Download Chest X-ray referral service – briefing doc August 2015

Community Pharmacy Briefing - Direct Access to Chest X-ray Pilot v20
The CCG is working with a range of partners on a 12 month pilot to evaluate whether the
introduction of direct access to chest x-ray by community pharmacists increases early detection
of symptomatic lung cancer presented as non-emergency, in the Doncaster area.
The Primary objective: The hypothesis is that through community pharmacy detection of
symptomatic lung cancer will be detected earlier and patients will therefore not present at
accident and emergency with advanced lung cancer.
The Secondary objective: to diagnose previously undetected lung abnormalities other than
cancer.
ELIGIBILITY CRITERIA
40+ smokers or ex-smokers and who have one of the following symptoms not explained by
obvious causes such as current lower respiratory tract infection, know heart failure or known
cancer etc.
All patients presenting at the community pharmacy who answer yes to one of the following
questions:
 Cough for three weeks or more
 Fatigue
 Shortness of breath
 Chest pain
 Weight loss
 Appetite loss
 Coughing up blood (haemoptysis)
 Persistent or recurrent chest infections
They will be eligible for further assessment by the community pharmacist.
Community Pharmacist Training
All participating pharmacists will have
(i)
skills around ‘sensitively sharing information’
(ii)
reviewed the lung cancer awareness training slides from January 2015
(iii)
training on the signs and symptoms for referral which will include - respiratory chest
symptoms from the Local Lung Cancer MDT lead from DBHFT in July 2015
(iv)
attended IRMER training, Understanding the Implications of Ionising Radiation
provided by DBHFT
Listed below are:



the pathway
a list of participating pharmacies and practices
the notification form GP’s will receive from pharmacies when they refer a patient for CXR
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Pathway stage
1. Community Health
promotion
Be clear on Cancer Lung Cancer 2014
DMBC Public Health Lung Cancer 2014
CCG/Doncaster Rovers, Pharmacies in house promotion and
awareness training on signs and symptoms January 2015
2. Pharmacy Counter
staff
Counter staff identification – All patients presenting at the community
pharmacy for cough medications, nicotine replacement therapy, pain
killers, nutritional supplements; collecting prescriptions for respiratory
medications such as inhalers; asking advice on smoking cessation or
respiratory conditions
40+ smoker or ex-smoker and who have one of the following
symptoms not explained by obvious causes such as current lower
respiratory tract infection, known heart failure or known cancer etc.
Who answer yes to one of the following questions:
Have you had any of the following symptoms:
 Cough for three weeks or more
 fatigue
 shortness of breath
 chest pain
 weight loss
 appetite loss
 coughing up blood ( haemoptysis)
 persistent or recurrent chest infections
Refer to Pharmacist if patient has any one of the symptoms above.
3. Pharmacist
From either:
- Counter staff (2)
- Meds use review
- Inhaler review
- Smoking cessation
- Other 1 to 1
Confidential consultation
Pharmacist questions to be asked:
40+ smoker or ex-smoker and who have one of the following
symptoms not explained by obvious causes such as current lower
respiratory tract infection, known heart failure or known cancer etc.








Cough for three weeks or more
Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss
Coughing up blood (haemoptysis)
Persistent or recurrent chest infections
A chest x ray/ GP referral for a chest x-ray will be requested by the
community pharmacist.
Discuss:
 Pathway below if any one of the above symptoms
or
 Information/advice
 Smoking cessation
2


Inhaler technique review
OTC product
Pharmacists to confirm which GP practice patient is registered
with …
Pathway A
Explain to patient what will happen
Screening if patient safe for x-ray (IRMER)
Pharmacists will advise patient to see their GP if they have had a
CXR within 1 month.
Complete DA Referral form for chest x-ray
Complete notification form for GP – copy to GP, copy to patient
Record on Pharm Outcomes
Patient takes form and has x-ray
Pathway B
Advise patient to see their GP
Complete notification form for GP – copy to GP, copy to patient
Record on Pharm Outcomes
Patient visits GP
Pathway C
If patient is registered with a practice which does not appear on the
list, pharmacists will verbally advise the patient to see their GP and
record on Pharm Outcomes. (Do not complete notification form).
4. CXR
Timeframe – the x-ray will be reported as ‘Urgent’
The report will automatically go to the patients GP practice and a
copy will go to the pharmacist
There will be a code to show that the patient was referred by a
pharmacist.
5. Follow up
Any suspicious CXR results will be picked up by the chest physicians
as per standard care.
A copy of the CXR result will be sent to community pharmacist and
GP. The community pharmacist will NOT be responsible for following
up any abnormal CXRs the GP and chest physician will.
The referring community pharmacist will contact the patient one
week after the referral and ask the Friends and family test question.
“How likely are you to recommend this service to family and friends if
they needed similar care or treatment?”
Any additional comments made can also be captured in the blank
text box.
6 month follow-up will be undertaken by Doncaster CCG
performance team.
COMMUNITY PHARMACIES and GP PRACTICES
3
Pharmacy
Sharp, D & R
(Chemists) Ltd
Sharp, D & R
(Chemists) Ltd
Weldrick's
Pharmacy
McGill, J M Ltd
Lloyds
Pharmacy Ltd
Eightlands
Pharmacy TA
Pharmacy M
Weldrick's
Pharmacy
Chestnut
Carcraft Ltd
T/A Chestnut
Pharmacy
Ann Raine
Weldricks
Area
Coliseum
Buildings
21 St David's
Drive
Amersall Road
Bentley
Locality Proposed GP practice coverage
North
West
Scawsby
Scawthorpe
125-127 Wath
Road
24 High Street
Mexborough
The New
Surgery, Adwick
Road
14 High Street
Mexborough
Carcroft Health
Centre
Carcroft
54 Brecks Lane,
Doncaster DN3
1JR
Kirk Sandall
South
West
Mexborough
Carcroft
Pathway
List Size
Bentley Surgery (C86023)
Scawsby Health centre (C86032)
Petersgate Medical centre
(C86038)
The Nelson Practice (C86613)
A
A
A
7228
5905
8723
A
3938
Mexborough Health Centre
(C86005)
The New Surgery (C86034)
The Mexborough medical
practice (C86605)
B
5883
A
A
6837
8643
North
West
Carcroft Dr’s group (C86001)
A
10,699
Central
Kingthorne (Branch)
A
9907
Maximum potential population
reach
67,763
Pharmacy to GP
Lung symptoms
FOR INFORMATION - NO ACTION REQUIRED AT THIS TIME
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Pharmacist details:
Patient’s Details:
Name:
NHS No:
GP Practice:
Address:
Name:
Address:
Tel No:
Fax No:
Tel No:
Date of
notification:
DOB:
Male / Female (Circle)
Ethnicity:
Presenting symptoms
Tick if criteria
applies
Age (40+)
Smoker?
Ex smoker?
Tick if criteria
applies
Order urgent CXR
All 40+ smokers or ex-smoker who have one of the following symptoms not explained by obvious
causes such as current lower respiratory tract infection, known heart failure or known cancer etc.
Cough
Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss
Blood when coughing (Haemoptysis)
Persistent or recurrent chest infections
Chest x ray form completed, given to patient and copy for GP with this referral form
I have advised this patient to arrange an appointment with your practice
Pharmacist signature …………………………………………………
Date ……………………………………
Branch Code ………………….
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