Minor ailments schemes: an overview of experience up to 2015 Dr Anne McCarthy Dr Gerald O’Nolan Dr Jean Long Published by: Health Research Board, Dublin © Health Research Board 2016 Health Research Board Grattan House 67-72 Lower Mount Street Dublin 2 Ireland t 353 1 234 5000 f 353 1 661 2335 e [email protected] w www.hrb.ie 2 Table of contents TABLE OF CONTENTS ............................................................................................................ 3 ACKNOWLEDGEMENTS ......................................................................................................... 7 LIST OF TABLES...................................................................................................................... 8 LIST OF FIGURES .................................................................................................................... 9 LIST OF FORMS ......................................................................................................................10 Abbreviations ........................................................................................................................................................................... 11 EXECUTIVE SUMMARY ..........................................................................................................12 Purpose of review ..................................................................................................................................................................... 12 Methods .................................................................................................................................................................................... 12 Background to minor ailments schemes (MASs) .................................................................................................................. 12 Findings .................................................................................................................................................................................... 13 Question 1: MAS structure .............................................................................................................. 13 Question 2: MAS governance structures .......................................................................................... 14 Question 3: Resource requirements for MAS delivery ...................................................................... 15 Question 4: Revisions to MASs ........................................................................................................ 15 Question 5: Costs and benefits of a MAS ......................................................................................... 15 Question 6: Enablers of and barriers to MAS ................................................................................... 16 Conclusions .................................................................................................................................... 16 INTRODUCTION ......................................................................................................................18 Background to and purpose of the review ............................................................................................................................. 18 Research questions ................................................................................................................................................................... 19 3 METHODS ................................................................................................................................20 Questions 1, 2, 3, 4 and 6 ......................................................................................................................................................... 20 Question 5 ................................................................................................................................................................................. 20 BACKGROUND TO MINOR AILMENTS SCHEMES (MASS) .................................................21 The changing roles of health professionals ............................................................................................................................ 21 Service provision ...................................................................................................................................................................... 22 National variation in the basket of pharmacy-based service provision .............................................. 22 Health system infrastructure ........................................................................................................... 25 Governance practices and related competencies ............................................................................. 25 Communication networks ............................................................................................................... 25 Desired outcomes ..................................................................................................................................................................... 27 Health sector and professional boundaries, pharmacy service and competencies overlap ............................................... 27 Pharmacists’ competencies ..................................................................................................................................................... 27 Professional competencies .............................................................................................................. 27 Required competencies .................................................................................................................. 27 Summary .................................................................................................................................................................................. 29 FINDINGS ................................................................................................................................31 Question 1 ................................................................................................................................................................................. 31 What is a minor ailments scheme (MAS)? ........................................................................................ 31 Scope of the MAS ........................................................................................................................... 31 Training and protocols for the MAS ................................................................................................. 34 National formulary ......................................................................................................................... 39 Summary .................................................................................................................................................................................. 39 Question 2 ................................................................................................................................................................................. 40 Governance structures .................................................................................................................... 40 Summary .................................................................................................................................................................................. 46 Question 3 ................................................................................................................................................................................. 47 Resources are used to deliver the schemes ...................................................................................... 47 Summary .................................................................................................................................................................................. 47 Question 4 ................................................................................................................................................................................. 49 4 The MAS in Scotland ....................................................................................................................... 49 The MAS in England ........................................................................................................................ 50 The MAS in Wales ........................................................................................................................... 51 The MAS in Northern Ireland .......................................................................................................... 54 The MAS in Canada ......................................................................................................................... 56 Minor ailment-related care in other Canadian provinces .................................................................. 57 Activities reported on the Welsh Choose Pharmacy pilot scheme ..................................................... 58 Pharmacists and practitioners’ views on Choose Pharmacy service users profile and ailments treated in Wales ............................................................................................................................................. 58 Summary .................................................................................................................................................................................. 60 Question 5 ................................................................................................................................................................................. 62 Costs .............................................................................................................................................. 62 Benefits .......................................................................................................................................... 63 Economic evaluation ....................................................................................................................... 64 Market entry .................................................................................................................................. 64 The patient ..................................................................................................................................... 64 The pharmacist ............................................................................................................................... 65 The general practitioner ................................................................................................................. 