Community Pharmacy Common Ailments Service (CAS) in Wales

The Community Pharmacy Common Ailments Service (CAS) The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

What is the Common Ailments Service? (CAS) NHS funded service covering 26 minor conditions, designed to improve access to appropriate advice and treatment where required, reducing common ailments burden on GPs/OOH Patients may self refer or be referred in from elsewhere (eg optician, GP, other pharmacy) Delivered by all but 3 pharmacies in Wales. Available to anyone resident or registered with a GP in Wales, and to temporary residents (visiting for >24 hours) The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

What CAS involves Consultation with pharmacist: May be face to face or remotely (eg via telephone) Self care advice, treatment if suitable or onward referral if required May not be instant access (Service Specification allows up to 48 hours to provide or refer onwards to other pharmacies/providers) The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

CAS - Service Information CAS is intended to: Encourage patients who would otherwise have visited a GP or OOH to visit the pharmacy instead Provide advice and- where necessary - treatment Promote self-care The service is not intended to: Be viewed as a free medicines supply service; Convert people who would otherwise have purchased a medicine from self-care to pharmacy care. The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

CAS - Conditions covered Colic, cold sores, ingrown toenail and diarrhoea are advice only as they have no evidence based NHS treatments available. Pharmacists will provide appropriate advice on self care and symptom management for all ailments The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

CAS - Conditions seen and service growth more stats available on https://public.tableau.com/app/profile/neil.jenkins4970/viz/PharmacyEnhancedServicesV1_2/EnhancedServices Top 8 conditions for which consultations are carried out across Wales Over 35k consultations per month nationally Weekly consultations have more than doubled year-on-year nationally The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Exclusions For some conditions there are exclusions based on: age/pregnancy/breast feeding/clinical exclusions. GP staff can use the referral information (right) if unsure (available here) Alternatively they/patient could ring their local pharmacist for advice. The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

CAS - Conditions Not Included Patients suffering from other conditions e.g. coughs, colds, rash will not be able to access CAS. Patients attending the pharmacy for conditions not included in the service will still be able to receive advice from the pharmacist, and the option to buy medicine over the counter Patients with some conditions may be able to access treatment via pharmacies providing the Independent Prescribing service Pharmacist will refer the patient to other HP if they feel that this is appropriate. The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Sore Throat Test and Treat/UTI Service Optional additions to CAS service available only at pharmacies who have signed up to provide and have a trained pharmacist on premises STTT Age 6+, uses clinical scoring and POCT if indicated. UTI From June 17th 2024 - PGD led assessment and treatment of uncomplicated UTI in females 16-64 The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Referral and documentation Consultations recorded electronically via Choose Pharmacy system, including any safety netting or follow up advice Consultation information is sent electronically to GP Referral letters are printed, a timescale for referral indicated and short additional info provided on reason for referral The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Navigating to Pharmacy Services Is the condition suitable? Does the pharmacy provide the service? Would the pharmacy prefer patient phones ahead? The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Next Steps? CAS triage/referral form here Promotional Material Welsh Government Communications Services Digital Toolkit What are the opportunities? Conditions to focus on as a cluster?

