Please note - pharmacists practise in a range of locations, not just in community pharmacies, it could be within the GP practice. Any prescribing for patients with LTCs would need to be through an agreed arrangement with the patient's GP, wherever the pharmacist is located.
As noted, emergency supplies of medication have been permitted under legislation for some time. There are requirements that pharmacists have to satisfy, and it doesn't include controlled drugs.
Patients won't like it as it is a private transaction and they will have to pay for the cost of the meds.
GPs can minimise the chance of patients forgetting to request their next script by considering these two interventions:
Optimise the number of months' treatment per script for the patient, DH has gone off the idea of 28 days for all now.
Use repeat dispensing (batch) scripts (where the pharmacy hold the batch copies) for stable patients reducing need for GP to issue repeat scripts.
Agree with 'GP partner' at 4.41pm.
The patients will expect a diagnosis and script (which will be private, expect a fuss) in the consultation. They won't be expecting to pay for any investigations that are necessary. Sounds like more hassle than it's worth to me.
Health professionals working in secure environments have been flagging the abuse problem of these drugs for years and nobody was listening. As mentioned, tramadol is also a problem and has been inappropriately prescribed since it first came onto the market.
I think the article provides an excellent summary of the issue.
The prescription charge is a tax levied from those who have not been assessed as less able to pay. The average cost of an item on an NHS script has been falling over the last few years, but is still higher than the prescription charge. Over 80% of prescriptions issued are exempt from charge for various reasons. I think it would be sensible to do away with the charge as has been adopted in the other GB countries.
Surprisingly well-presented comments on this topic! As should they all be whether named or anonymous. I don't think what is effectively a public site is the place for ranting offensive comments - GPs can do that on one of the closed groups.
I'm sorry if some GPs don't like non-GPs posting comments, when I do I try to be balanced and objective, I've been reading Pulse for over 10yrs, it's a useful indicator of what's interesting to primary care.
The reason Copperfield gets so much flack is not necessarily the topic but the often flippant, derogatory style. The latest one was much better written! There's a difference between raising key issues for broader consideration and upsetting patients and fellow HCPs.
Patronisingly ridiculing patients does nothing to address the problem of some people working the system to their advantage (supported by GPs who haven't managed requests appropriately over the years) which impacts on those in genuine need. This sort of article won't attract any sympathy for GPs from the rest of us.
And thanks Graham for providing evidence of the impact - more informative than frivolous comments comparing pharmacists to rabbits.
Well said Dr Simon Bradley, but whether or not a practice has sufficient GPs, leaving aside any clinic role, the right pharmacist can provide expert medicines management, audit etc input to free up GP time for doing those things GPs are best qualified to do.
My suggestion to the GPs with a poor experience of having a pharmacist in their practice is to get out and visit a practice which has one and values them to make an informed decision not based on single anecdote. It's key to have the right person that complements the practice team, just as not all GPs for in. Or maybe you just aren't very good at team working.
I'm sure CCGs will receive comments from GPs concerning community services if you actually provide them in a constructive way.
I worked as a practice pharmacist 10+yrs ago, PCT was intruding practices to the benefit of a pharmacist, they were nervous of being told off at first but once we were fully embedded they didn't want to give us up. The pharmacists were funded by top-slicing the prescribing budget and we more than paid for our cost.
The current practice pharmacist pilot of course isn't going to replace GPs - isn't the issue that there are insufficient doctors choosing GPractice to specialise in? Utilising a pharmacist in the practice adds an essential member of the practice team irrespective of adequate complement of GPs. Whether you make it work depends on how innovative and open-minded you are - pharmacists are really good value for money.
Correct Dr Turner. Perpetuating the adult/child relationship between a HCP and someone with a perceived health need reinforces that they aren't able to manage their own health whatever the issue. We should be encouraging people to consult an appropriate HCP (who will refer on as necessary) who provides expert advice and any treatment considered necessary is the informed choice of the individual.
It's the only way to cope with actual need.
Community pharmacists are giving advice on minor ailments all the time. The difference with such a service is the availability of free treatment. Pharmacists have their own indemnity insurance and will, as they do, refer patients to GPs if they see signs that suggest eg iritis or ulceration. This would free up GPs to concentrate on the patients who need their particular skills.
We don't live in a world of zero risk so there's no need for the public to see a GP for every condition however minor - you aren't now, and you wouldn't be able to cope if you were. A simple referral form, with signs/symptoms noted, recommended timescale to see GP and pharmacist name and details would formalise to the patient the relative importance of the referral.
The equivalence testing of generics to the standard required does not extend to bioequivalence. It's possible that there is some occurrence of reduced effectiveness compared with the original branded product. However, why would all generics be less potent than the original and why not a range including more potent?
Any worsening of symptoms should prompt questions about a recent change in product manufacturer which would help differentiate between disease progression and the (in my experience) few patients who have problems with a particular generic (or even branded) product.
We need also to consider that chronic pain is difficult to treat and analgesia is only moderately effective (estimated maximum 50% reduction in pain with optimal treatment). I'm not at all suprised that there was little difference in QoL. Derogatory comments about pharmacist skills by GPs and junior doctors is unnecessary and unpleasant. Analgesic use in pain control is a sensible area for pharmacist intervention.
Any pilot of new intervention is expensive as small scale and not mainstreamed.
Ah, what a 'good' idea - stop revalidation (demonstrating that knowledge and skills are being maintained to support delivery of a good standard of practice) and remove the need to attend those pesky meetings (oh, haven't a clue what's going on now) and fill out paperwork (should all be electronic extraction surely)
Patient group 'direction' to be legally accurate
Presenting solutions is good. But primary car isn't just GPs and their practice staff, there are community services that deliver it and have lots of ideas. So primary care solutions from GPs, community healthcare providers including community pharmacies.
Tom, we don't get paid that much, we're very good value for money. I suggest you lobby your CCG for some in practice support. Emails from a distance aren't going to work, you need the pharmacist reviewing clinical record, talking to patients and helping GPs.
To the other commentator, if you're short of GPs you'll still need them, but I can't imagine how a practice manages without a good support pharmacist.
I've practised as a community pharmacist, as a practice support pharmacist, worked with GP practices in a PCT developing meds management, in a prison and now as advisor to a health and social care provider. So I've seen primary care from all angles. The concerns voiced in the comments have some validity but it's wrong to assume that future engagement will be the same as past experience. I've always developed great relationships with GPs and it wasn't all about cutting cost, it was about effective rational prescribing and making systems efficient. GPs were happy to have the prescribing budget top-sliced by PCT to fund their practice pharmacist because of the benefits. I believe the CCG have continued this. Some of the pharmacists were from community, some hospital, some PCT and understanding what goes on in a GP practice is essential for any pharmacist providing support. Not all pharmacists will have the skills to do this in my view but don't dismiss it as there are many out there who can.