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Millions from GPs' drug budgets to go to pharmacists

By Nigel Praities

GPs will lose hundreds of millions of pounds from their prescribing budgets under Government plans to dramatically expand the services provided by pharmacists, Pulse can reveal.

Department of Health documents also reveal plans for pharmacists to take on large chunks of GPs' work, claiming they will do it more cheaply and efficiently.

The impact assessments for April's white paper on pharmacy predict up to 50% of GP minor ailment work will move to pharmacists, cutting prescribing costs by up to £300m ‘through resource reallocation at GP practices'.

‘We have assumed the increase in pharmacists' costs will be matched by a comparative decrease in GPs' prescription costs. PCTs are assumed to relocate prescribing budgets from GPs to pharmacies,' the assessment of minor ailment services reads.

Another document warns GPs are too expensive to be employed for monitoring patients with chronic conditions, warning: ‘Unit costs for GPs of providing these additional services would be significantly higher than for pharmacies.'

Under proposals in the pharmacy white paper, pharmacists would run chronic disease clinics, cardiovascular screening and public health programmes.

But GP prescribing experts warned the proposals thrust pharmacists directly into competition with GPs for resources, and risked seriously fragmenting patient care. Dr Bill Beeby, chair of the GPC clinical and prescribing subcommittee, said: ‘If you are asking pharmacists to suddenly take on long-term care, I am just not sure how that is safe. We start to fragment and compete for doing little jobs.

‘GPs are at risk, because we are not accustomed to breaking down things in terms of cost. So when it comes to bidding for services we tend not to be good at that.'

The assessment of services for long-term conditions predicts the cost of running pharmacist-led clinics would run to between £2.3bn and £3.6bn, but would be offset by increased medication adherence and reduced GP visits.

It follows Pulse's revelation last week that £20m is already being spent by PCTs on pharmacist medicines use reviews.

And the assessment of minor ailments services says pharmacists could decrease the overall primary care drug bill, as they are ‘more conservative' in their prescribing habits than GPs. It adds that the average cost of an NHS prescription for minor ailments is £10.80, whereas for Scottish pharmacy-led minor ailment services it is £2.

But Dr Jim Kennedy, RCGP prescribing spokesperson, said the claims were based on flimsy data, and that any shift in money from GPs to pharmacies was based on an ‘erroneous principle'. ‘To justify moving stuff to the pharmacy budget, they need to be able to prove medications currently in the GP budget will now only be given by the pharmacist. I can't see how they will argue that,' he said.

‘Conservative prescribing is not always good. Prescribing is more than just giving a drug to a patient and as pharmacists manage more complex patients I think we'll find their prescribing to be close to GPs,' he said.

The Department of Health insisted its proposals were ‘not about pharmacists taking over the work of GPs – it's about complementing them' and that cuts in prescribing budgets would not mean GPs were paid less.

It added that the plans were out to consultation, and that assumptions made in the impact assessment documents were ‘not a firm policy proposal'.


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