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Pharmacists to diagnose and treat sore throats


14 Nov 2016

Patients with sore throats will be directed to pharmacists for testing and treatment, under a new scheme being rolled out across England that NHS chiefs claim will help save GP appointments and cut use of antibiotics.

Under the scheme, pharmacists will use a risk score to assess patients’ symptoms, carry out throat swab tests and provide antibiotic treatment if a bacterial infection is detected.

The Government’s chief pharmacy advisor, Keith Ridge, said the scheme will cut down on use of antibiotics and reduce pressure on GPs.

But the BMA’s General Practice Committee questioned why a national scheme was being set up on the back of ‘one small pilot’, and warned it could even increase the unnecessary use of antibiotics.

The scheme – called Sore Throat Test and Treat – was piloted at 35 Boots pharmacies in England in 2014/15. Trained staff used the Centor scoring system to assess patients, offering a throat swab test for Strep A to those with a score of three or more. Patients with a positive test were offered antibiotics.

A study of the pilot over six months claimed it dealt with two-thirds of patients who would have otherwise gone to their GP – suggesting it could save some 800,000 of the 1.2 million GP visits that are for sore throats each year.

Dr Keith Ridge, chief pharmaceutical officer for England, said: “This is a good example of how the NHS wants to make the most of pharmacists clinical skills.

“It will help avoid unnecessary use of antibiotics whilst reducing the pressure on busy GPs.”

But Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, said he “would be reluctant to roll-out nationally a service based on the results of one small study”.

He added: “Proving that a patient with a sore throat has streptococci present is very different from proving that they need treatment, and with antibiotics making no difference at day three to the majority of patients.”

Dr Green said: “Community pharmacists are more appropriate for initial care than GPs, but for most cases they should provide self-care advice rather than validate intervention with testing and possible unnecessary treatment.

“If this scheme encourages those who would otherwise self-care to attend and be tested, there is a very real risk that the numbers of antibiotic prescriptions will increase rather than decrease, especially if pharmacies receive an item of service payment encouraging intervention.”

PSNC Director of NHS Services, Alastair Buxton, said: “Whilst we welcome the news that NHS England has recognised community pharmacy as a key member of the primary care team that can help reduce pressure on GP practices, this announcement seems to run contrary to the DH funding cut which is due to be implemented next month and will which will adversely affect the ability of pharmacies to provide patient care.

It should also be noted that no central funding is being made available to commission this service and its adoption will be subject to local decisions made by CCGs.

Cormac Tobin, managing director of Celesio UK (which includes AAH and LloydsPharmacy) said:

“This shows some joined up thinking – pharmacists are in an ideal position to conduct this type of service and the benefits are considerable in terms of taking pressure off GPs, not to mention the effect on antibiotic resistance.  But these medium term cost savings to the NHS must be addressed through new money for pharmacy, not more tinkering with the global sum.

“The pharmacy profession is very used to doing more for less, and there are many other ways that pharmacy could and should be contributing…But it will happen if the government backs up its rhetoric with a proper — and properly funded —plan.”

A number of GPs also questioned the plans on social media.

Dr Dean Eggitt, Doncaster LMC medical secretary and a GPC member, said on Twitter: “With pharmacies enduring 12% funding cuts, now is not a good time to introduce more work.”

Former RCGP chair Professor Clare Gerada said: “Most bacterial infections don’t need antibiotics, so what’s [the] point.”

Caroline Price


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