Minor Ailments Scheme

Noshi IqbalPrimary Care Pharmacist

Presentation to GPs & Practice Managers

What is the Minor Ailment Scheme (MAS)?

Patients suffering from a minor ailment visit their local pharmacy rather than the GP

surgery

Bradford has a higher than average consultation rate for minor illness compared with the national picture.

The reasons for this are multifactorial but inner city Deprivation and low income are key contributors

Aims of the Scheme

• Reduce GP Workload by transferring consultations for minor ailments from the surgery to the pharmacy

• Increase patient access – helping to fulfil Government target max wait of 24 hr to see primary care professional & 48 hr to see GP

• Development of the role of the pharmacist as part of the primary care team

• Gradually change patient culture to pharmacy first for minor ailments

Patient inclusion criteria

• Only for patients who are exempt from prescription charges

• Patients can refuse to go onto the service• Patients who pay for their prescriptions

should be referred to a pharmacy to purchase medicines in the usual way

Community Pharmacy criteria• Service can only be provided by a qualified

pharmacist who has completed a Minor Ailment Scheme training package

• Service can only be provided by pharmacies whose staffing level is sufficiently adequate to enable pharmacists to do so safely

• Only a selected list of OTC medicines can be supplied by the pharmacist (in practice guide)

The tPCT will pay the cost of medicines & £3 to the pharmacist which includes fees for the intervention and administration

of the scheme

Minor ailments included• Cough• Sore throat• Headache / earache /

temperature• Hay fever• Head lice• Indigestion / heart

burn / tummy upset• Diarrhoea

• Constipation• Muscular back pain• Soft tissue injury• Athlete’s foot• Vaginal thrush• Contact dermatitis• Teething

LimitationsCurrently (to cash limit scheme):• Each Surgery has max 50 patients that can be

referred• Each patient referred can have a max of 6

pharmacy consultations• Referral document valid for 6 months from issue• If a patient is re-issued with another referral after

6 months this patient will be counted as another patient out of the 50 allocation

Referral back to the GP by the pharmacist

• If the patient does not meet the MAS criteria (patients will be asked to make a routine appointment unless urgent)

• If a patient presents more frequently with the same symptoms than the max stated in the protocol for that minor ailment (e.g. more than 1 request for indigestion remedies in a month)

• If the ailment falls outside the remit of the scheme and a counter sale is inappropriate

• If a pharmacist suspects a patient is abusing the service the GP & pharmaceutical advisor need to be informed; the patient may be barred from the service

Rapid referral procedure• If the patient presents to the Pharmacy with

symptoms indicating need to be seen by GP, the pharmacist will ring & make an appointment for the patient

• If GPs have second ‘bypass’ telephone numbers then the community pharmacy should be informed of these in order to allow rapid communication

• Out of hours, depending on the nature of the symptoms the patient will be advised to contact the on-call doctor or attend A&E

What happens at the Surgery• Patients presenting to the surgery with ‘minor

ailments’ will be advised of the service by the GP & issued with patient leaflet on the MAS & conditions covered

• If patient agrees to be registered on to the service GP will issue a registration form to take to a participating pharmacy of their choice (list at the bottom of referral form)

• Registration form is a template on Systm1 which will automatically read code patient involvement onto the scheme (‘referred to pharmacy service’ – can be used to generate a report on how many patients registered on the scheme)

• For patients under the age of 16 the parent / guardian can accept transfer into MAS on their behalf

• The surgery will co-operate & liaise with local pharmacists to activate the rapid referral procedure when required

• If a patient refuses to transfer into MAS they will be treated as normal NHS patients and refusal will be entered into patient record

• If GP wishes to put limitations onto MAS for individual patients, these can be written on referral form

• There is option on template for GP to tick to be informed of all consultations of his patients at the Pharmacy – the pharmacist will fax a copy of the pharmacy form outlining consultation & any supplies of medication made

Clinical responsibility

The pharmacist will be clinically responsible for any advice or treatments that he / she

provides as part of this service

What happens at the Pharmacy• On the first visit to the Pharmacy, the patient

presents his / her referral form and is accepted into the service; for subsequent presentations the patient only needs to attend the pharmacy

• The pharmacist interviews the patient (or guardian) and:- provides healthcare advice about the treatment of the minor ailment- supplies medication from a set formulary for the treatment of the ailment free of charge (similar to doing a Rx)- refers the patient to GP if the ailment falls outside the remit of the scheme

• At each consultation at the Pharmacy the patient signs a receipt & declaration of exemption form – the ‘pharmacy form’

• This form includes details of any medication supplied (along with labels), and is kept in the Pharmacy for audit purposes; it can be faxed to the GP if requested after the consultation

• The following will be recorded onto the PMR:- the presenting symptoms- any supplies of medication- any advice given

Monitoring & evaluation• Participating pharmacies & surgeries will be expected to

participate in monitoring & evaluation to show:- changes to GP prescribing data both by cost and volume- cost & volume of pharmacy prescribing- impact on GP appointments & time- evaluation of joint working between pharmacies & GP surgeries

• Attitudinal surveys will also be carried out among:- GPs- receptionists- pharmacists- patients

Summary of the Bradford MASPatient presents to GP

with minor ailment

Registration card & infoleaflet issued to patient

by the GP

Patient presents registration card at a

participating pharmacy, pharmacist ensurespatient entered on

pharmacy PMRPatient attends pharmacy

With minor ailment Pharmacist interviews

patient

At end of month pharmacistfills out electronic invoice form

on tPCT website

Pharmacist fills out MAS form, obtains patient signature confirming exemption from Rx charges. Form kept by pharmacist

Patient fulfils criteria for a minor ailment

Pharmacist gives adviceto patient & supplies

treatment if appropriate

Pharmacist makes entry on PMR & produces labels

for use on MAS form

Patient does not fulfil criteria

for MAS

Patient exits scheme, Pharmacist deals with

Patient as normal

Pharmacist considersrapid referral to GP or

out of hours service

How to refer patients onto the scheme• The ‘tree’ in Systm1 needs to be amended to include

‘Pharmacy Minor Ailments’To refer a patient• Access the patient record in the usual way• Left click on the ‘Pharmacy Minor Ailments’ template on the

tree• Left click on the icon at the top left of the ‘journal view’ screen• Left click to check the referral box at the top of the screen (e.g.

for limitations)• Ensure plain sheet of paper is in the printer• Press the print button at the bottom of the screen• Sign & date the referral in the space provided towards the top

of the form• Print a blank normal prescription with the right hand side

listing the patients current repeat medication• Hand the referral form & the repeat medication list to the

patient & ask patient to take this to one of the participating pharmacies

References

• Bradford City tPCT ‘Pharmacy Treatment of Minor Ailments Scheme’ Practice Guide April 2006.