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

3 The Pilots

3.1 The programme had two main aims:

1) Expand the range of health and health improvement services offered though a community pharmacy.

2) Extend access to services during out-of-hours services.

3.2 Pilots varied in how they interpreted the aims within each of the eight pharmacies. Each pilot combined several different types of services, with service models drawing from a combination of the below:

• additional health improvement services (smoking cessation, sexual health, healthy weight);
• new services, either nurse-led or pharmacy-led clinics (minor injuries, minor ailments, unscheduled care);
• hosting existing NHS and/or voluntary organisations health and health improvement services;
• · extending opening hours for new and existing services.

3.3 A brief description of each of the pilots is below.

NHS Lothian: included two pharmacies; Boots, Shandwick Place, Edinburgh offered services run by specially trained pharmacy independent prescribers for patients presenting with a wide range of minor acute illnesses including respiratory, chest, urinary or skin complaints during out-of-hours periods; The Inch pharmacy, Edinburgh, operated for the first two years of the pilot offering extended range of health services (sexual health, needle exchange, smoking cessation, blood borne virus diagnosis, vaccination and treatment service, alcohol brief interventions) run by NHS services within an independent pharmacy.

NHS Greater Glasgow and Clyde: also ran a pilot in two pharmacies; Boots, Central Station, Glasgow hosted the Community Addiction Team who worked out of the pharmacy during extended opening times and supported the introduction of Alcohol Brief Interventions which were delivered both by the team and by the pharmacy staff; Boots, Braehead, Glasgow operated within a shopping mall and offered extended health improvement services though the pharmacy as well as advice sessions provided by Citizens Advice Bureau (CAB). Both pharmacies also included a prescribing service and tested new ways of working (i.e. smoking cessation, collaboration and development with specialist sexual health service and methadone delivered in collaboration with the community addiction team).

NHS Grampian: tested a model of nurse-led minor injuries services in a community pharmacy located within Boots, Bon Accord Centre, Aberdeen Sat 9-5pm and Sun 12-5pm. An independent pharmacy, Bairds, Aberdeen was identified, however, this did not subsequently take part in the pilot. As well as making Healthcare and treatment more accessible the pilot provided residents of Aberdeen City and surrounding areas an alternative option for managing their injuries other than going to A&E Aberdeen Royal Infirmary (which up until the pilot was their only option out with GP Surgery times). The pilot aimed to replicate the Nurse - led Minor Injury Service which is provided in the Community Hospitals in Aberdeenshire and Moray. The Nurse follows the NHS Grampian Minor Injury protocols & Patient Group Directions (PGDs) to assess, treat and discharge patients who present with injuries which are less than 48 hrs old and fall within the 30 Minor Injury protocols (patients also have to be over the age of 2 yrs). Patients could also be referred to the service via NHS24.

NHS Lanarkshire: tested a new care pathway for pharmacists with an independent prescribing qualification to provide unscheduled care in an extended-hours opening community pharmacy. Nurse practitioners were initially utilised to test the feasibility of the pilot. The pilot then consisted of specially trained pharmacists offering a minor illness service offered to patients presenting with respiratory conditions, skin complaints and urinary tract infections during out of hours. Patients requiring the appropriate level of care (carefully defined range of presentations) were referred through NHS24 to the community pharmacy participating in the pilot. Initially nurse practitioners delivered the service but there were not enough nurses within Pharmore+ to maintain the planned rota and the nurses felt a sense of insecurity in working in a stand-alone setting. In the end, a clinic rota for two pharmacists with an Independent Prescribing qualification (Pharmacist Independent Prescribers - PIPs) was established.

NHS Tayside: offered an extended health and health improvement service as part of an extended hours pharmacy located in an inner city deprived area. The pharmacy also offered facilities for NHS and voluntary groups to deliver additional health and wellbeing services. Services included for example the British Heart foundation running group and individual sessions at the Albert Street site as well as NHS mental health services 'Beat the Blues' group support.

Location

3.4 One of the key aims across all the pilots was to ensure their services were accessible.

• Central location: all pilot sites chose pharmacies within central locations to enable greater footfall across the wider population to provide access to services which may not be readily available. NHS Grampian, for example, were interested in providing a minor injury clinic within the city centre. Although wider Aberdeenshire minor injury clinics were being delivered from casualty units and A&E, the pilot tested the transition to a different (pharmacy) setting within the city centre. Locations were accessible by car and public transport.
• Attention to wider location: pilots were influenced by the wider context in which the pharmacy was located. NHS Greater Glasgow and Clyde, for example, located one of the pilots within a shopping mall offering health improvement services where people may have more time to access health information advice.
• Extended opening hours: all pilots chose pharmacies which already had extended opening hours and which could enable services to be available outside normal working hours (for example NHS Grampian and NHS Lothian were able to offer their services at weekends).

3.5 The programme was initiated in March 2008 for two years initially, however was extended for a further year. Some pilots, especially those developing new delivery mechanisms found more time was required to consider local priorities, develop and implement services: three years was considered insufficient to fully test out a model especially where in most instances there was a requirement to deploy and train staff. The programme also experienced delays due to the swine flu crisis which occurred over the period of implementation. The pilot implementation dates are set out below:

Pilot implementation dates

3.6 Three of the five Health Boards have completed piloting these services. The two remaining pilots, NHS Grampian and NHS Lothian are still currently in operation.