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GPs go forth

Pharmacists want to bypass GP and refer patients directly to hospital

Pharmacists should have the power to refer directly to specialists and social care teams to ease the burden on GPs, a report has recommended.

The Royal Pharmaceutical Society of Scotland said such a move would help patients get access to care and reduce the number of unnecessary appointments for people with long-term conditions.

There is work underway to increase the number of pharmacists in general practice in Scotland, with RCGP Scotland recommending that every GP practice has a clinical pharmacist.

In 2015 £16.2 million was announced for recruiting up to 140 pharmacists with advanced clinical skills training over three years to support GPs in managing patients with long term conditions in Scotland.

Meanwhile, NHS England has pledged that every practice in England will gain access to a clinical pharmacist, in a £112m expansion of its current pilot.

The RPS policy document says the current referral process can cause delays in access to treatment for the patient and contributes to unnecessary workload for the GP.

The report said: ‘When people present at a pharmacy with problems or symptoms that require referral to, for example, a dietician or physiotherapist, the pharmacist has few options other than to default to the traditional route of referring individuals to their GP.

‘The pharmacist may have already recognised that the patient would benefit from quick access to another health or social care professional and should be able to do so as an integrated member of the multidisciplinary team.’

RPS Scotland also call for pharmacists to carry out more simple screening tests for long-term conditions such as blood sugar testing and blood pressure measurements.

Around two million people in Scotland are living with a long-term condition, which take up around 80% of GP appointments, according to the report which outlines the ‘key role’ the pharmacist can have in the ‘on-going monitoring, support and treatment’ of patients with long-term conditions.

‘The funding for pharmacists working in GP practice should become permanent to enable continuity of care and build a wider primary care team.’ RPS Scotland concludes.

John McAnaw, chair of the Scottish Pharmacy Board said: ‘I want to see these recommendations being taken forward in Scotland, so that people with long term conditions benefit further from the knowledge and expertise their pharmacist can offer as part of the wider care team.’

Dr Alan McDevitt, GPC Scotland chair, said: ‘There is definitely scope for pharmacists to be more involved in patient care and we are keen to explore ways in which this can be done that will give GPs more time with their patients.’

It comes as the NHS 111 care helpline in England has begun sending patients with minor ailments directly to pharmacy instead of GP out of hours, including for emergency prescriptions.

Readers' comments (36)

  • End of gatekeeper role
    End of general practice and all its efficiencies

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  • A&E will be even busier . Our local pharmacist had a patient faint while doing a flu jab.
    999 ambulance called.
    Pharmacists have inadequate training in diagnosis and in particular where examination is needed. Absolute nonesense.

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  • Considering there is a real time wait for secondary care of about 40-50 weeks - not sure how pharmacists , even if referring appropriately, will suddenly "help access care." Let's be arrogant for a minute - GPs are by far the best people at gatekeeping and referring appropriately. Consider how many patients with a bit of dry skin are seen in other clinics and a Dermatology referral is recommended with no consideration that we successfully manage most things without involving anyone else. Let pharmacists refer, waiting times will simply be measured in years and decades not weeks and months.

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  • excellent why not. will their referrals be audited also?

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  • As 10.25 says- end of gatekeeping role will lead to the opening of the floodgates. Just how much uncertainty can you tolerate Mr/Mrs Pharmacist?

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  • I agree with the suggestion particularly referrals to dietician etc would be really helpful. As mentioned there they will be audited. Same for opticians to refer directly. I am drowning with workload and I dont mind some of it taken from me.

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  • Fantastic news. On one hand CCG are on GPS back to cut down referral rates. SO it won't be our problem anymore. Lets see how CCG will monitor referral rates and most importantly see how hospital will cope with sudden increase in demand.

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  • Locally our referrals are triaged and "inappropriate" referrals returned to the GP even if the GP did not make the initial referral. Looks like more work for GPs.

