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'Gold in them hills' - why pharmacists are the future of general practice

Dr Dean Eggitt believes pharmacists offer the true nuggets of hope for general practice 

General practice is in a workforce crisis like we have never known. We have been promised 5,000 extra GPs by 2020 but the current progress toward this target casts a dark and foreboding shadow of doubt. Despite this workforce crisis, patients continue to seek professional healthcare advice in record numbers showing that demand is outstripping capacity in this NHS on the brink of catastrophe.

A cynic might suggest that the 5,000 GPs are never going to arrive, that this statement was just a useful soundbite to silence the cry for help from the emergency LMCs conference calling for the undated resignations of our workforce.

The reality is that GPs are expensive, both in temporal and fiscal terms. It takes 10 years to grow a GP from scratch, costing a debatable £498,489. On top of this, GPs are expensive, demanding six figure sums for full time work. With a £20-30 billion funding shortfall expected by 2020 you can start to understand why expanding the GP workforce might not appear to be an affordable solution. Admittedly, this viewpoint requires you to overlook the argument of ‘getting what you pay for’: if you’re stuck on that, then don’t bother reading on.

One solution is to use physician associates. Indeed, we have seen that physicians associates have been used successfully across the pond, and our own Royal Colleges here in the UK seem to be advocating that we also pan this river of workforce gold. The arguments for and against this have been rehearsed in detail elsewhere, so I won’t labour these points.

In my mind, we already have an abundant resource that doesn’t need mining or panning, but needs refining and polishing. A workforce that, having completed five years of undergraduate education, sit in plain sight, already working hard in the NHS, waiting to be realised. These professional colleagues and friends gained the ability to prescribe independently in 2006 and are already nationally regulated and independently accountable for their actions. Furthermore, they are required to be indemnified against such actions, understanding the risks of litigation as we do in general practice. ‘Who are these professionals, who might answer our calls?’, I hear you ask. ‘Pharmacists,’ is my reply. I believe this profession is an element in current abundant supply whose potential as a malleable material is only just being realised.

In March 2016, there were 11,688 community pharmacies acting to serve the NHS in the UK with a total UK pharmacist population of around 61,000 souls. There is no secret that schools of pharmacy have overproduced pharmacists over the years leading to fears of unemployment. At approximately one third of the cost of a full time GP, is it not time to think about integrating pharmacists into the GP workforce?

For me, I do not want to employ a pill counter – I do not need one. What I really need is a GP but I cannot find or afford one. This is where Richard comes in. Richard is my friendly neighbourhood pharmacist. We started working together to optimise prescribing in my practice and it quickly dawned on me that Richard could do much more than this, so after a phone call to Richard’s indemnifier I gave him a stethoscope and we started to see patients together.

As a trainer, this was second nature to me and I quickly realised that the human body was second nature to Richard. Now, Richard is an integral part of my team. He sees, assesses and treats patients independently and I am sure with time he will understand complex patients and manage them just as I do.

The ability of this pharmacist seems only limited by our time to sit together and share learning and I know that he has learnt to use his education to diversify his practice according to the needs of the population. What I have learnt in return is that we already have an answer to our workforce crisis sitting in plain sight, should we choose to invest our time wisely.

‘There be gold in them there hills.’

Dr Dean Eggitt is a GP partner in South Yorkshire and medical secretary at Doncaster LMC

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Readers' comments (32)

  • So let me get this straight..... the 'hope' of our profession, our holy grail, our salvation, is actually getting another profession to bail us out, well that won't undermine our cause will it......mmmh the Royal College of General Pharmacy...... perhaps thats the plan, to franchise Euston square out as a Boots superstore (Probably be more profitable)......don't get me wrong, a pharmacist in the team is a great asset, but its not going to solve the recruitment crisis......I think the comparison of pharmacists with gold nuggets is over-egging it a bit, describing the future of UK general practice as floating like a lead balloon seems rather more apt....glass-half....hang on I can soon fix that :-)

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  • Oops, apologies, left out a 'more' there....somewhere between westminster and than..... but more is good, more is a reminder.... bottoms up!

