Digital Minor Illness Referral Service (DMIRS) pilot

Digital Minor Illness Referral Service (DMIRS) pilot

As part of the work to integrate community pharmacy into local NHS urgent care pathways, as an element of NHS England’s Pharmacy Integration Fund, a new pathway defined as the Digital Minor Illness Referral Service (DMIRS) has been tested since December 2017.

This model has been based on a referral from NHS 111, following an assessment by a call advisor, leads to the patient being transferred for a consultation with a community pharmacist instead of being booked for an urgent GP appointment or signposted to their own GP, depending on the time of day.

The service is intended to increase capacity and relieve pressure on existing urgent care services, deliver care closer to home in the community and potentially result in cash releasing savings. These aims will be achieved through:

  • Referral of significant numbers of patients to community pharmacy, therefore increasing capacity in urgent primary care locations;
  • Promoting a strong self-care message to patients;
  • Robust use of IT for referrals from NHS 111;
  • Ensuring patient safety and high levels of patient satisfaction; and
  • Academic review of the service.

All pilots are currently set to run until 31st March 2019 with the evaluation timed to inform any future commissioning for 2019/20.

What does DMIRS involve?

NHS 111 will refer appropriate patients to community pharmacies using PharmOutcomes or NHSmail; the patient will then be advised to attend the pharmacy for a consultation. A range of low acuity conditions have been selected for inclusion in the service, including the following ‘symptom groups’: rashes, constipation, diarrhoea, vaginal discharge, sore eye, mouth ulcer, failed contraception, vomiting, scabies and ear wax.

When at the pharmacy, the pharmacist conducts a face-to-face consultation using a structured approach to responding to symptoms and the patient’s Summary Care Record (if appropriate). As part of the consultation, the patient receives self-care advice on the management of the condition and relevant printed information from a reputable source, such as NICE Clinical Knowledge Summaries. If the patient requires treatment, this can be sold over the counter or supplied via a locally commissioned minor ailments scheme (if available).

A record of the consultation and any medicine that is supplied is made on PharmOutcomes and a notification is sent to the patient’s GP. If the patient has a condition or symptom which is urgent and cannot be dealt with by the pharmacist or which requires further investigation, the pharmacist will escalate the case to a more appropriate care setting, such as the patient’s general practice.

Phase one sites

The first phase of the service (initially named as the Community Pharmacy Referral Service) was launched in December 2017 and covered the geographical area of Durham, Darlington, Tees, Northumberland and Tyne and Wear.

This first pilot has shown good progress with patients consistently referred and reporting high satisfaction rates. Episodes of care are completed safely and appropriately instead of patients having to wait for a GP appointment and with the understanding that patients will be escalated to an appropriate service if necessary.

Phase two sites

Following a successful first pilot, NHS England extended the service to London, Devon (eventually Somerset) and the East Midlands in Autumn 2018.

Phase three sites

Greater Manchester LPC has secured a DMIRS pilot for Greater Manchester as part of the next wave of this national NHS England programme. The Greater Manchester version will trial a different approach, with GP practices referring suitable patients direct to pharmacies. It will be piloted in Radcliffe and pharmacies in the pilot area have been invited to express interest in participating.

Training and resources

PSNC’s minor illnesses resource hub contains links to a range of resources that can help pharmacy teams providing DMIRS.

The Centre for Pharmacy Postgraduate Education has published a dedicated gateway page for DMIRS to include resources, videos and assessments.

A training animation has been developed for NHS 111 call advisors and pharmacy teams to describe the DMIRS and to describe the patient journey through the service.

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