The Minor Ailments Scheme (MAS) pilot in Bradford

1. Minor Ailments Scheme
Presentation to GPs & Practice Managers
Noshi Iqbal
Primary Care Pharmacist

2. What is the Minor Ailment
Scheme (MAS)?
Patients suffering from a minor ailment visit
their local pharmacy rather than the GP
surgery
Bradford has a higher than average consultation
rate for minor illness compared with the national picture.
The reasons for this are multifactorial but inner city
Deprivation and low income are key contributors

3. Aims of the Scheme
• Reduce GP Workload by transferring
consultations for minor ailments from the surgery
to the pharmacy
• Increase patient access – helping to fulfil
Government target max wait of 24 hr to see
primary care professional & 48 hr to see GP
• Development of the role of the pharmacist as
part of the primary care team
• Gradually change patient culture to pharmacy
first for minor ailments

4. Patient inclusion criteria
• Only for patients who are exempt from
prescription charges
• Patients can refuse to go onto the service
• Patients who pay for their prescriptions
should be referred to a pharmacy to
purchase medicines in the usual way

5. Community Pharmacy criteria
• Service can only be provided by a qualified
pharmacist who has completed a Minor Ailment
Scheme training package
• Service can only be provided by pharmacies
whose staffing level is sufficiently adequate to
enable pharmacists to do so safely
• Only a selected list of OTC medicines can be
supplied by the pharmacist (in practice guide)
The tPCT will pay the cost of medicines & £3 to the pharmacist
which includes fees for the intervention and administration
of the scheme

6. Minor ailments included
• Cough • Constipation
• Sore throat • Muscular back pain
• Headache / earache / • Soft tissue injury
temperature • Athlete’s foot
• Hay fever • Vaginal thrush
• Head lice • Contact dermatitis
• Indigestion / heart • Teething
burn / tummy upset
• Diarrhoea

7. Limitations
Currently (to cash limit scheme):
• Each Surgery has max 50 patients that can be
referred
• Each patient referred can have a max of 6
pharmacy consultations
• Referral document valid for 6 months from issue
• If a patient is re-issued with another referral after
6 months this patient will be counted as another
patient out of the 50 allocation

8. Referral back to the GP by the
pharmacist
• If the patient does not meet the MAS criteria (patients
will be asked to make a routine appointment unless
urgent)
• If a patient presents more frequently with the same
symptoms than the max stated in the protocol for that
minor ailment (e.g. more than 1 request for indigestion
remedies in a month)
• If the ailment falls outside the remit of the scheme and a
counter sale is inappropriate
• If a pharmacist suspects a patient is abusing the service
the GP & pharmaceutical advisor need to be informed;
the patient may be barred from the service

9. Rapid referral procedure
• If the patient presents to the Pharmacy with
symptoms indicating need to be seen by GP, the
pharmacist will ring & make an appointment for
the patient
• If GPs have second ‘bypass’ telephone numbers
then the community pharmacy should be
informed of these in order to allow rapid
communication
• Out of hours, depending on the nature of the
symptoms the patient will be advised to contact
the on-call doctor or attend A&E

10. What happens at the Surgery
• Patients presenting to the surgery with ‘minor
ailments’ will be advised of the service by the
GP & issued with patient leaflet on the MAS &
conditions covered
• If patient agrees to be registered on to the
service GP will issue a registration form to take
to a participating pharmacy of their choice (list at
the bottom of referral form)
• Registration form is a template on Systm1 which
will automatically read code patient involvement
onto the scheme (‘referred to pharmacy
service’ – can be used to generate a report on
how many patients registered on the scheme)

11. • For patients under the age of 16 the parent /
guardian can accept transfer into MAS on their behalf
• The surgery will co-operate & liaise with local
pharmacists to activate the rapid referral procedure
when required
• If a patient refuses to transfer into MAS they will be
treated as normal NHS patients and refusal will be
entered into patient record
• If GP wishes to put limitations onto MAS for individual
patients, these can be written on referral form
• There is option on template for GP to tick to be
informed of all consultations of his patients at the
Pharmacy – the pharmacist will fax a copy of the
pharmacy form outlining consultation & any supplies
of medication made

12. Clinical responsibility
The pharmacist will be clinically responsible
for any advice or treatments that he / she
provides as part of this service

13. What happens at the Pharmacy
• On the first visit to the Pharmacy, the patient
presents his / her referral form and is accepted
into the service; for subsequent presentations
the patient only needs to attend the pharmacy
• The pharmacist interviews the patient (or
guardian) and:
- provides healthcare advice about the treatment
of the minor ailment
- supplies medication from a set formulary for
the treatment of the ailment free of charge
(similar to doing a Rx)
- refers the patient to GP if the ailment falls
outside the remit of the scheme

14. • At each consultation at the Pharmacy the patient
signs a receipt & declaration of exemption form
– the ‘pharmacy form’
• This form includes details of any medication
supplied (along with labels), and is kept in the
Pharmacy for audit purposes; it can be faxed to
the GP if requested after the consultation
• The following will be recorded onto the PMR:
- the presenting symptoms
- any supplies of medication
- any advice given

15. Monitoring & evaluation
• Participating pharmacies & surgeries will be expected to
participate in monitoring & evaluation to show:
- changes to GP prescribing data both by cost and
volume
- cost & volume of pharmacy prescribing
- impact on GP appointments & time
- evaluation of joint working between pharmacies & GP
surgeries
• Attitudinal surveys will also be carried out among:
- GPs
- receptionists
- pharmacists
- patients

16. Summary of the Bradford MAS
Registration card & info Patient presents
Patient presents to GP
leaflet issued to patient registration card at a
with minor ailment
by the GP participating pharmacy,
pharmacist ensures
Patient attends pharmacy patient entered on
With minor ailment Pharmacist pharmacy PMR
interviews
Patient fulfils criteria patient
Pharmacist considers
for a minor ailment rapid referral to GP or
out of hours service
Pharmacist gives advice Patient does not
to patient & supplies fulfil criteria
treatment if appropriate for MAS
Pharmacist makes entry
on PMR & produces labels Patient exits scheme,
for use on MAS form Pharmacist deals with
Patient as normal
Pharmacist fills out MAS form, obtains patient At end of month pharmacist
signature confirming exemption from fills out electronic invoice form
Rx charges. Form kept by pharmacist on tPCT website

17. How to refer patients onto the scheme
• The ‘tree’ in Systm1 needs to be amended to include
‘Pharmacy Minor Ailments’
To refer a patient
• Access the patient record in the usual way
• Left click on the ‘Pharmacy Minor Ailments’ template on the
tree
• Left click on the icon at the top left of the ‘journal view’ screen
• Left click to check the referral box at the top of the screen (e.g.
for limitations)
• Ensure plain sheet of paper is in the printer
• Press the print button at the bottom of the screen
• Sign & date the referral in the space provided towards the top
of the form
• Print a blank normal prescription with the right hand side
listing the patients current repeat medication
• Hand the referral form & the repeat medication list to the
patient & ask patient to take this to one of the participating
pharmacies

18. References
• Bradford City tPCT ‘Pharmacy Treatment
of Minor Ailments Scheme’ Practice Guide
April 2006.