Community Pharmacy Sore Throat Test and Treat Service The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Common Ailments Scheme NHS Wales funded consultation service Advice on management, self-care, prevention Supply of NHS treatment where clinically appropriate and necessary, using PGD for POMs Symptomatic treatment available on Common Ailments Scheme Age 2 and over The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Common Ailments Scheme Sore Throat Test and Treat Service Only in Community pharmacies with a Pharmacist who has undergone STTT training Utilises RADT (POCT) for GAS and FeverPAIN/Centor as decision aids Allows for additional provision of antibiotic treatment via PGD where clinically appropriate for those aged 6 years and over The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Background Original pilot in 2018 Suspended during COVID reintroduction without POCT in BCU and CTM pilot sites in 2021, Relaunch with POCT 2022 Optional Additional clinical service, nationally commissioned, where there is a trained pharmacist available Pilot and pre COVID roll out results show: High level patient satisfaction Less than 20% consultations resulted in antibiotic supply Reductions in Phenoxymethylpenicillin Rxs in areas where STTT available GP consultation rates lower in STTT areas https://www.sciencedirect.com/science/article/abs/pii/S1551741120306100?via%3Dihub https://bmjopenquality.bmj.com/content/bmjqir/9/1/e000833.full.pdf The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Sore Throat Test and Treat Sore Throat Test and Treat service expands on standard CAS sore throat service (symptomatic treatment) to allow for additional provision of antibiotic treatment via PGD where clinically appropriate Children and adults 6 years and over Only in Community pharmacies with a Pharmacist who has undergone STTT training The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Decision Making FeverPAIN Do not offer Point of Care Test (POCT). Offer appropriate symptomatic treatment (Paracetamol or Ibuprofen) Score 0 or 1 or Self Care Advice Do not offer an antibiotic. Centor score Safety Netting 0, 1, or 2 With a NEGATIVE POCT result, advise: Antibiotic is not needed Return for re-assessment if no improvement in 3-5 days, or if symptoms worsen Need to seek medical help sooner if symptoms worsen rapidly or significantly or the person becomes very unwell FeverPAIN Offer Point of Care Test (POCT) to support clinical decision making. With a POSITIVE POCT result, advise: Score 2+ Antibiotic supply is indicated (if clinically appropriate to supply) Need to seek medical help if symptoms worsen rapidly or significantly or the person becomes very unwell or symptoms do not improve within 3-5 days of treatment or Consider antibiotic if positive POCT result. Centor score 3+ Where POCT is not undertaken, advise: Unable to determine if antibiotic is indicated or to supply antibiotic (refer to GP if appropriate) Return for re-assessment if no improvement in 3-5 days, or if symptoms worsen Need to seek medical help sooner if symptoms worsen rapidly or significantly or the person becomes very unwell. Assess and refer for red flags as appropriate

RADT use Rapid Antigen POCT, Minimum 96% Sensitivity and Specificity for Streptococcus A Not used for all consultations- only as an aid to diagnosis Not all patients will require (STTT not a swabbing service) +ve POCT not indication for Abx The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Role in AMS the (POCT) delivery model has advantages over pathways (in Community Pharmacy) in which POCT is not routinely used. POCT in addition to clinical scoring tools may play a role in antimicrobial stewardship, by reducing the number of antibiotics prescribed for sore throat symptoms * Reduction in use of Abx using POCT vs using FeverPAIN/Centor scoring alone -56% of those eligible on scoring not offered following negative POCT *RT Journal Article Mantzourani, Efi,Cannings-John, Rebecca, Evans, Andrew, Ahmed, Haroon; To swab or not to swab? Using point-of-care tests to detect Group A Streptococcus infections as part of a Sore Throat Test and Treat service in community pharmacy. Journal of Antimicrobial Chemotherapy, 2022 DO 10.1093/jac/dkab470 , VOL 77 IS 3, SP 803, OP 806, SN 0305-7453 The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Formulary Ibuprofen/Paracetamol only NICE approved treatments for symptomatic relief (e.g. no difflam) Phenoxymethylpenicillin Where indicated, following discussion of risk/benefit with patient Clarithromycin Erythromycin recently amended to include amoxicillin if other options unavailable The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Communication with GP Welsh GPs notified electronically via Choose Pharmacy Referral letters printed locally agreed mechanisms based on urgency as per existing arrangements CPs should inform GP practices of availability (or lack thereof) The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Key points - Is a Sore Throat Triage service with appropriate onward referral if required Additional to CAS, where there is availability of a trained pharmacist May not be instant access, even where a trained pharmacist is present The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Key Points Not a swabbing service only swabbed (POCT) if patient history suggests possible Strep A Not all +ve POCT recieve antibiotics discussion of risk/benefit with patient, Antibiotics typically only reduce symptom duration by 16 hours (NICE CKS) Advice on self care and safety netting provided The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Any Questions? The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

