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GPs go forth

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)

  • 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!
    ROGPML

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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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