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Sore throats, mixed message


Sore throats, mixed message

Half the people who took part would have gone to their GP instead

Withering sees the screening service tried out successfully by Boots as a “no-brainer” but wonders whether CCGs will have the sense to implement it

The big story about pharmacy in the past week or so (yes, I know – the only story we’re really interested in is the one about the looming pharmacy cuts – about which, more later!) has been the news that NHS England has selected the sore throat scheme piloted by Boots to be one of eight to be included in this year’s NHS Innovation Accelerator programme. For this year, the criteria for selection were that projects had to focus on prevention, early intervention and management of long-term conditions, all of which are highly relevant to community pharmacy.

In the strep throat scheme, people presenting with a sore throat or asking for throat pastilles were offered the option of a throat swab to test for bacterial infection. Those who tested positive for streptococcus were offered antibiotics; others were told antibiotics weren’t needed. There was a charge of £7.50 for the test and an additional £10 if antibiotics were provided.

A review of the pilot, published in the Journal of Antimicrobial Chemotherapy, found that following screening, 41 per cent of people were eligible for throat swab testing, and, of these, only one in four were positive for streptococcal infection. If the service had not been available, half the people who took part would have  gone to their GP instead, and, in two- thirds of cases, this would have taken
up an avoidable appointment.

The main benefit of a service like this is the potential to prevent unnecessary prescribing of antibiotics for large numbers of patients in primary care. But that’s not all: if this service were made available across the NHS, an estimated 800,000 GP consultations could be prevented annually, which would save millions. So, well done, and thanks to Boots for organising and funding it.

The next step is a no-brainer, isn’t it? NHS England should commission a national strep throat service in community pharmacies. Isn’t that what the Innovation Accelerator malarkey is all about? Well, actually, no, it’s not. It seems that CCGs will be informed about the scheme, and they’ll be encouraged to take it on, but whether they choose to do so is up to them. 

It’s also unclear how much community pharmacies will be paid to deliver the service, and whether similar incentives will be made available to pharmacies as are offered to GPs. To put it into perspective – the total antibiotic incentive fund for this year is worth £150 million, and a typical CCG could receive up to £150,000 a year ‘to support GP practices improve their antimicrobial prescribing’.

It sounds too good to be true, doesn’t it? A win for everyone – the public, community pharmacy and the NHS. And, in other circumstances, it would be. The problem is the context and the timing of this announcement. Deep and damaging cuts will affect us from December. What little goodwill was left in community pharmacy has finally been whittled to nothing, first by the wilful long-term neglect of pharmacy by government and then by the offensive and bullying cuts to our remuneration in
the name of non-existent efficiency.

The bottom line for us is that money must not be deducted from the global sum to pay for this. That would be an outrage – insult heaped on top of injury. I would love to be able to offer a strep throat service to my customers, but in this current climate, if NHS England or my local CCG think I’m going
to do it for peanuts, or one taken from the global sum they can think again.

Withering is the pen name of a practising independent community pharmacist. Withering’s views are not necessarily those of ICP

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