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CAMHS won't see you now

'Managing minor illnesses at pharmacies is just mad'

new scheme has been set up in North Tyneside in which minor illnesses are managed not by GPs but by pharmacists. It is designed to save GPs' time and cut their workload, but in my opinion it will simply increase pharmacists' income. Inexplicably, it seems that this idiotic scheme will become part of the new contract.

This is how the scheme works. Patients with minor illnesses (who decides?) attend surgery and, if they are eligible for free prescriptions, are given a voucher to take to the pharmacist. Once there, the pharmacist will take the vouchers, thrust some medicine into the patient's hands, pocket a fee from the NHS and collect the profit on the medicine.

However, if the pharmacist believes the patient has been 'inappropriately referred' the patient will be speedily sent back to the surgery.

Who diagnoses whether the illness is really trivial when the patient is at the surgery? The patient? The receptionist? The practice nurse? (Surely not the latter, because the supporters of the scheme tell us that 'it frees up nurses' time for other things'). The doctor?

Yes, it is the doctor, because the doctor is responsible for the actions of all his or her staff.

So if a patient comes to serious harm as a result of this scheme, and later sues the practice (which is bound to happen in this compensation-crazy and vindictive culture), who will pay the price? It won't be the pharmacist. It will be you, the GP.

What about cost-effectiveness? It is hooey.

The figures quoted are that the scheme costs £6.31, including £1.50 pharmacist's fee and an average of £2.92 per item for medicines if the pharmacist supplies the cheapest item and only one item.

This, they say, compares with a £10 per item cost for a prescription medicine and £15 cost for a GP consultation.

Those figures insult one's intelligence. If the illness is really trivial, then it is the doctor's duty and right to refer the patient to the pharmacist without a prescription. Cost: nil. As for the cost of seeing the GP, if, by some fluke, instead of 20 patients turning up for surgery, none do, does the NHS save £300? Of course not.

Pharmacy prescribing is hazardous. You will not find many pharmacists prepared to put their careers on the line if it ever comes to taking full responsibility for their decisions.

Like so much in this Milburnian NHS, the proposed voucher scheme is superficially a good idea. But when the thinking person examines it more carefully, it has definite and unacceptable weaknesses.

If just one patient dies, and one doctor faces the GMC because of that, then no matter how much time is allegedly saved, the price is too high.

If a patient comes to harm as result of this scheme who will pay the price?~

Why a GP believes that letting pharmacists manage minor illnesses will not save any money

 · Dr Lorna Gold continues her look at contract proposals

page 19

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