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Pharmacists to treat sore throats 'to free up GPs and cut antibiotic use'

Patients with sore throats will be directed to pharmacists for testing and treatment, under a new scheme being rolled out across England that NHS chiefs claim will help save GP appointments and cut use of antibiotics.

Under the scheme, pharmacists will use a risk score to assess patients’ symptoms, carry out throat swab tests and provide antibiotic treatment if a bacterial infection is detected.

The Government’s chief pharmacy advisor said the scheme will cut down on use of antibiotics and reduce pressure on GPs.

But the GPC questioned why a national scheme was being set up on the back of ‘one small pilot’, and warned it could even increase the unnecessary use of antibiotics.

The scheme – called Sore Throat Test and Treat – was piloted at 35 Boots pharmacies in England in 2014/15. Trained staff used the Centor scoring system to assess patients, offering a throat swab test for Strep A to those with a score of three or more. Patients with a positive test were offered antibiotics.

A study of the pilot over six months claimed it dealt with two-thirds of patients who would have otherwise gone to their GP – suggesting it could save some 800,000 of the 1.2 million GP visits that are for sore throats each year.

Dr Keith Ridge, chief pharmaceutical officer for England, said: ‘This is a good example of how the NHS wants to make the most of pharmacists clinical skills.

‘It will help avoid unnecessary use of antibiotics whilst reducing the pressure on busy GPs.’

But Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, said he ‘would be reluctant to roll-out nationally a service based on the results of one small study’.

He added: ‘Proving that a patient with a sore throat has streptococci present is very different from proving that they need treatment, and with antibiotics making no difference at day three to the majority of patients.’

Dr Green said: ‘Community pharmacists are more appropriate for initial care than GPs, but for most cases they should provide self-care advice rather than validate intervention with testing and possible unnecessary treatment.

‘If this scheme encourages those who would otherwise self-care to attend and be tested, there is a very real risk that the numbers of antibiotic prescriptions will increase rather than decrease, especially if pharmacies receive an item of service payment encouraging intervention.’

A number of GPs also questioned the plans on social media.

Dr Dean Eggitt, Doncaster LMC medical secretary and a GPC member, said on Twitter: 'With pharmacies enduring 12% funding cuts, now is not a good time to introduce more work.'

Former RCGP chair Professor Clare Gerada said: 'Most bacterial infections don't need antibiotics, so what's [the] point.'

NHS England is announcing the national scheme today alongside seven other medical innovations it plans to introduce into the NHS over the next year. The others include a self-management tool for patients with epilepsy, a new automatic hospital appointment booking scheme and web programme to improve end-of-life care planning.

What is the ‘Sore Throat Test and Treat’ scheme?

The Sore Throat Test and Treat scheme that NHS England plans to roll out across England directs patients with sore throats to pharmacists instead of the GP.

Under the scheme, patients are assessed by trained pharmacy staff using the Centor scoring system. Patients meeting three or all four of the Centor criteria are then offered a throat swab test for group A streptococci; those positive for strep A are then offered antibiotic treatment – penicillin V or clarithromycin – under a Patient Group Direction.

Boots funded a pilot of the scheme at 35 of its pharmacies in London and Leicestershire, with patients charged £7.50 for the throat swab test and a further £10 for a course of antibiotics.

Results from a six-month period showed that 367 people accessed the service out of a total of 2,087 that enquired about it.

Of these 367:

- over half self-referred, just under half were recommended by the pharmacy itself and 1% were signposted by a GP

- 149 (40%) were eligible for the throat swab test;

- 36 (24%) of these were positive for strep A - all of whom accepted the antibiotic treatment

 

Of 222 people with available info on their usual course of action:

- 98 (44%) said they would have self-treated

- 97 (44%) would have gone to the GP – just under a third (31) of whom still had to be referred to their GP, for example because of symptoms of more serious infection, unilateral symptoms, difficulty swallowing saliva or significant voice change.

Source: J Antimicrob Chemother 2016; 71: 3293–3299

Readers' comments (11)

  • Whilst only 8% of the population pay for their prescriptions,this will only make a difference to GP appointments if OTC preparations are subsidised or free of charge

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  • thought NICE said do not do throat swabs these days unless atypical symptoms??

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  • As far as I am aware, pharmacists have no formal training in diagnosis. Furthermore, declining antibiotics is actually a difficult part of our job, requiring good communications skills. Not sure pharmacists do communication skills training either.
    Can anyone clarify what my MBBS qualifies me to do that a pharmacist can't? I am wondering why I went to medical school.

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  • This is a scheme already used in US. The difference being that patients pay $30 for the test. If positive the cost then includes antibiotics. Therefore there is an incentive for patients to only present if they really suspect they have a bacterial infection otherwise they have wasted $30.
    If patients can just walk in have a test with no consequence then the scheme will offer no savings.
    This is a good idea but only in a setting where there is a consequence of using it when you don't need it. That is the whole issue that's wrong with the NHS.

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  • I agree that this is not a very good idea and is probably not needed.

    Anonymous | Sessional/Locum GP 14 Nov 2016 1:18pm
    The Centor scoring system that pharmacists used was actually very simple. So diagnostic skills weren't really needed.
    As for consultation skills, we carry out many more consultations than you, albeit in a less formal setting. On many occasions I've been told of awful consultations with GP's, who although are undoubtedly intelligent, don't possess people skills or are condescending.

    Good and bad in both professions I'm afraid.

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  • Isn't this just encouraging people to seek treatment for self limiting illness. Exactly the opposite of self care. Most of the OTC treatments in a pharmacy for minor ailments are snake oils that any self respecting GP would refuse to prescribe. They are cheaper at your local pound land anyway.
    I thought the evidence was that early treatment with antibiotics in tonsillitis makes very little difference to the length and severity of illness and may encourage reinfection and re-attendence? With 100% of those who were shown to have group A strep accepting treatment well of course they would if they didn't want antibiotics they wouldn't have bothered with the swab. Also they sent 1/3 of patients on the GP anyway I hope that does not include patients with a peritonsillar abscess!!
    If you're going to charge £20 a pop for these consultations I will quite happily become a sore throat GPSI and switch my brain off.

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  • Is this something which NICE has said is worthwhile and cost-effective?

    If not, is it a purely political initiative for purely political motives?

    ps - knocking pharmacists doesn't help; we're all professionals in it together, don't allow DH/politicians to use divide-and-rule tactics.

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  • Stop whinging. Anything to reduce my contact with trivia is a good idea.

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  • It's nice to have a few quick sore throats as catch up appointments. The slots will only get filled by more complicated chronic patients, making me more busy not less

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  • So only 17.6% of those who enquired paid to access the scheme. Only £7.50 but deemed too much for the 82.6% majority. Wonder how much access to a GP is worth? Northern Ireland could be the test bed. Amazing how parting with cash changes people.

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