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A faulty production line

Pharmacy flu scheme 'leaves GPs with £4m loss'

Exclusive The Government’s pharmacy flu vaccination scheme is leaving GP practices with a predicted £4m bill without reaching intended groups, GP leaders have claimed.

The latest immunisation data from the Pharmaceutical Negotiating Services Committee showed that pharmacies have administered some 470,000 (5%) out of 8.9m flu vaccinations recorded by Public Health England to date this season.

The GPC said the figures could translate to a combined £4m loss to practices in flu payments, money they had budgeted to provide other key services throughout the year.

One practice had already estimated the cost to general practice could be as much as £4m, ’money that could have been spent on caring for patients’.

NHS England announced the new pharmacy scheme over the summer, which it said would help boost uptake in ‘hard to reach’ patients, but the GPC warned pilots have consistently shown that pharmacy schemes do not change the overall number vaccinated - and that national scheme would undermine practices.

PHE has said the latest figures on flu immunisation uptake are ‘encouraging’ but GP leaders said the uptake remained largely the same as at the same stage last year. Although there was a marginal increase among some groups compared to last year, including pregnant women, concerns remained about coverage in other risk groups under 65.

And LMC leaders said there was no signs that the pharmacy scheme was reaching the hard-to-reach groups that the Government had targeted, who would not normally visit their GP.

Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, said: ‘What is clear is that while GPs continue to do the grunt-work for the vaccination programme, providing care to about 19 out of every 20 patients, they are being deprived of resources required to fund their practices.

‘The loss of 5% of vaccinations equates to at least £4m of resource being unexpectedly lost to GPs – money which will have been budgeted to provide services throughout the year.’

Dr John Grenville, secretary of Derbyshire LMC, said: ‘I don’t think we’re seeing an increase in overall uptake in any of the groups – I think we’re just seeing a redistribution of who is being done where.’

Solihull LMC secretary Dr Peter Scott said ‘around one in 20’ eligible patients who would usually have been vaccinated at the practice in previous years had opted to be seen in a pharmacy instead.

He said: ‘That has been the figure, so we are left with 5% of our vaccine undesignated. These are all low-hanging fruit. Not one of them was by any definition what I would call a hard-to-reach patient, a patient who would not ordinarily have seen us. None was receiving their first flu jab.’

NHS England said that as with ‘all new schemes’, this one would be reviewed and evaluated ahead of next year’s flu season but maintained that patients had benefited.

A spokesperson said: ‘The new community pharmacy service extends choice for patients wishing to get their flu vaccination in an accessible and convenient location.

Since the scheme got underway GP leaders have been warning this year’s flu immunisation campaign risked becoming a ‘shambles’, partly because of confusion caused by pharmacists, with some wrongly informing people their GP is too busy to give them the jab this year.

Correction: The story was updated 18 Dec to clarify that the £4m loss to practices is due to lost item of service fees, rather than unused vaccine

Readers' comments (30)

  • NHS England gave pharmacists the opportunity to provide flu vaccines in a deliberate attempt to destabilize general practice finances and line the pockets of pharmacists. NHS England has plenty of otherwise unemployed pharmacists, active in its ranks and devising ways of employing and funding their professional colleagues.
    It has become unviable for GP practices to mailshot their patients in the face of a dwindling return for their investment and this has lead to a breakdown in the coordinated recall system that worked so well.
    Pharmacists represent a massive threat to GP’s. In spite of lacking the skills of doctors, these retailers wish to muscle in on our work and are happily misrepresenting their skills (or lack of) to achieve this. Most people are shocked to learn that pharmacists have absolutely no training in diagnosis. So why do we tell people to see their pharmacist when they are unwell?

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  • This comment has been moderated.

  • I am pretty sure that our unused vaccinations can be returned without a loss to the surgery.

    We do lose out on not giving them (which is a major issue), but not because of wasted vaccinations.

    I think that spreading the vaccinations was always going to make the scheme work less well - but spinning the outcome benefits nobody.

