Journal of Pharmacy Management - Jan 2022

Journal of Pharmacy Management • Volume 38 • Issue 1 • January 2022 Betsi, and our target of one-third would be 50. By the end of 2022 we might be almost touching our third. It will be a bit of a scrape, but I know that we are almost there! I don't think the other health boards are quite as high as that, but they're not far behind us. Certainly there was a bit of a shaky start to begin with as we worked through the challenges around getting services like this up and running, but I think there's a good momentum behind it now. GB: If Health Boards are moving at different paces, doesn’t that create inequalities? AM: It's part of the negotiations for a new contract settlement in Wales. There's been discussion around moving the service to be a nationally commissioned one rather than a locally commissioned one, which will create more similarities across the Health Boards, but also give some assurance that if you invest in training that pharmacist, there will be a service that you can recoup some of that investment through. GB: And what clinical areas have been covered? AM: Looking at the cases that they were seeing before COVID, it was predominantly respiratory issues, upper and lower respiratory tract infections. When COVID and the lockdowns hit, we asked them not to see respiratory patients initially. Then it became UTIs and skin. Since then we've said to get respiratory patients to do a lateral flow test or a PCR before they come in depending on the symptoms, and there's been a few more respiratory consultations again, but they're still quite low, but I think that's probably because of COVID. It also depends on the competence of the pharmacists and their scope of practice. A number of the pharmacists in the first few pharmacies that went live had done exacerbations of respiratory conditions, COPD and asthma in their original training, so they would manage people presenting with those symptoms with steroids and antibiotics rather than refer to the surgery because it was within their scope and it was within the appropriateness of their service, but the service largely covers things like UTI, upper and lower respiratory tract infections, and skin conditions such as infections, general viral illness, gout, and musculoskeletal pain; generally, conditions with a higher acuity but ending in a prescription in the pharmacy rather than referral to a GP, where it can bemanaged in the pharmacy. The way I tend to define it in Betsi Cadwaladr is if it's something you can manage there and then, and you don't need any tests doing or anything like that, then it's appropriate. If it's something that's going to need two or three consultations then it's probably not appropriate. There are some exceptions to that, like if you've got haematuria in a UTI, I'd expect to call them back after a week and re-dip their urine just to check that it's clear because we're concerned that we don't end up delaying treatment for people with more serious conditions. GB: Do you have any figures for the numbers of consultations? AM: Yes, up to the end of August 2021 our community pharmacists have done 21,500 consultations through these IP services acrossWales. We've got 43 pharmacies who are actively providing a service, but we have 30