provision. Therefore, there could potentially be parts of the Borough where access was slightly less than in other parts. However, it was assured that data would be continuously monitored and evaluated.

The next question asked by the Sub-Committee asked a question about whether there was any financial remuneration available for those pharmacies participating in the scheme. It was explained that there was no direct remuneration, although, there would be other benefits for the participating pharmacies, such as higher footfall and higher revenue.

A Sub-Committee Member asked a question about whether there was any monitoring of who was providing medical advice in a pharmacy.  It was explained that only a qualified pharmacists could provide medical advice.

The next question asked by the Sub-Committee considered the possible expansion of the medical conditions that were treatable under the scheme. It was explained that they were not aware of any concrete plans at this stage. However, if the scheme was successful, it was possible that opportunities to expanded the number of conditions would be considered.

Subsequently, the Sub-Committee asked a question on how the NHS worked to increase patient confidence in the scheme. Also, it was queried whether there were any particular groups that would be more reluctant to go to a pharmacy for advice, and if so, how was this reluctance being addressed. It was explained that at this early stage, there was no indication that any particular group or areas were more or less likely to use the scheme. However, data would be reviewed both locally and nationally to identify any areas of concern and action would be taken as needed.

Actions:

Following its discussion of this item, the Sub-Committee agreed the following actions for follow-up after the meeting.

1.     It was requested that more information would be provided regarding the suitability checks of participating pharmacy’s facilities.

Conclusions:

From its discussions of the Update on Pharmacy First scheme, the Sub-Committee reached the following conclusions:

1.     The Sub-Committee agreed that ensuring the cleanliness and tidiness of the examination spaces within participating pharmacy’s facilities would be a key factor in building patients trust in the scheme.