For many reasons, the ways in which people access healthcare are changing, and never has the pace of change been as fast as it is at the moment. This is partially down to advances in technology, but also out of necessity, as GPs, the traditional “first port of call” for health concerns, face into a serious workforce shortage and a general population which is getting older. This brings with it a complex set of problems associated with having many long-term conditions. The impact of this on front-line services is that some patients are reporting difficulty in getting timely appointments at their surgery. This means they seek the advice of a healthcare professional via different routes, with some of this unmet need landing at the doors of Out of Hours services such as NHS 24 and A&E departments. These hugely valued and essential parts of our NHS already see considerable numbers of patients every week, so this additional flow of people looking for solutions to their health concerns is putting undue strain on the system as a whole, the resources of which are finite. We must also consider the effects on patients – few would opt to wait in a queue for long periods of time or to attend A&E for something that is neither an accident nor an emergency if they felt they had a choice. In fact, some will choose not to, and in doing so their illness may well get worse and does become a matter of urgency.
Given that the opportunities to increase the capacity of these services is limited, we must ensure that our healthcare system works smarter and it is easy for people to access the right care, from the right person and at the right time - every time. Broadly speaking, there are two actions which will make the biggest contribution to this effort: maximising appropriate use of existing services by raising awareness of them and when they should be used and; finding novel ways of efficiently delivering the high-quality care that is expected of NHS Scotland. In previous articles I have talked about the Minor Ailment service, a shining example of how common clinical conditions can be assessed and treated by highly trained professionals without the need for appointments. The Scottish Government have recognised the contribution that this has already made to providing NHS care that would previously have been delivered through general practice, and have established a pilot to assess the feasibility and benefit of expanding the service to the whole population. We believe that this would be the most effective and impactful action to relieve pressure from our primary and secondary care colleagues, particularly if accompanied by sustained mass media communications to promote appropriate use of the service. The pilot evaluation is due early next year, and we eagerly await its recommendations.
In the meantime, we have welcomed a further two developments in community pharmacy practice which will divert clinical workload away from our colleagues and which can be safely and effectively undertaken by pharmacies. The existing service which allows community pharmacists to make supplies of medication to those who have run out and cannot reach their doctor has been enhanced. Whilst the pharmacist will always have to use their professional judgment to assess each case individually, many of the strict criteria which could previously have prevented a supply being made have been removed or reduced. This will, wherever possible, minimise the use of NHS 24 as a means of obtaining medication, and allow their teams to focus on caring for those who are acutely unwell. The second service which is in the process of national roll-out is Pharmacy First, which will see pharmacists able to treat patients with impetigo (a common skin condition), as well as assess women aged 16-60 who have the symptoms of an uncomplicated Urinary Tract Infection (UTI). Together, these simple conditions account for between 1-3 per cent of all GP appointments in Scotland in any given year, so changing the public mindset to “Pharmacy first!” for certain illnesses will go a long way to providing more efficient care and making the most of each healthcare professional’s specific skillset.
The unique and unrivalled accessibility of community pharmacies must be exploited to the fullest – hundreds of thousands of people pass through their doors every day, in some cases right into the evening and through the weekend. We can support the NHS in addressing access issues, and will continue in our work with other primary care colleagues to find new ways to sustain the world-class care that Scotland is rightly renowned for.
Harry McQuillan is chief executive of Community Pharmacy Scotland