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GPs buried under trusts' workload dump

'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)

  • Dear Nigel (ed) and all readers- my response to being moderated.
    I would just like to point out that anyone who is 'criticised' could find such criticism 'insulting', but I would quote Abraham Lincoln, "Our critics are our friends, they show us our weaknesses'. It seems ironic that when we are abused in the press and by irrational patients on a daily basis, and expected to be able to cope with it by our college, that those leading our profession seem to be exempt from the rough and tumble that accompanies leadership in this otherwise great publication, if this is indeed what my 'moderation' relates too.
    I spent many years working in a private company overseas. Their attitude was that if you are 'offended' by something then it is your problem, not the 'offenders', as you have been unable to depersonalise it, and we were challenged on what 'being offended' actually means. We choose to be offended at some level, It is an internal emotion. We have control over it. Or, as the Dalai Lama puts it- 'the people we find challenging are those we should embrace as these are the people who come into our lives to teach us our people skills'. This approach allowed for free and frank expression of opinions, and interestingly, I found it a much more productive strategy than walking on egg shells and political correctness. This wasn't meant to engender downright rudeness, but meant to help foster our skills when challenged by 'awkward' individuals so that we wouldn't become stressed in these pressurised situations and remained in control at all times. It also meant meeting were much more time efficient, and less ambiguous.
    Politics is a nasty game, our leaders need to be up to the task to fight for our profession. I take the reporting as being 'offended' as suggestive of an inability to cope in a pressurised environment and further reason to question if those who are 'offended' are actually emotionally robust enough for the role.
    I had a patient cause me of being a 'dirty filthy child molestor' today out of the blue. How should I have responded? And should I be offended? (And no Im not before anyone asks :-)
    I don't think the comments which have been moderated are anywhere near the kind of abuse myself and many of my colleagues face on a daily basis yet we have to deal with these day to day with no recourse in most circumstances. So why is there so much moderation in this forum? I think a discussion around this issue would be helpful.
    I think Vinci Ho has the right idea..... "I might not agree with you, but I will defend to the death your right to say it"......

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  • What a sad tale. We have to be very clear about this sort of anecdote.

    This example is a doctor on the cheap and is worse for patients. Essentially you're saying that everything I do can be done by a pharmacist; just give them a stethoscope and a tutorial or two.

    I am embarrassed this man is an elected GP representative.

    Shame on you.

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  • We must realise that the only reason that there is a drive to replace doctors is because the desire by the powers to be is to reduce costs and improve productivity.

    History has shown that when less qualified people are trained up to perform functions above their normal workstation it is fine for a short while. However when these people are then used to replace more expensive personnel, in time those less qualified people end up demanding more money per hour until there is little difference in pay between themselves and the people they are replacing. As an example in the United States today there is for less pay differential between highly trained nurses and family physicians. Nurses pay has been increasing while that of family physicians has been decreasing.

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  • Thank you MC Hammer 15 Jul 2017 @ 8:16am. Spot on.
    Doctors particularly GPs are their own worst enemy.
    How can any GP in their right mind think that simply giving a pharmacist a stethoscope and a few hours of observation makes them a doctor. Dr Eggitt do you think that what GPs do is so simplistic that this will suffice as 'training' to be a GP? Please do not ridicule the years of training and hard work it takes to become a doctor. Thank you.

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  • If general practice were to become 'contaminated' by too many nurses and pharmacists, the poor cost-effectiveness of the newcomers would not be so clear.
    It would be preferable if primary care systems staffed by paramedicals (presumably with a token supervisory doctor) were entirely separate, then they could be shown either to be the cost-effective, efficient future of primary care, or, as I suspect, an inherently dangerous, inefficient and ultimately more expensive mess. I gather that there are one or two practices in the Grampian area largely staffed by nurses with the latter outcome.

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  • My general experince, from patients accounts of the advice they have been given by pharmacists before they come to see me, and of my contribution to the training of a clinical pharmacist, is that the majority of pharmacists have only the sketchiest understanding of clinical medicine and are a million miles from being able to stand in place of an experienced GP. On the other hand their professional expertise, in areas of primary care to which they are suited by virtue of their training and experience is very much to be welcomed.

    But substitute GS? Never.

    They'll miss us when they've driven us all away.

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  • Pharmacists are excellent business people , I assume any savings by HMG will be short lived

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  • Or you could stop experienced GPs leaving the NHS. Fix unlimited risk of complaints and rising insurance premiums.

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  • Dr Eggitt may wish to consider the points made to a similarly foolish article in the BMJ a few years ago:

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  • Right, my experience of pharmacists is they they just increase my work by sending every patient who tries to buy anthisan to me for antibiotics for 'infected insect bites' ditto for every mum with a snotty kid who tried to buy cough medicine - 'they need to see the doctor' plus those flippping medication reviews that sent the patient scurrying back to the doctor for every twinge and ache, finger prick cholesterols etc, they seem to generate more work then they save!

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