Digital Minor Illness Referral Service (DMIRS) training animation


Hello and welcome to this video explaining
an exciting service, which refers patients directly in to Community Pharmacies from NHS
111. This is known as the Digital Minor Illness Referral Service or DMIRS. This video is specifically
for those people working within NHS 111. This brief video will explain more about this
service. If you have any further questions, please speak to your DMIRS contact (for example
NHS 111 supervisor or Pharmacist within your contact centre).
So what is the Digital Minor Illness Referral Service?
Currently, less than 1% of all NHS 111 calls result in a referral to a community pharmacy.
Calls are normally directed to other services such as GPs (in hours and out of hours), walk-in
centres and sometimes A&E. This blocks access to GP appointments for patients with greater
clinical need. This Digital Minor Illness Referral Service
aims to reduce the burden on urgent and emergency care services by referring patients with minor
conditions away from these overstretched services towards less pressured more cost effective
services, in this case community pharmacy. This service was first developed in the North
East region which covers 616 community pharmacies and a population of around 2.6 million people.
The service was assessed and found to be clinically safe, effective for referrals from NHS 111
and valued by patients. It is now being introduced in additional geographical areas, such as
yours. Pharmacies are being encouraged to sign up
to deliver the service with the aim of ensuring that patients have better access to care,
closer to home and an increased understanding of how to manage and treat their own health.
We want you to understand how the service works, so that you feel confident in referring
patients in to the service. Only patients who have called NHS111 and been
referred are eligible for this service. Suitable patients are assessed using NHS Pathways
and referred by NHS 111 to a pharmacy for a private consultation with a pharmacist , advice
and treatment, making better use of the substantial skills and knowledge within community pharmacy.
A patient should be referred on to a DMIRS pharmacy where one is presented at the top
of the Directory of Services (DoS) list. You should always offer the service at the
top of the list first, then to move down the list of services presented if patient choice
indicates another preference. When you select the DMIRS service on DoS a
referral is sent electronically to the pharmacy using ITK electronic messaging via the pharmacy
IT platform, or NHS Mail in the event of an ITK failure. This is the same way that you
would send an electronic referral to a GP. Please make sure you read the service referral
instructions listed on the DoS entry. Advise the patient that the pharmacy will
be expecting them and they should attend within the period indicated by disposition timeframe.
Assure the patient that this is a new NHS service, so the pharmacist will see them in
a private consultation room where their condition will be assessed and they will be given advice
about their symptoms and may also be supplied with a medicine. Advise the patient that when they arrive they
should let the pharmacist know that 111 sent them. Let them know that telling the Pharmacist
that they rang 111 means the Pharmacist will be able to know how to help them more easily. Patients under 2 years of age are NOT routinely
eligible for this service. If any under 2 years of age attend the pharmacy, the pharmacist
will however support the patient and carer with advice and ensure appropriate referral
to other services as necessary. When the patient arrives at the pharmacy the
Pharmacist will check their IT platform for an electronic referral from NHS 111.
If no electronic referral/email has been received, the pharmacist will contact NHS 111 to confirm
whether a referral has been made and, where appropriate, to confirm the patient’s NHS
number and GP details and to request that the electronic referral/email is resent. To
do this the pharmacist will ring NHS 111 to ask for a shift manager to resend the referral. Pharmacists are experts in medicines, and
can use their clinical expertise, together with their practical knowledge, to advise
patients on minor health concerns. The pharmacist will conduct a face-to-face
consultation in the pharmacy consultation room using their IT platform. The pharmacist
will assess the patient’s condition using a structured approach, responding to symptoms
and using Summary Care Record where appropriate. The Pharmacist will refer to NICE clinical
knowledge summaries to access clinical information as and when they need it.
For every consultation the pharmacist will close with the statement: “IF YOUR SYMPTOMS DO NOT IMPROVE OR BECOME
WORSE, THEN EITHER COME BACK TO SEE ME OR SEEK ADVICE FROM YOUR GP” An electronic message is sent to the patient’s
GP with a summary of the consultation. Every patient who accesses the service will
be provided with verbal advice, and printed information relevant to their condition if
required. This includes self-care messages, expected symptoms, the probable duration of
symptoms, and when and where to go for further advice/ treatment if needed. Effort is made to ensure the patient understands
the advice provided or is referred onwards if necessary. Patients are also informed that pharmacy is
an ideal first port of call for many minor conditions. There will be times when the pharmacist will
need additional advice or will need to escalate the patient to another care location. The pharmacist may refer the patient for an
urgent in-hours appointment with their GP, or call the NHS111 service or local IUC Clinical
Assessment Service when the patient’s own GP is not available. If the patient presents
after referral from NHS 111 with severe symptoms indicating the need for an immediate consultation,
the pharmacist will refer the patient to attend A & E immediately or indeed call an ambulance. DMIRS information is captured and monitored,
so that the value of the service can be demonstrated. This information includes referral data captured
from NHS 111, such as when DMIRS is being selected or rejected on DoS. It also includes
information recorded by the Pharmacists in their IT platforms –- and patient feedback
collected via an easy-to-access online survey. You can feedback on the DoS returns to your
team leaders. This will ensure that appropriate action can be taken to ensure this service
is high quality at all times. Please let us know your feedback as this will allow us to
monitor what is happening and improve the service where needed. Pharmacists will also
be able to provide feedback on their experience of the service.
DMIRS will be evaluated independently. If you have any questions then your DMIRS
contact will explain to you a little bit more about the service.
Thank you very much for listening to this video and for your work supporting an integrated
urgent care service.

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