OBJECTIVES: Inappropriate antibiotic prescribing is a significant concern. Sore throat patients receive antibiotics from their general practitioners (GPs). However, only a minority are due to bacterial infection (often group A streptococcal). A rapid diagnostic test can improve diagnosis and guide treatment decisions. While NICE guidance indicates unlikely cost-effectiveness of this test in GP settings, Health Technology Wales suggests it could be cost-effective in NHS Wales pharmacy settings. This study estimates potential cost-savings to NHS England if implementing Strep A test in community pharmacies while highlighting role of community pharmacists in promoting self-care and optimizing antimicrobial use.

METHODS: Patients aged ≥16 years with sore throat symptoms and FeverPAIN scores 4-5 were tested by pharmacists using OSOM® Strep A rapid diagnostic kit. Positive strep A test results led to GP referral, while patients with negative results received self-care advice. To estimate avoided GP visits, patients completed a questionnaire on treatment choice (A&E, GP visit, Pharmacist, self-care) if the diagnostic service had not been available.

Costs data and yearly GP appointments were derived from Personal Social Services Research Unit and NHS digital respectively. Potential cost savings were estimated as the monetary value of avoided GP visits for sore throat.

RESULTS: Following the screening, 86% (18/21) tested negative for Strep A infection. Of the 59 patients who completed the questionnaire, 34 opted for GP visits, with only 12 requiring GP referral leading to 61% avoiding GP visits.

Based on the difference between the number of patients that would have booked GP appointments if the service was unavailable and total GP referral; potential saving to the NHS was estimated as £ 509 million per annum.

CONCLUSIONS: Rapid diagnostic testing for Strep A in community pharmacies in England could alleviate NHS pressure and save costs. Pharmacists would also feel empowered to treat while preventing antimicrobial misuse and promoting self-care treatment.