The Community Pharmacy Independent Prescribing Service The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Independent Prescribing Service Service allows the provision of a National extended minor illness service and/or national contraception service (and other local LHB commissioned services) for qualified IP pharmacists Service spec allows a range of conditions, however prescribers are expected to deliver within their scope of competence. Initially range of conditions will be narrow, with increase as prescriber expands knowledge and scope Communication of treatable conditions key, as will change pharmacy to pharmacy More info on IP FAQ https://cpwales.org.uk/wp- content/uploads/2023/04/IP-FAQ-1.pdf The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Independent Prescribing Service Now over 12k consultations per month, from 178 pharmacies across Wales 96% Would otherwise have seen a GP Patient Action if IPS Not Available - April 2024 Called GP, OOH, 202, 2% The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Any Questions? The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

CAS-UTI Service The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

What is the CAS-UTI service Extension of the common ailment service Pharmacists need to complete additional training to offer Not available universally initially NHS 111 Wales Pharmacy Services Directory will list providers Cluster and practice collaborative working arrangements can support local implementation and Referral pathways The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Who can be referred to CAS-UTI Service Refer to pharmacy Offer GP appointment Female aged 16 to 64 years (inclusive) If the patient: is pregnant or may be pregnant. Has other medical conditions that could indicate more complicated infection (e.g. kidney disease, uncontrolled diabetes, immunosuppression) Has symptoms indicative of more complicated infection (fever, rigors, backpain, nausea) Has a catheter Is resident in a care home has recurrent UTIs (one or more UTIs in the last 6 months or two or more UTIs in the last 12 months). Exclusion Criteria Females aged 15 or under Females aged 65 or over Male patients Please note: the terms male/man/men and/or female/woman/women are in reference to the sex assigned at birth The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Service description Pharmacists providing the CAS-UTI service will clinically assess patients presenting for treatment, following current NICE guidance set out in the Common Ailment Service UTI formulary monograph Patients may be offered urinalysis as part of the clinical assessment to support appropriate diagnosis and management of the patient. Patients will be offered self-care advice and where appropriate, The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Possible Consultation outcomes Referral to suitable prescriber (GP/ANP/Community Pharmacist etc) where symptoms indicative of more complicated infection or other condition Make recommendations for pain-relief (and make a supply where needed) Supply of Antibiotics (Trimethoprim/Nitrofurantoin) under PGD as immediate or back up supply Advise patients with a UTI and haematuria (visible or detected on urinalysis) to have a follow up urinalysis in six weeks The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Communication and referral As for all CAS consultations, pharmacists will provide the GP practice with an electronic summary of the consultation, this will include urinalysis results (where this has been undertaken) and any follow-up advice provided to the patient. Patients requiring urgent referral (within 48hours of the pharmacy consultation) will be given a printed referral letter to take with them, this will also be summarised on the GP electronic consultation summary. Patients who are referred to the pharmacy service but are not eligible to access will be referred back to the GP practice. locally agreed referral processes (such as the unable to treat form) should be used to support the onward referral. The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Local Referral Pathways - PIPS and CAS-UTI Not all pharmacies will offer UTI, either under CAS or IP service, but there will be a mix of provision across clusters CAS Collaboratives and clusters should consider how to gather and communicate this information (considering service availability tool on prescribing.wales portal/NECAF) PIPS GP Pharmacies offering management of UTIs under the Pharmacy Independent Prescribing Service may be able to treat an extended cohort of patients presenting with UTIs. The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Resources to support communication WG assetbank: Welsh Government Communications Services Digital Toolkit CPW - https://cpwales.org.uk/clinical-services-2/ccps/common-ailments- service/ The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Delivering the Services Clinical Record Keeping Choose Pharmacy Clinical platform available for all Welsh Pharmacies Some IPs use alternative GP linked clinical systems for IP Choose Pharmacy allows you to view Welsh GP Record Consultation shared electronically with GP (in Wales) The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru

Any Questions? The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales The Voice of Community Pharmacies in Wales Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru Llais fferyllfeydd cymunedol yng Nghymru