Yes, a little. The government and Department of Health and Social Care (DHSC) announced the Pharmacy First plan for England today.
The DHSC should be applauded for this new plan and investment. It brings England into line with services available in Scotland and Wales. In the system, that fully launches next year, you will be able to go to your local pharmacist with a range of problems including the 7 conditions (below); that you may have previously consulted your GP about or treated yourself.
And your local pharmacist will be able to directly prescribe medication including antibiotics and oral contraception, without going through the GP.
A typical pharmacy consultation. Many believe they are an underused resource in the UK.
So. Why is it necessary?
GPs are by far the largest group of British doctors. And general practice is the most important part of British medicine, and the front line of the NHS. Full stop.
The population is enlarging, and getting older and frailer. And GPs, as we all know, are not coping with their current workload. A typical GP sees about 15-20 patients per clinic, and does 7-8 clinics a week. They often work 12 hour days. So they need us all, not just the government/DHSC to help them.
Primary care (which is largely GP) deals with around 90% of patient contacts for under 10% of the NHS budget. In this way, GPs are the ‘gatekeepers’ to the NHS, providing over 1 million patient consultations a day, compared to 45,000 million visits to A&E majors. Pharmacy is also very busy, with 1.6 million contacts a day. MyHSN has more information on a typical day (and costs) of the NHS.
When patients struggle to see their GP, work spills into unscheduled care settings including A&E, leading to inappropriate attendance and use of hospital services.
Seven conditions covered
These are the seven conditions covered. The cynic would argue all are mild and most will get better anyway, often with no treatment.
- Earache – often gets better with no treatment (including no antibiotics; MyHSN’s has info how to use antibiotics)
- Sore throat – ditto
- Sinusitis – ditto
- Shingles – a virus, ditto
- Insect bite – ditto
- Impetigo – ditto
- Uncomplicated UTI – may or mat not need antibiotics.
We think you should see a pharmacist first for 40 or more more conditions (especially skin diseases) not just these seven. When Pharmacy First takes off, they will need direct photo or video contacts with dermatologists; and if it really takes off, with all hospital specialists. These are yet to be sorted.
Potential problems
IT issues
The pharmacist will not have access to all the GPs’ information and vice versa. In fact the GP will be unaware of the patient seeing a pharmacist, unless they contact them. This is not easy to sort – e.g. if you see a pharmacist in the ‘wrong’ place and they have no relationship with local GPs.
Here is an example of another IT issue. For a patient with an uncomplicated UTI, the pharmacist will not easily be able to access previous microbiology data – so may prescribe the ‘wrong’ antibiotics. They may also be unaware of potentially life threatening allergies.
Logistic issues
Where will they see a patient who needs privacy? What if they need to be examined? They may not have the skills.
Medicolegal issues
- If they make a mistake who will be responsible? Them? The GP? Integrated Care Board (ICB)??
- They will need extra insurance. Who will pay for that?
- How will their regulator regulate them, if they also have no examination or direct prescribing skills?
Complex flow systems
The NHS is a vast and complex flow system, with millions of contacts a day. Demand will always outstrip supply. So it is not always true that ‘reducing workload’ in one area will ‘free up’ space somewhere else. All it can mean is that some other (as yet non-provided for) area ‘moves into’ the space freed up.
For example, if a pharmacy consultation ‘takes out’ one GP appointment per day, that appointment will be filled by someone else (say, with a social or ‘life problem’) that would have given up contacting their GP, after being told there is no appointment soon. So the overall ‘gain’ is more unnecessary work. Rationing care does tend to make the NHS more focused and efficient. It’s complicated.
Summary
The Pharmacy First plan will take off a small workload from GP in England. It is a useful addition to NHS care. It may be especially useful for skin diseases. And medicolegal, logistic and IT issues will need to be addressed, to make it work safely. The flow system argument is complex but real. Either way, the new system is a good start, and remember,
.. if general practice fails, the whole NHS fails.”
Sir Simon Stephens, ex-CEO of NHS England
MyHSN would add ..
Every citizen of the UK (including you), has the responsibility to make sure GP does not fail. If we allow that, the consequences for us a society will be devastating.”
