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GPs go forth

Pharmacy care saved hundreds of GP consultations a month

A trial allowing pharmacists to supply medicines for free for common ailments such as hay fever and conjunctivitis has reduced the numbers of GP consultations by more than 500 across one region a month, the Welsh Government has claimed.

The scheme, launched in 2013, encourages patients to go to pharmacists for conditions such as constipation, dyspepsia, coughs and sore throats by not charging for treatments.

Government analysts estimated that the number of GP appointments avoided per month across Betsi Cadwaladr and the Cynon Valley area of Cwn Taf - which has 32 pharmacies - was as high as 1,658, although they said the most realistic estimate was 547.

They added that their most realistic estimate of costings was that the Choose Pharmacy scheme would save about £1.4m over five years. Their other estimates of savings ranged from £0.3 million to £4.3 million over these five years.

There was question mark over the capacity of pharmacies to cope with increased numbers of patients in some regions, however.

The report states: ‘The impact and economic evaluation suggests a positive return on investment in Choose Pharmacy over the next five years based on the performance in the two pathfinder sites. 

‘If the rollout can follow the same pattern as experienced in the Betsi Cadwaladr and Cwm Taf sites (in terms of the number of consultations and prescription items issued) this evaluation provides evidence that the benefits of the service outweighs the costs.’

The Welsh Government plans to roll out the scheme nationally but wants to learn lessons from the trial.

Readers' comments (13)

  • Great but what was the cost per consultation? Don't suppose anyone would give this to gps on all you can eat contract.

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  • I don't agree with this at all. In my experience pharmacy involvement often complicates matters. They are very black and white and don't understand the grey areas in medicine. The patients then come and book a consultation with the GP. This happens very often.
    Also there are issues of indemnity which are not looked at in this study. If the patient actually had iritis or a dendritic ulcer instead of conjunctivitis who is responsible and liable. I could imagine the lawyers having a field day .."what examination did you make ?"
    If pharmacists want to take more clinical responsibility then they need to be aware they need to take accountability.

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  • 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.

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  • Does the trial contain detail of those conditions for which we no longer prescribe antibiotics, for example, acute conjunctivitis, sore throat not meeting Centor or FeverPAIN threshold, most cough etc?

    Was the trial run for long enough to examine the rate of reattendance? Pharmacist have often worked in a commercial environment where they are incentivised to maximise sales and encourage customers to return.

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  • We have a duty to use nhs resources responsibly. We are not supposed to give free prescriptions for short term self limiting conditions when they can be bought otc.

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  • 542 consultations saved per month across 32 pharmacies = 17 per phamacy per month = less than 1 per day.
    Gross generalisation 2 pharmacies for each surgery(?) so saves approx 1 GP consultation per surgery per day.
    How much did it cost?

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  • To be honest if GPs want to carry on seeing patients for straightforward conjunctivitis I.e. No red flag symptoms simply because the patient doesn't want to pay for an OTC product then I'm quite happy for them to do so. But you can't then complain that your workload is unsustainable. We have a minor ailment scheme locally which we get paid an extremely small fee for and to be quite honest my life would be easier without it but I actually believe that most GPs want to spend time on patients who need their specialist skills and in fact the GPs attached to us generally seem to appreciate that we can help their workload by dealing with the daft minor things which would use up their time.
    Obviously a major part of our training is knowing symptoms that require a doctor and I often tell patients 'I am not a doctor' and actually I don't want to be. I respect GPs knowledge and am quite clear were my expertise ends. I wish GPs could know the number of times I am asked 'Do I need to see the doctor?' and its someone who has a cold for a few days (and no underlying heth conditions because I always check that) or the smallest patch of dry skin. Why can we not work together!! Not saying there aren't rubbish pharmacists but there are some unhelpful GPs too!

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  • It does make me smile. GPs are quite rightly complaining about workforce pressures and increasing demands but when a scheme is piloted and evaluated and shows that it could free up GP time they still complain. The average cost to the NHS of each GP appointment is £46 (PSSRU UCoHSC 2014) so paying a pharmacist a small fee to dispense on a minor ailment scheme is fantastic value for the NHS and frees up GP time

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  • "They are very black and white and don't understand the grey areas in medicine."

    Any evidence for this statement, or is it purely stereotyping?

    I'd suggest that we have a very good understanding of the grey areas, as well as an understanding of how constrained we are by licensing, funding etc. A properly funded, well organised minor ailments scheme should and could be an amazing asset to any primary care scenario. Sadly, negotiations for a national minor ailments service have been quietly dropped.

    This us vs them attitude is extremely unhelpful. Whilst I'd encourage skepticism at every opportunity, it's plain old, begrudging cynicism that I see here. For every "ooh that mean pharmacist sold one of my patients a cough bottle that didn't work" I could reel off a million bad GP stories, but that would get us absolutely nowhere.

    So, emotions to one side, and let's bring in the evidence.

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  • We are hearing all the time at how stretched GP's are. From a pharmacists perspective we are being asked to alleviate some of the pressure by providing new services. Flu vaccines, minor ailments etc. And why should we not get paid for this? Bear in mind that the fee is one that you would laugh at.

    Pharmacists are taught to know their limits and legislation ensures this. Personally, I don't think this is a bad thing when it comes to patient safety. We are not trained to the same level as GP's and we know this.

    If you complain about not being able to cope then the NHS will open up the services that others can safely provide. Surely this is a good thing?

    Giving you more money doesn't solve the problem. It just gives you more money.

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