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  • BUT THEY WON'T TAKE RESPONSIBILITY-UNLESS THEY GET THE LOLLY £££££££-GPs ARE DIRT CHEAP GATEKEEPERS BUT HUNT AND THE DAILY MAIL ARE TOO THICK TO SEE THEY ARE ONTO A GOOD THING.

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  • This plan completely misunderstands the skill of being a GP.
    Referring patients to hospital is the really easy part of the job - in fact I would say anyone could do it. It is the 'not' referring that is the clever skillful part of the job.
    if Pharmacists are allowed to refer Secondary care will soon be completely overwhelmed.

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  • Referral to a dietician or physio ? Good luck with that........

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  • Yes yes yes YES. Can't get referral from GP for totally unnecessary problem. Go see your friendly pharmacist. How much will they be paid for said referral? Just to make it worth while

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  • All GP's do is write out prescriptions. And anyone can refer . It's really easy . I'm surprised there aren't more people wanting to do such a well paid simple job.
    Must be a catch somewhere.

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  • Please remind me someone why I have medical degree, membership of rcgp, 25 years of primary care experience, so I can be replaced by anybody with a healthcare related role? I am constantly astounded that our true value is so grossly underestimated, seems like anybody can do my job better than I can! Good luck to them because it really is not so simple a job as some people make it out to be.

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  • I really needed a good hard laugh. Thanks Pulse.

    Do you get Advantage points with each referral?

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  • And, of course, no commercial conflicts of interest?

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  • I have never had to admit someone who has been advised to see GP. Very occasionally I may need to refer for further tests and a further opinion but a rare occurance -24 years and counting
    We are gate keepers, a job we do well. Howmany times are we asked to refer on by other professionals? Just a thought !

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  • AlanAlmond

    This is a bad idea. Pharamacists aren't Drs, they are pharmacists. I'm sure there are plenty of wonderful pharmacists who might want to give this a go, and I'm sure the Royal College of pharmacists (if that's what they are called) would think it's a great idea..how flattering would no doubt improve the status of Pharmacists and do no end of good for the collective 'Pharacist ego'. But this is about cutting costs, fragmenting care and getting people trained for one thing to do something else cause it's easier administratively and superficially cheaper. It totally under estimates what a GP is and what they do. Why not train and employ some more bleedin GPs??? Why not do something to make the job less insufferable?

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  • cough not cleared in 3 days by benylin then TWR to respiratory easy work

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  • Knowledge is Porridge

    OK, this may not work, but can we try it?
    Having experienced using a paramedic for home visits, they were great. It makes a big difference when they are clinically supported and with full access to records.
    A lot of the problems come from care silos: We may get the very best out of pharmacists, paramedics, physician assistants and indeed district nurses when they are fully integrated into the primary care team.

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  • David Banner

    I don"t mind this provided these referrals aren"t added to our total referral figures and used as a stick to beat us.(as usual).
    When patients self-present at A&E we are presented with the figures as though we are some how to blame (usually with the "poor access" excuse).

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  • I hate to come over all Jerry Maguire, but really we should all be pushing for less medicine, fewer referrals, better quality. Stop medicalising lifestyle choices, or age related changes. A hba1c of 44 does not constitute disease.

    This is especially true when NHS resources are scarce. If the DoH can't see that giving pharmacists referral rights will deluge secondary care then there really is no hope. Look at the referral rates from Noctors and learn the lesson. There is more to this formula than salary cost, or at least, there should be.

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  • Anyone. Can refer to hospital .that is what patients do at a and e

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  • Go for it I say. And while you're at it, why not cut out the "middleman" altogether, let the patients refer themselves directly!!!

    Let the Hunger Games begun!!!

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  • Completely agree with all of the above.

    In fact, why not get rid of all doctors? Pts should be able to self test (inc CT/MRI/angio/endoscopy etc), self medicate and self treat.

    We'll get min living wage paid technicians to do surgical procedures - they are not making any decisions, they'll just be told to perform as dictated by the patient.

