Care at the Chemist consultation

Background

The minor ailments service ‘Care at the Chemist’ was initially commissioned by a former Primary Care Organisation for St Helens residents in 2004. The service is available to the public in all but two patient facing pharmacies in St Helens. Patients can obtain treatment for 27 minor ailments free of charge if they are eligible for free prescriptions. Prior to this service being set up, some patients (exempt from prescription charges) booked appointments and consulted GPs for minor ailments so that they were able to obtain treatments free of charge on prescription.  The service was set up to divert patients away from the consulting their GP in order to obtain free medicines on prescription.

The Current Position

The current spend on Care at the Chemist is in the region of £200-250k per annum.

Pharmacies in St Helens are not paid to provide this service. The CCG pays the cost of the medicines and pharmacies receive a small administration fee.

The pharmacies accessed most frequently for this service are around Parr, Thatto Heath, Four Acre and a pharmacy in the Town Centre and Haydock, areas of known deprivation.

The CCG also has a Self-Care Policy that was first published approx. 3 years ago after a 12 week public consultation. The Policy has recently been updated in line with National Guidance.

Self-care Policy https://www.england.nhs.uk/publication/conditions-for-which-over-the-counter- itemsshould-not-routinely-be-prescribed-in-primary-care-guidance-for-ccgs/

Rationale for Change

• National Guidance

NHS St Helens Self-Care Policy has been aligned to national guidance and sets out St Helens Clinical Commissioning Group’s approach to ensure that prescribing of certain products in the following circumstances is stopped and to support prescribers in implementing this decision:

• Medicines and treatments available to purchase over-the-counter, used for the treatment of minor, short-term medical conditions.
• Medicines and treatments where there is insufficient evidence of clinical benefit or cost-effectiveness.
• Medicines and treatments that are prescribed to treat conditions where there is no clinical need for treatment.
• Malaria prophylaxis

St Helens CCG spends over £2 million per year on prescribing medicines and products that are available to buy over the counter without a prescription from community pharmacies and retail outlets such as supermarkets. It is recognised that some of this cost is attributable to long-term or complex conditions. However, removing specific medications from routine prescription for minor, short-term conditions and for conditions, such as a common cold, sore throat or minor cough, which would naturally get better themselves in the majority of patients if untreated, would release money to treat more serious conditions such as heart disease and diabetes and would help maintain financial balance in the health economy.

• Financial

The CCG current spend on Care at the Chemist is approximately between £200k and £250k. In not providing this service this money would be saved given the financial challenge that the CCG faces.

• Self-care

Over the last 12 months the CCG has carried out work promoting self-care and will continue to raise awareness of self-care and where patients can access treatment for minor ailments. This will be done as a dedicated campaign and will link into other engagement activities across the borough, linking in with parent groups, seldom heard groups and other local community / third sector and voluntary groups. This campaign will also be shared across social media and allow partners and providers share messages to maximise reach.

Timeline

Consultation will start 1 July 2019 and run for 12 weeks and will end 21 September 2019

Options

• Cease the service
• Limit the number of pharmacies who offer the minor ailment service, for example only those pharmacies that are open 100 hours will be able to offer the service.
• Limit the number minor ailments and treatments offered
• Only offer the service to those aged 17 years and under

General Mitigations

Patients are still able to obtain treatments on prescription as per the information in the NHS England consultation information.

NHS England will initially consider that the cases below are examples of exceptions which may apply to the proposed restrictions:

• Circumstances where the product licence doesn’t allow the product to be sold over the counter to certain groups of patients. This may vary by medicine, but could include babies, children and/or women who are pregnant or breast-feeding. Community pharmacists will be aware of what these are and can advise accordingly.
• Patients prescribed OTC products to treat an adverse effect or symptom of a more complex illness and or prescription only medications should continue to have these products on the NHS.
• Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an OTC product.
• Patients where the clinician considers that the presenting symptom is due to a condition that would not be considered a minor ailment.
• Circumstances where the prescriber believes that in their clinical judgement exceptional circumstances exist that warrant deviation from the recommendation to self-care.
• Patients where the clinician considers that their ability to self-manage is compromised as a consequence of social, medical or mental health vulnerability to the extent that their health and/or wellbeing could be adversely affected if left to self-care.

Consultation and Questionnaire

The consultation questionnaire is available to complete online here or you can download a hard copy and complete then return to the address on the form.   

How to get involved and have your say

We will be working with the community, third sector and voluntary groups to ensure everyone across the borough has the opportunity to have their say.

There are a number of ways people can give their views

• By visiting sthelensccg.nhs.uk
• By calling 01744 627596
• By emailing engagement@sthelensccg.nhs.uk
• By attending a planned drop in session

FAQs

Question/comment: The pharmacies make £10 for each one prescription do when the items cost significantly less to buy.

Response:  Pharmacies in St Helens are not paid £10. The CCG pays the cost of the medicines and pharmacies receive a small administration fee.