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Independents' Day

'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)

  • I am uncertain about this entire project, employing pharmacists as cheap pretend gps seems intrinsically wrong to me
    It denigrates our raison d'etre and suggests to hmg that unlike greedy overpaid gps this body of professionals can replace doctors thus giving a solution to the chronic underfunding in primary care
    If I am sick I would prefer to see an experienced doctor over and above a pharmacist, if I needed an operation is unlikely a pharmacist would be tasked to do it, so why does hmg feel that gp can be done by anybody with a vaguely medical like degree?

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  • The problem is that Pharmacists have no formal training in this country to become 'Clinical Pharmacists' like elsewhere in the world. My experience of employing Pharmacists is that they are very variable regarding their individual ability and confidence in managing anything more than simple minor issues. Mind you nothing that formal training could not sort out.

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  • @8.31

    I agree with your sentiments, but the same process is already taking place in hospitals with trained up nurses replacing hospital doctors.

    It's all about improving productivity, which has taken place in other services. This could be replacing highly trained people with cheaper lower trained ones, or the use of computers and modern industrial robots.

    The problem is the whole of the capitalistic western economy is based on constantly improving productivity in order to increase profits / growth. The NHS is not 'currently' for profit, but the cost is a drain on the economy.

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  • doctordog.

    we should all embrace this, not feel threatened.
    pharmacists can provide very useful input, including, prescribing issues, medication reviews and queries, audit, managing long term problems etc etc

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  • "On top of this, GPs are expensive, demanding six figure sums for full time work".

    This is an LMC secretary speaking? I don't consider 100K for a full time GP expensive at all.

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  • Oh the joys of muddled thinking.

    As many hospitals have noted the use of 'nurse consultants' was borne out of desperation and has had significant negative impacts on the running of wards with often senior nurses moving into these roles.

    Pharmacists will do a job, they will create a body of work to justify an existence. Whilst their indemnity is subsidized by a GP.

    There is danger of large scale self deception if we think GP's can be replaced by 'apparently cheaper' individuals, the dangers of false economies are well documented.

    It is truly awful to see GPs contributing to this intellectual fraud.

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  • Cobblers

    Six figure sum for GPs?

    Attributed to Red Adair: "If you think it's expensive to hire a professional to do the job, wait until you hire an amateur".

    5 years dedicated to pharmacopeia makes you good at (hopefully) medicines and related. Not to the dealing with the unwell human being.

    This is the Noctor/Phoctor debate. Studies to date show them to be slow and unable to make decisions. Indeminity might well deal the death blow. Then it might be the end of all of us.

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  • We are getting it all wrong. If the front line is staffed with the inexperienced and risk averse then everything upstream will suffer. Just look at 111. Historically the high pay and esteem seem to go to those inhabiting the backwaters of medicine. It should be simple to reverse this, incentivise A+E/MAU/GP docs and watch the system improve.

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  • I could write a book on this subject but for the benefit of everyone's sanity, I will summarise.

    Pharmacists are highly intelligent, highly capable professionals. They are experts at managing medicines - from reconciling discharge summaries to managing ongoing audits. Their in depth knowledge of therapeutics means they have a significant role in polypharmacy so are potentially a huge asset for the elderly, especially in nursing homes.

    I think they should definitely be part of a primary care team as they are better than GPs at performing certain tasks.

    BUT there is a big BUT. They can assist with GP retention as they make the job more manageable and the days less long. However, I don't think they have a role in assisting recruitment.

    The reason? GPs seeing more patients in place of their medicines management admin is a sure pathway to burnout. We simply cannot see more patients. And I have grave reservations about anyone else examining and diagnosing without the required training attached to it.

    So I definitely think pharmacists can make our days easier. But no way are they the answer to the shortfall of GPs. Anyone who thinks they are, is really undervaluing our knowledge, skills and experience.

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  • Forgot to add - I have been the practice prescribing lead for 10 years and several members of my family trained in pharmacy

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