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  • Slightly unfair. Pharmacists have been commissioned to do flu jabs and are trying their best to do so, within the constraints of the PGD and our access to records.

    On the whole I don't think that we are after your business and I was trained to respect the superior knowledge and training of the GP.

    In reply to the earlier comment. We are trained to diagnose minor conditions and if we weren't there to field these patients then GP's would be even more under the cosh.

    I also feel that this website churns these allegations out time after time with no evidence whatsoever, with the sole aim of stoking the argument between professions.

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  • I don't think that we as a practice are going to have unused vaccines on our hands as a result of the pharmacists carrying out 'Flu imms. In our surgery pharmacists have done around 50 out of 2 700 which is a statistically insignificant sum. However these 50 so called "hard to reach patients" are without exceptions able bodied individuals who have had regular 'Flu immunizations in the past and were consequently not exactly hard to reach OR were non at risk patients immunized privately. And then of course we have to do the work of entering the data onto the patient record as well-that's if they bother to send it. And then telling the patients "have it here and it will save your surgery the work". In other words cherry picking some easy patients, getting paid in excess for doing it and leaving us to enter the data. Cannot say that I am overly impressed with this. We as a surgery have very high coverage rates 83% of 65s last year I cannot see a pharmacy getting anywhere near this.

    So all of this for what? A few patients having their jab at a slightly more convenient time / place?

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  • A DH/NHSE spokesman called Ivan said 'we applaud the (predetermined) success of this scheme in improving patient choice'.

    Mo - We welcome....

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  • To 11.56
    Here we go again, trying to give the impression that your colleagues are trained in minor illness. The vast majority of pharmacists have not been trained in this. Whilst pharmacists can opt to do a minor illness course, it is not a standard part of their training. Furthermore, there is no revalidation of pharmacists.
    Pharmacists should stick to what they know. When I visit a restaraunt I expect the waiter to serve the food, not cook it.

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  • Integration? No

    Fragmentation, duplication, inefficiency, waste, confusion, professional resentment

    Any advantages of this scheme?

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  • Anonymous | Sessional/Locum GP17 Dec 2015 12:33pm

    Minor Ailment schemes are merely a vehicle for patients to get over the counter medicines without having to pay for them. Pharmacists are trained to deal with these ailments otherwise we would not be allowed to sell 'pharmacy only' medicines.

    Nice analogy about the restaurant. Friendly, hardworking and approachable waiter out front and aloof, self-righteous chef in the back. Takes both to make the restaurant work efficiently. That one was a tongue in cheek response for you and not for the GP's who don't feel threatened by pharmacists. There is no need to be as we can't do a great deal of what you do. That doesn't mean that there are jobs that you need to pass on if you are not to be swamped.

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  • If a flu jab was so hard to do then you wouldn't delegate it to someone who was answering the phones last week.

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  • The Pharmacist's Hymn:
    "Take this and if you are getting worse or not better very shortly go and see your GP as soon as possible."

    When waiting my turn I cringe to hear most pharmacists taking histories and advising. Most of their profit making "medicines" we stopped prescribing due to lack of evidence years ago.To be fair they do not get their feedback- we do and it teaches us a lot about the in-effectiveness of most of the stuff.
    One ancient way of paying doctors was to do so whislt one was well and stop it wnen ill till better.Consider that below.
    GBS's statement about private medicine fees is very applicable to pharmacies"If you pay a judge only to find accused guilty would it influence them in their judgements?.
    I have been trying to teach patients not to seek treatment but to let nature take its course with advisements of course.This takes time and sometimes extra reviews. This principle is undermined by some other professions. The pharmacy ethos is to make profits. I have never heard of a pharmacist just giving advice though I suppose this is possible.
    Their selling tactics undermine the priciple of natural cures where-ever possible.
    The NHS to some degree acts like the ancient payment method. If you do not satisfy your patients they will come back more often - more work less pay.
    Unfortunately if you are a hateful doctor you may frighten them away makeing your colleagues overwork.These do exist.

