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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 1 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 4 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 …………………. 5 6