Self-care and pharmacy services do not ease GP workload
By Nigel Praities
Schemes encouraging patients to self-care or consult a pharmacist for minor ailments do not ease GP workload, and may even increase it, a new evaluation of pilot programmes concludes.
The study blows a large hole in Department of Health claims that developing pharmacies as ‘healthy living centres' will free up time for GPs to treat more patients with more complex needs.
Researchers analysed data from more than 1,000 patients in three pilots of self-care or pharmacy services - and found two of them appeared to increase GP visits.
In the ‘Self-Care Aware' programme for asthma, patients gained self-confidence about their treatment compared with controls, but were also more likely to see their GP.
‘Pharmacy First', which encourages patients to use a minor ailments service rather than make a GP appointment, received positive feedback from patients but made no difference to GP consultation rates.
A cardiovascular prevention programme in pharmacies and workplaces was more successful, helping patients do more exercise, stop smoking and eat more healthily, but again there seemed to be an association with an increase in GP consultations.
The authors concluded the study – published online by Primary Health Care Research and Development – showed self-care programmes were popular with patients, but might not bring reductions in GP workload.
Study author Professor Mike Pringle, professor of general practice at the University of Nottingham, said: ‘The idea all these consultations can be seamlessly moved to another health professional is unrealistic. What we can do is involve the pharmacist in the team and over time people will choose which professional they wish to go to.'
The Department of Health's impact assessment for its pharmacy white paper estimated over half of the 57 million GP consultations for minor ailments could be shifted to pharmacies, cutting GP prescribing by £300 million.
But Dr Peter Fellows, a member of the GPC prescribing committee and a GP in Lydney, Gloucestershire, said: ‘The Government is trying to provide cheap doctors, which undermines the skills of the GP.
‘Pharmacists do have a role in educating patients on minor ailments, but I don't think they should be pushed into a new role.'
The DH said it was committed to working pharmacy leaders about how minor ailments schemes could best be incorporated in the community pharmacy contractual framework: ‘Other studies have shown such schemes can be more convenient for people, offering more choice and value for money.'Research vs Government
Minor ailment services
DH: ‘Such a service, while not releasing cash to use elsewhere, could help reduce pressures on surgeries'
Research: No significant difference in numbers of GP consultations
DH: ‘Many people do not want to spend any more time than is necessary visiting their GPs and going to hospital'
Research: ‘Small but significant rise' in numbers of GP consultations
CVD management programmes
DH: ‘Pharmacies offer an excellent point of contact with the general population'
Research: ‘Participants reported significantly more risk-reducing behaviours'
Sources: Primary Health Care Research and Development 2009; early online Feb 2009; Pharmacy in England: building on strengths – delivering the future, April 2008