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  • To Arrogant, sorry, anonymous session/locum GP -
    MOST GPs are forward-thinking and supportive of what Pharmacists can do. I can only surmise from your foam-flecked rhetoric that you can not be counted among them and you use anonymity to hide your own short-comings. That, I feel, is to the detriment of you and your patients and I am pleased you are not representative of those of your profession it is my pleasure to work alongside

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  • One aspect is not covered in the comments above. Surgeries maintain the clinical records and produce the lists. We send out mail shots, text and phone patients to get them in. We hold Saturday flu clinics where a doctor is present and the nurses get time and a half. All this costs a great deal. The drop of 5% in uptake can make the difference between profit and loss. I know that doctors are not meant to consider economics but when you are going through the through a GMS contract imposition you have to question everything. Next year I will reduce my vaccine order and if the enhanced service becomes unviable we will consider not opting in for future years. What will NHS England do then?

    They talk of patient choice. More like the wild west. The system was not broken; it is now.

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  • Here we go again. We want cooperation between health professionals not criticism and competition. There are good doctors and not so good doctors just like pharmacists. I can still remember some of the prescribing mistakes I have had to correct during my career. The NHS needs us to work together respecting each others slightly different skills.

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  • Jose Mourinho has just been sacked as Chelsea manager. See what happens when you disagree with a doctor...

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  • Time wasting excercise. There should be central hubs with administrators doing home visits.

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  • As a practice nurse I have given hundreds of flu vaccinations to patients this season. I see patients who rarely visit their GP. This gives me the opportunity to check their electronic notes & bring them up to date with annual reviews.

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  • According to the GPC “A GP, even a dispensing GP, is not allowed to sell any ‘over the counter’ medicines.”
    According to the Telegraph this is to “make sure that decisions to recommend medication are based solely on clinical factors.”
    But it’s ok to tell patients to consult with someone whose significant interest is to make profit from the sale of medication.
    Anyone else spot the contradiction here?

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  • I have been told that one of the highest performing pharmacies in the country for flu jabs is owned by a group of GP's.

    Is that ok?

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  • Dispensing GP. Anyone spot the conflict there?

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  • DH just announced 6% cut to community pharmacy contract

    "GP practices allocated 4% funding boost every year until 2021" whose "pockets are being lined" Anon Sessional/Locum GP?

    If some GPs "don't see Flu jabs as viable in future" there is somebody whos income is about to drop waiting in the wings to step up!

    Pharmacists DO have a role to play in managing patients health and minor illness and providing clinical services to patients whether egotistical Locum/sessional GP likes it or not. The "commercial interest" of pharmacists is negligible at most as most pharmacy income comes from NHS services (90%) . Most pharmacIES are owned by a multinational conglomerates and pharmacISTS get a salary like any other employee, they usually have little concern in what buying choices patients make [Patient: "I'll stick to the Nurofen because its got a nice shiny packet and an advert with a target in it so it must be better than the generic Ibuprofen which you're recommending as its cheaper/the same, thanks anyway though Mr. Pharmacist"] .All businesses need to make a profit though, otherwise they are not sustainable, whether thats a pharmacY or a General Practice. The double standards of "pharmacists are only in this for the money" vs. "I'm really upset beacuse I'm losing profit is laughable!"

    Can't we all just get along for the benefit of the NHS, ourselves and most importantly the patients? If they make a choice to get their jab from a pharmacy for whatever reason they choose, should we be denying them that? Particularly in the era of Patient Centred Care

    Rant over!

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  • Has anyone else noticed that a significant proportion of the 'flu jabs given to patients by pharmacists were given to patients who weren't in any risk group?

    So, have I got it wrong, or were pharmacists paid to vaccinate patients in respect of whom GPs would *not* have been paid? If not, then how would pharmacists have known who was entitled to receive an NHS-funded vaccination?