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  • And for anyone who thinks Virgin is a risk...... imagine if Boots thinks they can move into General practice..... heres how the profession of pharmacy got on once corporates got involved....
    https://www.theguardian.com/news/2016/apr/13/how-boots-went-rogue

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  • We've already tried this. It didn't work for a number of reasons. Firstly, you need a quite senior pharmacist to cope with the clinical stuff and they are less abundant that the inexperienced ones. Secondly, we need prescribers. Thirdly like all 'practitioners' they often add to your burden by requiring supervision and generating extra work e.g sending tasks back and forth. Fourthly it takes considerable resource to train them. Fifth, we have vicarious liability for them and their indemnity is not sorted out. Large claims are starting to come through the system against pharmacists.

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  • A quote from the above article....

    "Now Tony saw his workplace as a factory. “It’s a profit factory where we’re doing piecework,” he said. All these decades after university, his working life was suddenly dictated by people who had little respect for his education or his profession. “The standard of education of these managers … some of them can’t even spell prescription; they put ‘quiet’ when they mean quite.”“How can Boots call itself a healthcare company when it’s done this to me?”

    This could be a description of the modern NHS?........I suggest you all discourage your patients from using Boots until Boots pays tax...before I left the UK I used to educate my patients about this issue..after all,informed consent is important, now where has the Sommelier gone to?

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  • Indemnity is sorted for this cohort with a shopping list tick box proforma depending on the work they will be doing e.g telephone triage first contact costs £350 extra etc. (I have been through this with a pharmacist last week and seen it first hand)
    I could not see a problem with their indemnity costs although with the full fat package of what GP's tend to do it is nearer to the £2k for the year (bargain compared our costs but expensive for them as they usually pay £150 or so in the community)
    I agree variability on candidate but there are now postgraduate training courses at prestigious uni's (3 years long) that train these people into mini doctors. I have assisted on these and for example the level of clinical examination examined on the OSCE is MRCP standard!
    Experience is another matter and thats where good training on the shop floor comes in.
    lets face it there is no one else to do this work and if you think there is going to be a large lottery windfall for us GP's from the government fahhhgetttabbbouttiiittt! so best get on it and support if you are a young/middle aged GP

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  • So as I see it:
    Your kid either doesn't have the grades or masochistic tendency to accumulate 6 years tuition and maintenance fees so guess what........
    Daddy I now realise that 2 years will get me a pa job at over 50 grand a year or once I get my quasi medical degree I can apply for various noctor jobs throughout the NHS......
    Why would an astute 18 yo do a medical degree anymore as it is no longer needed to be employed as a noctor in the current nhscsetup
    RIP medical schools, you are no longer needed as we will get our noctors from elsewhere....

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  • GP recruitment | Locum GP13 Jul 2017 2:36pm

    Indemnity is certainly not sorted

    We send out our employed pharmacists for various drug trial projects and have to take the entire indemnity bill associated with these projects.

    The costs of single trial projects can be very substantial.

    The cost you may seeing is a false one, essentially any complaint within primary care tends to bypass non doctors for historical reasons. indemnity organisations are now factoring in those costs in the GPs indemnity bills.

    We are seeing huge insurance cost rises for drug trials where clinicians ( typically from hospital CRFs ) are now being asked to declare their involvement in trial projects where historically this was covered by terms of hospital/crown indemnity.

    For pharma the insurance costs can be costed into the project design, however it is entirely unreasonable to suppose that individual Gps could ever take on the costs and the risks long term.

    Especially when you consider the training of GPs /junior drs and the disaster in planning is the responsibility of HEE/NHSE etc

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  • A Practice with 4000 patients unable to afford a full time Nurse and/ or a full time second GP has really got to be completely insane to try to fit in a Pharmacist of dubious efficacy. This promotion of PA/Pharmacists/NPs etc is strange - How can Practices afford these if they can't afford frontline staff and are paid only for 80% of their list sizes reduced every year by 100 patients for 3 to 4 successive years despite no significant change in list size.

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