A Study of Pharmore+: Pharmacy Walk-in Service Pilots

2 INTRODUCTION

2.1 The Better Health, Better Care Action plan (2007) committed to introducing community pharmacy based 'walk-in' service pilots in five health board areas and evaluate walk-in access to a wide range of primary care services through selected pharmacies. This was part of a wider package of planned improvements within the action plan to increase the flexibility and availability of primary care services. By providing greater access to advice and treatment through community pharmacies, it was anticipated that demand on GP and A&E services would be reduced.

2.2 The pilot programme, Pharmore+, was formally launched in September 2008 by the Cabinet Secretary for Health and Wellbeing with the expectation that it would run for a minimum of two years. The Scottish Government provided funding of around £1.5m to five NHS Boards for the Pharmore+ programme. Eight pharmacies participated in the pilot from the following five NHS Health boards:

NHS Greater Glasgow and Clyde (two in Glasgow)
NHS Lanarkshire (Airdrie)
NHS Lothian (two in Edinburgh)
NHS Tayside (Dundee)
NHS Grampian (two in Aberdeen)

2.3 The pharmacies were situated in a range of locations, which included:

Main commuter points
Major shopping centres
City centres, including inner city deprived areas

2.4 The pilot programme was implemented in two phases. The first phase allowed for the establishment of appropriate infrastructure requirements (e.g. IT, staff, and training) and working processes to support the smooth running of the piloted walk-in services. The second phase was fully focused on the delivery of services.

2.5 The services provided during the pilot programme varied between sites. The range of services included:

• Pharmacy-led minor illness clinic
• Nurse-led minor injury clinic
• Healthy living sessions
• Substance misuse clinics
• Sexual health clinics
• Alcohol Brief Interventions
• Enhanced smoking cessation treatment and support

2.6 Pilots were committed to undertaking local monitoring and evaluation throughout the test period. In addition there was a commitment to undertake review of the pilot programme to draw out key lessons from across the pilots to inform further development of such services. A study of the pilots was undertaken by Health Analytical Services in spring 2012.

Study aims

2.7 The aims of the study were to assess the impact, sustainability and implications for the development of these types of approaches, in particular explore what are the underlying key principles of service development which may have utility more generally within community pharmacy services.

2.8 Key questions included:

• How effective were the services in reaching target groups and widening access to services?
• How well were resources identified and used to support the implementation of the services?
• What was the impact of the services?
• What are the implications for future service development?

Study methods

2.9 A review of the individual pilot evaluation reports was undertaken in February 2012 with a view to identifying key findings relevant to national interests and to inform key questions for further exploration across the eight pharmacies.

2.10 Interviews were then conducted with each of the five NHS Health Board areas during March and April 2012. Interviews included NHS leads, Boots managers and pharmacists and staff supporting the implementation of the pilots.

2.11 A workshop was held on 25 June 2012 which brought together the pilots along with Scottish Government policy leads and key national stakeholders. The workshop considered the findings emerging from the study and suggested recommendations for future development. Key points and recommendations raised by the workshop are included in Annex A.

2.12 This report summarises the findings from the interviews conducted with pilots in each of the five participating NHS Health Boards. The report then draws on key discussion points and recommendations raised by the workshop. Finally, the report summarises the key lessons lesson learned an implications for future development.

Study limitations

There are several limitations of the study. The study is largely qualitative in nature and relied on local evaluation reports and interviews and a workshop with key stakeholders involved in the design and implementation of the pilots. An analysis of cost information was not undertaken as there was no standard financial reporting to Scottish Government and none of the pilots gathered the data necessary to conduct a detailed cost-analysis. Within the parameters of this particular study therefore, it was not possible to produce a cost analysis. However in the interviews participants discussed how well resources had been utilised to support the implementation of services.

Another limitation is that the study participants mainly involved those implementing or managing the pilots. Wider NHS Board staff or service users themselves did not participate. In the case of wider NHS Board staff it could therefore be argued that the findings may be limited. However it is our view that those interviewed provided an honest view of both the opportunities and challenges of designing and implementing the pilot. In the case of service users, we drew on the information provided by some of the pilot sites about their local evaluation work with service users. Although this was generally limited, it nevertheless provided some insights around the experience of service users.