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  • Ref: Anonymous 9:12 - Any patient not in a risk group is not eligible for vaccination as paid for by the NHS; these must be paid for by the patient, therefore this assertion, whilst it may be true that the majority of those vaccinated by pharmacists are not in a risk group (I am not in a position to verify your comments) is a red herring as it does not "divert NHS funds" or "line pockets at NHS expense" - this is a private transaction between the pharmacy & the patient

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  • Dear Anonymous Sessional GP - you comment that Pharmacists are not trained to diagnose and will, in the event of their recommendation not working, refer the patient to the GP. I take from that the following:
    1. You diagnose first time, every time
    2. You never refer on for additional testing
    3. You are Sessional/Locum GP so you may spread your munificence as widely as possible amongst the sick & needy
    Please allow me to touch the hem of your robe as you pass those of us less worthy as we toil in the gutter!

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  • Often i see whinges from GPs when money is used elsewhere than in their own accounts. Public health promotion, personal budgets etc. Now we see it in flu vacs by pharmicists.
    If you can guarantee i can get a flu jab just by walking through the doir to the surgery then i will. Thats how convenient it was for me. Oh, and whst about pharmacists giving health advice - is that taking away your business ir relieving you to do other work ?
    Cake and eat it?

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  • The problem is our NHS Contract with its mixture of private and Contract work.
    Either we resign and go private like Dentists etc or we go salaried. This mixture is becoming untenable as we do core poorly paid work and compete for profit making stuff.
    According to Prof Fields and other Professors eg Thomas, Grant etc we GPs are a failed profession.
    We should resign from the NHS forthwith.

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  • To all whingy locum/sessional GPs out there, I invite you to my workplace to see how many patients that kick off because I have refused to sell them a product which is of no benefit to them. As Mr Conibere mentioned earlier, I don't own the business and am one of the many pharmacists out there who have little interest in selling something that has no evidence base behind it. Maybe you need to develop a better understanding of the pharmacy business model? I suspect you might be one of the sessional/locum GPs that are happy to prescribe antibiotics for common cold symptoms and simple sinus infections on any given Saturday or Monday morning, just to appease the patient.

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  • OK, let's assume that we live in an imaginary world where pharmacists know nothing about diagnoses (and we just sit and make ointments for four years). What do pharmacists do know about? Medicines, their action on the body, their interaction with each other, etc.

    Seeing as physicians (unless you have a teaching degree, you ain't a doctor) are pretty poor at prescribing (9% of hospital prescriptions contain an error according to the GMC), why not stick to diagnosing and leave pharmacists (the experts in medicines) to prescribing and monitoring could be shared/the role of one group? As a side effect (pun intended), watch the drugs budget fall as formularies would be used and wastage minimised.

    Oh look, there's a pig flying over a freshly frozen hell, lit by blue moonlight...

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  • Sticking with the issue of flu jabs. It is one of convenience. Countless patients left my consultation room saying how much simpler the process of getting vaccinated was this year.

    You can't spend the whole year discouraging patients from coming to see you and pushing them elsewhere and then complain when they do exactly that come flu jab time.

    Pharmacists see their patients much more often than GP's so I can see the logic.

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  • I think 11:05 is being a bit harsh on pharmacists, and that is from someone not happy with this years change.

    We have had to work so much harder this year to try to stay static, it is not the most efficient use of NHS resources. We haven't been able to do another tranche of letters out to patients as they become unviable and we are spending too much time getting patients in for a flu jab,when we could have been offering other services.

    Because of pharmacy competition, we will be ordering a lot less flu vaccine unless we get a better deal to send those unused vaccines back to the suppliers.

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  • As usual I am not going to hide behind the "anonymous" cloak (which tends to be used by the bilious, vacuous, and gutless). Rather than blame pharmacists (whom some seem to think are all millionaires but average salary is c.£39k per annum per whole time equivalent and dropping), why not direct your ire towards the grinning weasel Hunt. After all, he's the one who launched this grand scheme. He must laugh when he sees how apparently easily he can divide and conquer.

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