Quality Payments

I was in Practice on Saturday – working for an independent community pharmacy owned by the adjacent GP practice. As frequently happens, we received a call from a young woman (late 20′s) who wanted to speak to the pharmacist.

This case highlights just how much value pharmacists add to the health system but goes completely unnoticed by those who hold the purse-strings.

She explained she had Lupus and had been late requesting a flu vaccination. She was visiting her mother from the North West and with the increased press noise about flu she was keen to have a number of queries answered before having the vaccination. Was the flu jab appropriate for her and if so, what could she expect? Would she be able to have it as she had recently been prescribed a course of steroids by her consultant and she had heard that she should not have ‘live’ vaccinations? She then went on to add that she thought the Prednisilone tablets were causing her bad stomach symptoms as she believed herself to be lactose intolerant and she had read that the tablets contained lactose – could this be the tablets and if so, what alternatives could she have?

One thing at a time – I explained that she should have the flu vaccination, it was inactivated so fine with her Prednisilone although she might expect a flare up of her Lupus symptoms as a side effect. I also explained the availability of the vaccination (we don’t provide it at the pharmacy I work in as adjacent to the GP practice and this is a decision they have made) and that she was eligible on the NHS – meeting our Healthy Living Pharmacy (HLP) requirement of signposting someone to the flu vaccination service. I encouraged her to find a pharmacy that provided the vaccine and gave her some local examples.

I then asked a few questions about her symptoms and whether she was on any other tablets – she was. Sertraline (confirmed by access to the SCR following her explicit permission) could cause an increased risk of bleeds/stomach problems combined with the steroids. She had previously been prescribed Omeprazole (but not taking) and so I explained that whilst it could be lactose intolerance (difficult to determine) but (perhaps more likely) could be the combination of both medicines causing her tummy to be upset. I advised she reinstate her Omeprazole (explaining that this may initially upset her tummy) and encouraged her to speak to her consultant/GP when back in the North West, monitoring her symptoms to see whether the PPI helped. I reiterated my recommendation to have her flu vaccination as soon as practical.

We finished the call with her very satisfied with the level of service she had received and with me having a glow of professional fulfilment. I had made a difference. From a system perspective, the contribution undoubtedly added value – here’s a patient who could have ignored the recommendation for a flu vaccination, fearful of having it and potentially had problems with her stomach and a bleed. Instead she felt empowered, informed and motivated to put in place what she needed to continue her treatment.

So, what’s the issue? This call took around 20 minutes of my time, some research and a call-back. From a sustainability perspective none of this was remunerated; this call actually cost the pharmacy money. With the focus on funding supply, our current reality is that the time spent on supporting and caring for patients is becoming increasingly difficult to justify. There was no ‘footfall’ within the pharmacy which would result in a sale, we did not benefit from a Rx nor an additional service or vaccination. None of this directly impacts my role or my desire to help, however phone calls for professional advice are an increasing trend in our pharmacy and I worry that we cannot continue offering ‘free’, easily accessible advice as a sector. I can only think this trend is going to increase further as patients want to speak to a healthcare professional but cannot get a GP appointment. This is fabulous for the profession but for it to be sustainable, the NHS must wake up to the hidden value that pharmacy offers.

What’s the answer? More of us MUST highlight stories such as these and help our local MPs, Commissioners and our negotiating body to understand what we really do. We need more evidence and research to persuade those who define policy and payment.  We require a new contract which reflects the care package we provide in our communities and perhaps a Quality Payment which recognises interventions made.

One thing is for sure, with pharmacies closing and finding it increasingly difficult to operate, we need to have our professional contributions properly recognised. I don’t know anyone who would turn a patient away and not help so please, NHS, properly recognise the difference we make and fully integrate us into the system.