Satyan Kotecha, independent community pharmacist at Belgrave Pharmacy in Leicester, talks to Saša Janković about running an extended care UTI service.

Service type: Extended care UTI service

Name and location of pharmacy: Belgrave Pharmacy, Leicester

Name of pharmacist: Satyan Kotecha

When did you start offering this service?

It launched in February 2021

Why did you start offering this service?

NHS England commissioned it as a Midlands-wide PGD-led service where pharmacists are able to assess if a patient requires antibiotics for an uncomplicated UTI (in women aged 16-64) and we thought this was a brilliant service to add on in the pharmacy.

What, if any, training did you or other team members have to undergo?

There was some straightforward online training about the delivery of the service. It was not onerous but involved enough to make sure you understand how to do the service properly, with lots of safeguards in place to ensure no inappropriate use of antibiotics.

In a nutshell, what does the UTI service involve?

It’s an open access service that people can walk into the pharmacy for, or patients come to us via referrals from CPCS or their GP.

The patient has to meet three criteria to receive antibiotics for an uncomplicated UTI, or we can either do a deferred consultation to see if things get worse or do a urine dipstick. If for some reason you can’t offer the service then and there, the contractual requirement is that you must find another pharmacy that can offer it to the patient and refer them there. There are 2,000 pharmacies in our region that can sign up to this, and we are able to see which others in the area are doing it so we can send patients to them if need be.

The other benefit is that the service uses the PharmOutcomes platform, so if one pharmacy has given an antimicrobial to a patient in the last six months the others can see that the person would not be eligible for another supply – and we also inform the GPs that we have done so.

Are there any opportunities to sell OTC or prescription products during or after the consultation?

As CPCS referrals into the pharmacy come from non-clinicians these may turn out to be cystitis rather than a UTI, which necessitates a different treatment and is something we can sell.

How have patients responded to the service?

People are delighted that they can be seen, tested and treated so promptly and efficiently, but the biggest challenge is still promoting the service to patients and them knowing its available.

Roughly how often each month do you carry out the service?

It does depend on how many referrals we get, but we probably see one person a week in our service. Lots of people still go to their GP for UTIs, but if you have good engagement with your local GPs you will see more.

How much do you charge for the service?

There is no charge to the patient unless they pay prescription charges.

Roughly how much a month do you make from offering the UTI service?

It’s more about professional satisfaction than financial reward. We get paid a consultation fee irrespective of supply, and only an extra £3-4 if we supply. This is good as it means we are not incentivised to make a supply, just to have a consultation, so we can exercise our autonomy and avoid criticism.

Would you recommend offering this service to other contractors?

Yes, and it is definitely complementary to the CPCS service. When CPCS launched most GPs said it would be great for cough and colds and that would be about it, but they have admitted that this service with UTIs now makes a big difference to them. GPs do not need to see these uncomplicated UTI patients, so it has improved access for patients to see them about other things. From a pharmacist’s perspective it makes sense for us in a professionally rewarding way as we are utilising knowledge, skills and patient access to make a difference to patients and the system. It definitely feels like this is what pharmacists should be doing. Dispensing will never go away but the future is in clinical services, which are safe, appropriate and professional.

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