65 Intangible benefits .......................................................................................................................... 66 Summary .................................................................................................................................................................................. 66 Question 6 ................................................................................................................................................................................. 67 Enablers and barriers relating to patients, pharmacists and general practitioners............................. 67 Enablers and barriers relating to the information and communications technology infrastructure .... 68 Enablers and barriers relating to the wider health sector: administration and policy development ... 68 Needs assessment .......................................................................................................................... 70 Summary .................................................................................................................................................................................. 70 CONCLUSIONS .......................................................................................................................76 ANNEXES ................................................................................................................................77 Annex 1: Methods .................................................................................................................................................................... 78 Annex 2: Clinical protocols details ......................................................................................................................................... 85 Scotland: Responding to minor ailments ......................................................................................... 85 Scotland – Responding to minor ailments (continued) ..................................................................... 87 5 Annex 3: Data collection and registration forms .................................................................................................................. 91 Form CP2 (SS)(5) [back] Scotland ..................................................................................................... 92 Annex 4: MAS scope and conditions .................................................................................................................................... 109 Annex 5: Information and communications technology checklists ................................................................................... 116 Annex 6: Contracts and agreements .................................................................................................................................... 123 Annex 7: Examples of pharmacy-based services provided in England between 2005–6 and 2013–14 ........................... 126 REFERENCES .......................................................................................................................128 6 Acknowledgements The authors would like to thank the Department of Health for requesting this review. We would especially like to extend our gratitude and appreciation to the following persons for providing background and information on the development and implementation of minor ailments schemes in the following countries: Scotland – Mr Michael Oswald, Community Pharmacy; Mr James Smith, NHS National Services; Mr Ken Truslove, Practitioner and Counter Fraud Services, NHS Scotland; Mr Barry Melia, Public Health and Intelligence Strategic Business Unit, NHS National Services, Scotland. England – Ms Charlotte Goodson, Adviser, Primary Care Commissioning; Ms Linda Bracewell, Baxenden Pharmacy Chair; Dr Lisa Rogan, Head of Medicines Commissioning; Ms Rosie Taylor, Pharmaceutical Services Negotiating Committee, and Mr John Vaughan, East Lancashire Clinical Commission Group. Wales – Mr Andrew Evans, Welsh Government; Ms Anne Hinchliffe, Public Health Wales; Ms Chrissie Collier, All Wales Therapeutics and Toxicology Centre; Mr Ian Jones, Health and Social Services, Welsh Government; Ms Deirdre Leigh, Health Statistics and Analysis Unit, Welsh Government. Northern Ireland – Professor Carmel Hughes, School of Pharmacy, Queen’s University Belfast; Ms Christine Kelly and Dr Joe Brogan, Health and Social Card Board, Northern Ireland. Canada – Ms Kelsey Skromeda, Blueprint for Pharmacy. We would also like to acknowledge the work of Louise Farragher and Brigid Pike of the Health Research Board, who assisted in the literature search, the initial screening processes and early meetings on determining the approach to be adopted by the review. We are particularly grateful to our peer reviewers: Mr Barry Melia, Scotland and Ms Anne Hinchliffe, Wales. 7 List of tables Table 1 Competencies for pharmacists with a special interest, England .................................................................21 Table 2 Suite of pharmacy-based services – four jurisdictions of the United Kingdom ...................................23 Table 3 Number of pharmacies in the four jurisdictions of the United Kingdom .............................................34 Table 4 Clinical governance assessment for minor ailments in the four jurisdictions of the United Kingdom 37 Table 5 Clinical governance training protocols for the four jurisdictions of the United Kingdom ...................37 Table 6 Governance structure: contracts, agreements, frameworks, forms and information and communications technology databases ...................................................................................................................41 Table 7 Choose Pharmacy logic model – inputs Wales .....................................................................................53 Table 8 Activities reported on in the Welsh Choose Pharmacy pilot scheme ..................................................58 Table 9 Key factors of successful change management ....................................................................................69 Table 10 Enablers and barriers to MASs .............................................................................................................72 Table 11 Search strategy .....................................................................................................................................78 Table 12 Organisations and individuals contacted .............................................................................................80 Table 13 Organisations and individuals identified for consultation on aspects of minor ailments schemes .....81 Table 14 Minor ailment conditions in the four jurisdictions of the United Kingdom and the province of Saskatchewan in Canada ........................................................................................................................................109 Table 15 Analysis of minor ailments service in England 2014 ..........................................................................112 Table 16 Minor ailments drug formulary ..........................................................................................................113 Table 17 Schedule I: drugs appropriate for prescription by pharmacists for specified conditions, Saskatchewan 114 Table 18 Electronic database establishment and testing checklist for the Minor Ailments Scheme (eMAS) Scotland 117 Table 19 Hardware and software requirements for the common ailments service Wales ..............................121 Table 20 The Community Pharmacy Assurance framework and terms in the service level agreement for the MAS, England ..........................................................................................................................................................123 Table 21 List of enhanced services which may be commissioned from community pharmacies, England 2005– 6 and 2013–14 ........................................................................................................................................................127 8 List of figures Figure 1 Overall communications network and individuals’ pathway requirements to ensure accurate understanding of eligibility in referral and treatment options ................................................................................26 Figure 2 Community care, health professionals and responsibilities in the wider healthcare sector ...............30 Figure 3 The self-care continuum .......................................................................................................................31 Figure 4 Minor ailments scheme resource requirements ..................................................................................47 Figure 5 Milestones in the development of the minor ailments scheme across the four jurisdictions of the United Kingdom ........................................................................................................................................................55 Figure 6 Search and screen strategy phase I ............................................................................................................83 Figure 7 Diagrammatic representation of bibliography databases, government and professional bodies, information systems and experts .............................................................................................................................84 Figure 8 Quick reference guide for registration on the Minor Ailments Scheme, Scotland ............................120 9 List of forms Form 1 CP2 (SS)(5) [front] Scotland ..........................................................................................................................91 Form 2 GP 34 Scotland ......................................................................................................................................94 Form 3 Request to access the Choose Pharmacy application Wales ...............................................................95 Form 4 Northern Ireland minor ailments service consultation record .............................................................98 Form 5 Pharmacy Voucher 1 Northern Ireland ..............................................................................................100 Form 6 Group consultation for minor ailments pharmacist record Northern Ireland ...................................101 Form 7 Order and receipt log for Pharmacy Voucher Northern Ireland ........................................................102 Form 8 Standard operating procedure process (key features) Northern Ireland ..........................................103 Form 9 Saskatchewan pharmacist assessment – tinea corporis (ringworm) .................................................106 Form 10 Contract for the Minor Ailments Scheme, Northern Ireland .............................................................124 10