Why has AF scheme ignored community pharmacy?
Community pharmacists have expressed their concern that a £9 million NHS England (NHSE) scheme that will identify people with atrial fibrillation (AF) in an attempt to prevent strokes will involve pharmacists based in GP surgeries and not community pharmacies.
As part of the scheme, which runs until March next year, NHSE said “specialist anticoagulation” pharmacists and nurses will carry out an "in-practice review" of GP records to find people at a high risk of suffering a stroke.
Those identified will have a face-to-face conversation or telephone or skype talk with a pharmacist or anticoagulation nurse and GP to determine a personalised treatment plan for the patient.
It is hoped the programme, which will provide checks to nearly 20,000 people across 23 areas of the country through those virtual clinics, will prevent 700 strokes and around 200 deaths.
NHSE said: “Specialist anticoagulation pharmacists or anticoagulation nurses (will) carry out an in-practice review of GP records to case-find people who have already been diagnosed with AF, but are not receiving optimal treatment.”
More than 147,000 people in England with AF and at risk of stroke are not receiving anticoagulants according to NHS Digital.
News of the scheme did not generate joy among community pharmacists, some of whom took to Twitter to air their concerns that NHSE had focused the programme on GP pharmacists and disregarded community pharmacists.
Pharmacist Tony Schofield tweeted the AF detection scheme was “eminently possible in a community pharmacy and they are better distributed throughout communities than surgeries.”
Hemant Patel, secretary of North East London Local Pharmaceutical Committee, said a trial in his area had proved how important community pharmacies are in the detection of AF. But he added it was “difficult to understand” how such evidence could be ignored.
He tweeted: “NEL: 21 pharmacies took part in NHS Testbed. In the trial, 672 traces were captured in the pharmacies of which 110 were referred to (heart) clinic. The clinic triaged out 74 which meant that 36 patients were invited for further tests. 2ignore such evidence is difficult to understand.”
Schofield replied: “Given the current antipathy towards those of us in community and the desperation to glorify the practice pharmacists are you surprised?”
Patel then tweeted: “I’m freaking angry. This highlights a problem. I’m not quite sure about antipathy. Champions of GP Pharmacists are able to lobby within the NHS system. Our lot, NPA, PSNC, CCA have to compete against them & since 2005 at least they have not been any good, have they? LPC discussion.”
Pharmacist and chairman of Associated Chemists (Wicker) Ltd Martin Bennett tweeted: “It appeared to me that until recently the multiples, in the main, were reasonably happy about the distribution model for funding and were reluctant to embrace new roles (or it may be just extra difficult for multiples). The result seems to be a desire to bypass community pharmacy.”
When contacted by ICP, NHSE confirmed the programme would involve specialist clinical staff, an anticoagulation specialist pharmacist or anticoagulation nurse, who would review untreated patients in the GP practice with the patient’s medical record.
NHSE also said that a specialist clinician will be seconded from the local specialist anticoagulation service, usually within secondary care.
Picture: syahrir maulana (iStock)