    NHS crisis sorted! Now, lets get rid of politicians next and let the citizens decide what they want to do?

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  • Edoardo Cervoni

    Then, let us not being anymore the gatekeeper, but the expert adviser and advocate of our patient instead. Please, let the Pharmacist accept new roles and duties. Also, please, let Pharmacists dispense antibiotics without GP prescription, privately. I am not so sure the number of prescriptions will increase much. And should it do it instead, I would be less than surprised to see a drop later on. As for the hospital referrals, in truth, it seems to me that a decreasing amount of people is willing to pay a visit to the local hospital. Actually, I should say local hospitals. I have observed that patients do learn from our actions. And yes, the raise of anti-claim/defensive medical practice has helped no one at all. A practice which has been indeed underpinned by medical reports we have generated. So, we cannot complain about that either. I am grown to believe that prevention is much better that cure. I would love to spend my 10 minutes, starting from a very early age, educating our patients in what to do and what to avoid instead, to keep our bodies and mind healthy. Perhaps, we could have a 20 minute appointment, which could be more productive in many ways. I would like to focus on early detection of important and progressive diseases to increase the chances of cure. I would like to have direct access to imaging. I would like to help patients to fully understand what is going on in an always more complex, multi-disciplinary, medical management, without losing their ways and remaining in charge of what they want to do with their bodies and lives. I would like to have the time to speak to the Consultant and to read their correspondence. I want the GP to be the most experienced and educated figure within the healthcare system. Perhaps, one day soon, most will accept that coughs and colds do get better without medical intervention. And maybe, one day, we will be in a position of saying that using a spray and smoking 40 cigarettes a day at the same time is an absurd that cannot backed up by a GP working for the NHS. The NHS is struggling. GPs are struggling.

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  • Personally see this as entirely positive,sound step forward
    Hard to see how such referrals could possibly be harmful
    The issue of secondary care capacity is none of our business
    I think the first step would be for pharmacists to be given blood test requesting priveliges
    They could dispense and monitor many drugs particularly levothyroxine
    Hard to see any reason they should not also prescribe it
    I would hope Wales would look carefully at this entirely positive step forward

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  • Well i lost the will to live reading 2.18 and as for 11.32- "The issue of secondary care capacity is none of our business' - that really is silo (silage?) thinking.

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  • then let us not detain you 3.30

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  • Tom Robinson | GP Partner/Principal23 Dec 2016 11:32am

    That's a shorted sighted view. As each CCG is allocated defined amount of money, more activity at secondary care (= more spent) means primary care will end up with more work load in order to balance the books.

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  • It will only make the matter worse as regards the referral rate-I know it well. Only GP should filter the referral. Patients are likely to demand even more than what are the are doing now-I have extensive experience in the secondary care services.

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  • I am married to a pharmacist. They would be the first to admit that they are not trained in clinical examination. Having taken a thorough history, done a thorough examination, a doctor may arrive at a clinical diagnosis, perhaps supported by some investigations. Since when were pharmacist so trained?
    Our hospital colleagues are already burdened with the referrals of 'want to be doctors' within secondary care, this would idea would only add to the waiting list for an OPD appointment, further keeping those with proper illness waiting for specialist care.

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  • And the cost? Whose budget it will erode? Who will get the hospital report and who will shoulder the responsibility to follow ups and continuity of care?

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  • What ? When I get sent sore throats, cut fingers & all children under 2 years because it is deemed a doctor should see them.
    Unfortunately this equates to 'an emergency' by the patient & they are often added on as extras on a friday afternoon.
    I would worry about the quality of secondary referral

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  • 140 pharmacists nationally will have NO impact, but will divert funding from General Practice

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  • I agree with previous comment, if referring was all we do and If we had fast and easy access to secondary care, there wouldn't be any need to reduce our workload, everyone would be seen and treated the same day in the hospital by a specialist!

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