WOMEN who suspect they have a urinary tract infection will be able to access fast-track testing and treatment — without seeing a GP — as part of a ground-breaking NHS England pilot scheme being trialed in 38 ‘Pharmacy First’ branches across Nottinghamshire and Derbyshire.
Instead of waiting for a GP appointment, women will be offered a Dip UTI test — a clinically proven home-use kit developed by Healthy.io, the creators of next generation smartphone-powered urinalysis.
Dip UTI combines the standard dipstick urine test used by GPs with an ingenious app that turns any smartphone camera into a clinical grade medical device.
Experts believe the initiative will provide women with rapid relief from symptoms, reduce complications due to delayed treatment and curb the number of unnecessary prescriptions for antibiotics. It also aligns with the NHS Long Term Plan to improve community health care by making greater use of pharmacists’ skills.
Samantha Travis, Clinical Leadership Adviser for NHS England in the Midlands, said:
This pilot scheme forms part of a wider project to improve community health care by making greater use of pharmacists’ skills. Our extended ‘Pharmacy First’ Scheme - which allows patients to have minor ailments treated by a pharmacist – has been running in selected pharmacies in Derbyshire and Nottinghamshire since February 2018. "
Dr Ken Deacon, Medical Director for NHS England in the Midlands, adds:
This innovative pharmacy scheme offers rapid relief for women while freeing up GP appointments. UTI is the most common bacterial infection in humans and it affects up to 15 per cent of women every year.
Under the scheme, women who don’t test positive for a UTI will have a follow-up consultation. This allows the pharmacist to explore further the possible causes of their symptoms and discuss treatment or a GP referral.”
As urinary tract infection (UTI) is one of the most common bacterial infections seen by GPs, this new care pathway has the potential to free up millions of GP appointments and save the NHS millions of pounds.
Suspected UTIs account for up to 3% of all GP visits. In England alone, this adds up to around 10.2 million consultations, and costs the NHS more than £316 million in GP time. Each GP consultation is estimated to cost the NHS £31, but a consultation with a community pharmacist costs the health service a tenth of that amount — just £3.40.
Pharmacist, a member of the Royal Pharmaceutical Society Board and an advisor to Healthy. io, Sid Dajani says: “If only one in ten women with a UTI was treated in a pharmacy instead of their GP, the NHS would save £28million a year in England alone and there would be millions more appointments available for more serious or urgent problems.”
Uptake is likely to be high. A pharmacy-based test and treat service has already been trialled successfully in a commercial setting, and showed that women were happy to pay £10 to buy the test kit, plus an additional £15 for antibiotics if required, to access the fast-track service.
Through the NHS pilot, the kit and consultation will be free and, if needed, antibiotics will be provided (under a Patient Group Direction) for the usual NHS prescription charge of £9 or free for those who do not normally pay for prescriptions.
East Midlands Academic Health Science Network (EMAHSN) Commercial Director Tim Robinson says:
Our aim as an organisation is to identify, test and spread innovation in health which improve outcomes and experiences for patients and save the NHS money.
By supporting this technology-enabled pathway, we hope to provide patients with quicker and easier access to UTI treatment and reduce GP appointments.”
Dip UTI has won approvals from the European Union and the US Food and Drugs Administration, and has been adopted by the NHS Innovation Accelerator program, which was established to fast-track evidence-based technologies with the potential to deliver major improvements in patient care.
The smartphone technology used in Dip UTI is already helping the NHS monitor kidney transplant patients and a recent rollout and economic evaluation by the University of York has shown it can also deliver huge improvements in diabetes care.
How it works
The new Dip UTI digital urinary dipstick test includes the same reagent dipstick test used by doctors, a pop-up plastic cup for no-fuss urine collection, plus the proprietary color-board and intelligent app which ensure swift and highly accurate results.
The app has a virtual nurse who talks users through the procedure and ensures every step is carried out correctly — and user-trials have confirmed this overcomes many of the potential pitfalls surrounding urine tests.
Once the strip has been dipped into a mid-stream urine sample, it is placed on the proprietary colour-board and the user scans it with their mobile phone. The Dip UTI app then uses color blocks on the board as a reference to accurately detect any color changes on the dipstick which indicate a bacterial infection.
The precision of Dip UTI test rests in its intelligent app and this color-board which eliminate any variation from phone to phone and replicates the result that would appear in a neutral, ambient light.
Research confirms it analyses results with the accuracy of laboratory analyzers and greater precision than the visual reads performed by GPs and other healthcare professionals.
UTI fast facts
Urinary Tract Infection is one of the most common bacterial infections seen in general practice. It is more prevalent in women than men, with one in three women developing a UTI before the age of 24, and one in two experiencing at least one infection in their lifetime.
Symptoms include urinary frequency, urgency, or feeling the need to pass urine despite having just done so; pain or discomfort when passing urine; producing urine that is smelly, cloudy, or contains blood; lower abdominal pain and generally feeling tired, nauseous or clammy.
Collectively these warning signs are also known as cystitis, which is inflammation of the bladder. Cystitis is usually, but not always, caused by a bladder infection. The most common cause of infection is Escherichia coli, which accounts for about 80% of bacterial UTIs.
The key to diagnosis is a dipstick urine test, which is used to detect nitrites, leukocytes and red blood cells — markers associated with UTIs.
If the dipstick test is positive, depending on the severity of symptoms, The National Institute for Health and Care Excellence (NICE) advises that women should be started on antibiotics immediately, or given a back-up prescription in case their symptoms get worse, or do not improve within 48 hours.
However, in practice there are challenges around this approach.
Urgent need for a new UTI pathway
NICE guidelines assume women are able to access medical care swiftly when they have symptoms — but in many parts of the UK this is not the case. Figures from NHS Digital, published in the British Medical Journal last year, showed that only two out of five appointments (40%) take place on the day they are booked — and one in five patients waits two weeks for a GP appointment.
These figures suggest that by the time they see a doctor, many women will already have had symptoms for more than 48 hours and should already be taking antibiotics — and this is confirmed by research for Healthy.io.
More than a quarter (26%) of the women surveyed have had to wait several days before they could see a GP and only 12% said it was ‘very easy’ to get a GP appointment when they had symptoms. Two out of five (41%) reported difficulty getting an appointment and only one in four women (24%) said they were always able to get an appointment when they had cystitis.
Research confirms that delaying antibiotics leads to a “significantly higher total burden of symptoms” and greater “activity impairment”.
More importantly, withholding antibiotics also leads to a five-fold increase in cases of pyelonephritis: kidney infection which can cause permanent renal damage, and invariably requires a longer course of antibiotics than is needed for a UTI.
The community-based health care which the Dip UTI test enables is also a key ambition outlined in the NHS Long Term plan, which aims to enhance the role of pharmacists to improve urgent care and ease the workload on GPs.