October 2018 Blog: Digital Minor Illness Referral Scheme (DMIRS)

Introducing the Digital Minor Illness Referral Service (DMIRS)

With current financial pressures leading to decommissioning of services, it’s not every day that a new service is introduced. So it’s great news that we have the opportunity to sign up to deliver the new Digital Minor Illness Referral Service (DMIRS). The service was successfully piloted in the North East where it was known as the Community Pharmacy Referral Service (CPRS).

So, what’s it all about? The North East pilot was part of the Pharmacy Integration Fund which was set up in October 2016 to ‘drive the greater use of community pharmacy in new, integrated local care models.’ This particular element involves a new pathway whereby patients who have contacted urgent care services can be supported with managing self-limiting minor illness closer to home.

Here, in the East Midlands we are part of the second wave of the pilot. This area is one of three chosen to progress the service and develop it further to see if the model can be successfully replicated. Locally it is open to any pharmacy in the area covered by the NHS 111 service run by Derbyshire Health United. This is a very large footprint and includes 20 CCGs, 5 LPC areas, 900 pharmacies and a population of 5 million people.

So, what might we expect to happen?  If we take a look at the figures from the first pilot it’s encouraging.  Since December 2017 there have been more than 10,000 referrals and 450 out of 600 pharmacies signed up to deliver the service. There have been no serious incidents and patient satisfaction has been high.

The outcomes were:

• 38% given advice on managing their illness;
• 28% given advice and also purchased an OTC medicine;
• 17% advised to make an appointment to see their GP;
• 14% referred back to the Out of Hours (OOH) provider for further investigation
• 3% treated under a local Minor Ailments Service (MAS)

How it Works

Access to the service is through the NHS 111 service. When a patient calls the call handler will ask them a series of questions to triage them to the most appropriate support. Depending on these answers the system will suggest a referral to a community pharmacy for a low acuity condition. The call handler will tell the patient: “I’m going to arrange for you to attend your nearest community pharmacy, where you will receive expert advice, closer to home and without the wait you would experience at your GP (or OOH).”

The Directory of Services will show the call handler a list of pharmacies which provide DMIRS, starting with the closest, and the patient can choose which pharmacy they wish to attend. Once the pharmacy has been selected a PharmOutcomes referral will be made to the pharmacy. The patient will be advised to attend, in person, within so many hours (depending on the severity of the symptoms) and that this is a new NHS service where a pharmacist will see them in a private consultation room to assess and advise on their condition.

The PharmOutcomes referral will provide all of the information that the patient gave the call handler (i.e. the answers to some 27 questions!). The service is integrated with the NHS pathway clinical triage system (validated to ensure appropriate decisions are made). PharmOutcomes will send an email to the management email address alerting the pharmacy to the fact that a referral has been made.

On the first occasion a pharmacist accesses the service they will need to enrol with their GPhC number and confirm that they know how to deliver the service. Subsequently, this step will not be necessary and they will be able to go straight to the referral. The pharmacist will consult with the patient in the consultation room and have access to the PharmOutcomes service for information and data capture. Appropriate advice is given about the illness and this may or may not involve the sale of an OTC product. During the consultation the patient is advised what action to take if their condition worsens.

It is a requirement that the pharmacist checks NICE Clinical Knowledge Summaries (CKS), Fortunately, links to NICE CKS are embedded in PharmOutcomes, so everything is to hand to ensure that appropriate advice is given and any risk factors are identified. If any ‘red flags’ are picked up, or the pharmacist has concerns about the patient’s condition, then they need to use the escalation pathway, as the patient requires higher acuity care. Options are as follows:

• Pharmacist calls NHS 111 and press *7 (out of hours) to discuss the patient’s condition;
• Pharmacist supports patient with getting an appointment with their own GP (in hours);
• Call 999 if more urgent.

Sign up to the service is through the NHS Business Services Authority website. Once this has been done the NHS England contracting team will send out a launch pack to confirm registration. Further work will then be done with Directory of Service (DoS) Leads, DHU testing with the pharmacy, followed by DoS ‘go live’ and then the pharmacy will receive an email informing them that DMIRS is active.

Why should you sign up? Importantly, you will be helping to build the evidence base for integrating community pharmacy into urgent care pathways and getting patients used to seeing a pharmacist about everyday minor illness. This is also a great opportunity to support patients, receive a £14 fee for each consultation and it will only take around 10 minutes for an average consultation.  In the North East 75% of pharmacies signed up, so we need at least 160 pharmacies in Derbyshire to do the same. Just use the NHS BSA hyperlink and you will be on your way.