Developing a prescriber led independent walk-in service in a Pharmacy

Why should a pharmacy manager invest in the package?

This package equips pharmacies with the knowledge, training and required documents to establish a successful, Pharmacy-based prescribing clinic, available to the public upon request. As such, the minimum added benefit achieved from this package will be a significant increase in footfall of the pharmacy. The package allows qualified Independent Prescribers to practice independently in the community rather than the often restricted and limited positions of GP surgeries. Information regarding insurance, SOPs and legalities are all provided, in addition to a comprehensive set of medical condition templates. These templates summarise symptoms, diagnostics and treatments for the majority of conditions likely to be seen in such clinics, allowing the prescriber to confidently and safely, prescribe within their competency.

How does the package meet patient demands?

There is undoubtedly a national demand for more prompt and accessible healthcare. With GP appointment lists often as long as 3 weeks, the alternative for a 3-4 hour waiting time in A&E and Urgent care centres is often highly inconvenient. This package provides a more conceivable alternative and the £20-25 consultation fee very often is a highly attractive substitute for the extortionate waiting times. There is also a possibility for NHS commissioning for this service in the future.

How does the package add value/innovation to the Pharmacy?

The presence of pharmacy-based/run clinics is extremely limited at best. Provision of such a service is not only novel, but will likely attract patients from competing pharmacies. Of note, the clinical setting provided by such a service will undoubtedly instil confidence in the patient and thereby, in the pharmacy as a healthcare provider.

How does the package counteract funding cuts?

Pharmacies are being bombarded with seemingly never-ending cuts, under the umbrella of overall NHS cuts. The provision of a Prescribing clinic in community pharmacies is a private service. As such, there is not only a fee attached to the private consultation, but any prescribed medication is dispensed and sold in the pharmacy in question, making profits two-fold in benefit. For further breakdown of financial forecast, we offer an excel spreadsheet of statistical data.

How does the package affect GPs?

The NHS is currently campaigning for more efficient use of healthcare services in an attempt to encourage patients and service users to access healthcare from a wider range fo resources and healthcare professionals including nurse practitioners, paramedics and pharmacists. Such efforts include the 111 service, and public education regarding pharmacy services. Together, the ultimate aim is to reduce GP and A&E admissions. Pharmacy based prescribing clinics, therefore, are an incredibly efficient way of utilising existing skills and resources, ultimately aiming to decrease the number of patients in GP waiting areas. This will reduce GP appointment lists and provide significant support GPs themselves. GPs will then have more time to see more complex and severe cases, often slipping through the cracks at the moment, since they are not occupied with cases that can otherwise be treated in pharmacies. Safety netting is an important aspect of the service outlined by this package. Following each consultation, the results of a consultation is to be promptly disseminated to the GP of the patient in question, leading to a more cohesive community healthcare service, strengthening the relationship between pharmacies and GP surgeries.

What is the difference between a prescribing clinic and a Patient Group Direction (PGD)?

Under PGD protocols, the list of prescription only medications that can be prescribed are limited (including vaccinations). On the other hand, in Pharmacy-based prescribing clinics, the prescriber is licenced to prescribe any medication within their competency, i.e. there are significantly less exclusion criteria.

Secondly, the presence of a pharmacy-based clinic eliminates the extensive paperwork and uploading that is part-and-parcel of PGDs. The prescriber will merely issue a private prescription to be dispensed in the pharmacy in question, with little or no paperwork.

Further, in the case of overseas patients, an emergency supply of prescription only medications cannot be provided without a private prescription and cannot be compensated with PGDs. As such, an independent prescriber will be able to prescribe the medication required.

To date, there are no PGDs covering long-term conditions, whereas independent prescribers can diagnose, initiate and prescribe medications for such chronic conditions (asthma, diabetes, hypertension, chronic pain).

Of importance to note is the visible professionalism and subsequent patient confidence resultant from a consultation by an independent prescriber. This largely differs from that of a pharmacist completing the check boxes of a PGD protocol form.

Thus, the establishment of a successful pharmacy-based clinic cannot merely be based on PGDs, considering the plethora of conditions encountered in community pharmacies. Rather, an independent prescriber can compensate for the vast array of conditions omitted under PGD protocols. This also extends this role to all independent prescribers including nurse practitioners who could work within the pharmacy setting running independent consultation clinics.