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Same-day pharmacy consultations could ease pressure on GP surgeries

Pharmacists will initially see minor conditions, such as earache or sore throats.

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Patients will be referred to their local pharmacist by GPs, A&E and NHS 111.

Up to 6% of all GP consultations could instead be addressed at a patients’ local pharmacy as part of a new deal outlined by the Health and Social Care Secretary.

Patients calling NHS 111 about minor conditions, such as earache or sore throat, will be offered an appointment with the new NHS Community Pharmacist Consultation Service.

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Over the next 5 years, patients will also be referred to the service from GPs and A&E – patients will still have an option to decline the referral.

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, explained, “Introducing a greater variety of roles into the general practice team and making the best possible use of primary care professionals in the community is key to helping relieve the intense resource and workforce pressures facing GPs, and ultimately ensuring our patients get the care they need when they need it.”

Expanding the community pharmacy role.

Focusing on prevention, urgent care and medicine safety, the framework gives £13 billion to expand the community pharmacy role, while supporting the new services being introduced over the 5-year contract.

Pharmacists will be able to offer patients recently discharged from hospital more advice and support, including helping with repeat prescriptions without having to return to the GP.

“Pharmacists are highly-trained healthcare professionals who already advise patients with a host of minor illnesses that don’t necessarily need the input of a GP, recommend suitable over-the-counter medication and self-care treatments, and play an important role in medication management on a daily basis,” Professor Stokes-Lampard stated. “In doing so, they are vital to delivering patient care in the community and alleviating pressures in general practice.”

‘Not a substitutes for GPs’.

The government has also highlighted other areas in which the community pharmacy role could be expanded over the next 5 years.

These include; spotting the early signs of sepsis, annual diabetic foot and eye assessments, and identify the warning signs of suicide.

“However, whilst this new scheme is welcome,” Professor Stokes-Lampard warns, “it is not a silver bullet to addressing the pressures in primary care. Pharmacists – or any other primary care professional – must not be seen as substitutes for GPs, so efforts to recruit more family doctors, retain the existing GP workforce, and make it easier to return to practice after a career break or period working abroad must continue and be redoubled.”

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Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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