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, NHS England has used its Pharmacy Integration Fund to support the development of a new pathway, described as the Digital Minor Illness Referral Service (DMIRS). This new model has been tested since December 2017 and it involves a digital referral to a community pharmacy from NHS 111, following an assessment by a call advisor. The patient is given the option of a consultation with a community pharmacist instead of being booked for an urgent GP out-of-hours service appointment or being 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. It is envisaged that 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
- Detailed review of the service.
After an initial pilot in the north east, three further pilot sites were selected; all four pilots are currently set to run until the end of June 2019 with the evaluation timed to inform any future commissioning for 2019/20.
At the end of January 2019, NHS England published a five-year framework for GP services agreed with the British Medical Association (BMA) General Practitioners Committee (GPC) in England and supported by Government. Within this document, NHS England stated that the Digital Minor Illness Referral Service has shown that many patients who would normally be advised to attend general practice can be successfully diverted to community pharmacies.
NHS England committed to exploring how DMIRS could be rolled out nationwide as rapidly as possible, as part of negotiations led by the Department of Health and Social Care with PSNC on the Community Pharmacy Contractual Framework. These potential changes, if implemented, will have an impact in helping to reduce in-hours and out-of-hours workload for GPs. In parallel, NHS England will also test models of redirecting patients who present in general practice to community pharmacy, described in the NHS Long Term Plan as a ‘pharmacy connection scheme’.
What does DMIRS involve?
NHS 111 refer appropriate patients to community pharmacies using NHSmail or other systems such as PharmOutcomes; the patient is 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 service (if available).
A record of the consultation and any medicine that is supplied is made 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 site
The first phase of the service (initially called 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 showed good progress, with patients consistently referred by NHS 111 and reporting high satisfaction rates. Episodes of care were 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 - general practice referrals
Greater Manchester LPC has secured a DMIRS pilot for Greater Manchester as part of the next wave of this 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.
Three GP DMIRs pilot sites have also been commissioned in Cheshire and Merseyside (C&M), with two sites in the Merseyside area, Newton/Haydock and Runcorn plus one in Cheshire, Helsby/Frodsham. The C&M LPCs are working closely with NHS England and anticipate the first pilot site Newton/Haydock will go live in June 2019.
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.