Evaluation of NHS Direct ‘‘referral’’ to community pharmacists

OBJECTIVES: To evaluate a pilot scheme of referrals from a nurse-led telephone helpline (NHS Direct) to community pharmacists.

METHODS: A multi-method approach, including analysis of routine data from NHS Direct, postal surveys of NHS Direct callers, analysis of anonymised transcripts of calls, a postal survey of callers referred to pharmacists, and face-to-face interviews with NHS Direct nurses.

SETTING: Essex, Barking and Havering.

KEY FINDINGS: During the first three months of the pilot scheme, 6% (1,995/31,674) of NHS Direct calls triaged by nurses were logged as referred to pharmacists. This built on an existing foundation of informal referral to pharmacists of 4%. There was no measurable change in callers’ views of the helpfulness of advice, enablement, or caller satisfaction associated with the scheme. Conditions sent to pharmacists included skin rash, cough, sore throat, stomach pain, and vomiting and/or diarrhoea. 86% (54/63) of callers referred to pharmacists during the scheme felt the referral was very or quite appropriate and 75% (48/64) attempted to contact a pharmacist. In general, those who did so found the experience a positive one: 65% (31/48) spoke to the pharmacist, and 80% (28/35) of people expressing an opinion were satisfied with the advice offered, but the lack of privacy in the pharmacy was of some concern. Although routine data indicated high usage of the scheme, nurse referral of callers to pharmacists declined over time. Their initial enthusiasm diminished due to concerns about the appropriateness of guidelines, their lack of understanding of the rationale behind some referrals, and the lack of feedback about the appropriateness of their referrals.

CONCLUSIONS: The evaluation of the pilot scheme has generated a range of recommendations for the wider national roll-out of the scheme, including revision of the guidelines and review of NHS Direct nurse training for referral to pharmacy. NHS Direct and pharmacists should consider how to strengthen the system of pharmacist feedback to NHS Direct.