An innovative scheme at a south coast general practice aims to improve antimicrobial stewardship and speed up time between symptoms and treatment of winter infections.

Every patient under the age of 12 at the Brighton Health and Wellbeing Centre GP practice has received a ‘winter pack’, containing information about common winter conditions and what a parent should do when a child is unwell.

The packs also contain a bottle to be used for urine samples, and a throat swab kit.

Pharmacist partner at the practice Shilpa Patel told The Pharmacist she was confident that the scheme would save time, money, and prevent burnout among general practice staff.

‘We see a lot a UTIs [and] chest infections, where people want antibiotics,’ said Ms Patel, with many children being prescribed antibiotics during the winter months.

To diagnose whether an infection is bacterial or viral, normally a GP would have to test the patient with a throat swab.

‘And then there's such a delay, because first of all, they wait two days to get the appointment with the doctor… they do a swab test, and they wait a couple of days for the swab to come back,’ said Ms Patel.

‘And then by the time the patient is given their antibiotic, they might not even need it.’

The new ‘winter pack’ pilot equips patients with the swab in advance.

‘They will have done their swab before they come in and see the doctor. And the same with the UTIs… they'll bring in a sample before they see the doctor with their urine symptoms,’ Ms Patel told The Pharmacist.

She added: ‘All of that can be turned around so much quicker. So, at best the results could come back on the same day. At the worst, it might take two days. But that's still less than the four or five days that it's been taking so far.’

Patients don’t even need to book an appointment – they can just bring their swab into the practice and describe the child’s symptoms.

‘We are fairly sure that this is going to save loads of appointments, and just save that whole chaos of so many people coming in with their children crying and waiting in the waiting room,’ she said.

And she added that she plans to evaluate the scheme as quality improvement incentive and hopes to retrospectively claim funding for it.

The winter packs are the latest in a series of interventions by Ms Patel and her team to improve patient care and reduce pressures on GPs.

Ms Patel has been part of the practice for nine years, where she leads a team of pharmacists, who she said are ‘quite embedded’ in the multidisciplinary team there.

Faced with an increase in demand for general practice services over winter, Ms Patel started looking into how the pharmacist team could understand and help to relieve the pressure.

The team already worked on long-term conditions management, medication reviews, and ran minor illness clinics for ailments like urinary tract infections (UTIs), thrush and cystitis – ‘things that we kind of were involved with in community pharmacy’, Ms Patel said.

‘We've just brought skills over and we're just upskilling a bit and providing it at a slightly higher level than we were in community pharmacy.’

But last year, facing rising demand in the winter, the practice trained one of its pharmacists to run an ear, nose and throat (ENT) clinic.

‘Within a couple of weeks, they were booked up, seeing 40 patients a day,’ she said.

Patients accessing the practice are triaged using its online consultation system, or by the triage team. Both were taught to refer ‘anything ENT related’ to the pharmacy team’s telephone list.

The pharmacist would be able to ring patients on the same day in many cases, and the team found that ‘a lot of the queries didn't need to come in.’

Instead, they used the community pharmacy referral scheme (CPCS) to refer to the patient to a local community pharmacy where they would be able to get the treatment and advice that they needed.

If the pharmacist was not able to deal with the patient on the telephone, he invited them to come in for a same day face to face assessment in his clinic, which he ran every day, noted Ms Patel.

And while a clinical lead was always contactable and present in the same building, Ms Patel said that there was ‘hardly anyone that he had to refer to the GP’.

While there was an investment in his training and supervision, ‘within two or three weeks, he was so competent, and he's been running those clinics ever since’, said Ms Patel.

This pharmacist has also taken on the role of the practice’s antibiotics champion.

With so many patients with sore throats presenting at his clinic, ‘he's become really good at saying “no, you don't need antibiotics”,’ Ms Patel said.

And this year, the practice is working with a pharmacist who already runs an ENT clinic in community pharmacy and will come and work in the practice for one day each week.

Read how the Brighton Health and Wellbeing Centre is using a giant 'self care' advent calendar to educate patients, tackle misinformation, and relieve winter pressures on the practice.