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CAMHS won't see you now

Do we really need pharmacies?

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It may seem like a strange day to write this blog post, with news of Boots planning to extend its private services to checking sore throats for £8 and dodgy moles for £35 a pop.

Perhaps it is time to break down the barriers between pharmacists and GPs

But I have heard a number of GPs say –  including Copperfield – if you designed the NHS from scratch I doubt anyone would invent pharmacies. Pharmacists – yes. Pharmacies – no.

But is that really fair? I have great respect for pharmacists and their skills (and not just because they withstood the university pharmacology lectures that I fell asleep in).

The NHS recognises that the pharmacy profession – quite rightly – should play a much greater role in the future of primary care. With so many more people living longer, and on a cocktail of medicines to do it, access to their expertise is badly needed. They are absolutely brilliant at what they do, but some question the current position, where their skills are based in a building a few streets away, tucked behind shelves of corn plasters and toothpaste.

As some say: why are we continuing to support this bizarre arrangement when everyone recognises that NHS services must work better together to improve care?

The GP Forward View promised GPs access to a clinical pharmacist for every 30,000 of population, but this could be much more ambitious. The average pharmacy gains 94% of its income from NHS services, so the question is, why not hive this bit off and integrate it with GPs at a stroke by ensuring all practices have a fully-funded clinical pharmacist service in-house, to conduct medication reviews, check repeat prescriptions and take the pressure off hard-pressed GPs. At no additional cost.

And while we are at it, some say, why not remove the archaic restrictions on practices being able to dispense? If pharmacies are able to set up – and charge fees for – services that compete with GP practices then surely every surgery should have the option to dispense medicines right there and then?

If we follow this argument on, we could ditch FP10s altogether and - rather than making patients trog around the corner with a green slip in their hand - give them the medicines they need immediately while they still remember why they need to take them. It is already done this way in hospitals, why not primary care too?

Repeat dispensing could be done by post – so shorter opening hours would not be a problem - and the non-NHS ‘drug store’ part of the business would still exist in the larger chains (and is being cannibalised by supermarkets anyway) so there should be no effect on people seeking products to self-care.

Yes, by raising this I am deliberately being a bit provocative to stimulate debate, and I am sure that pharmacists themselves will have other alternative arguments that will refute all I have just said, but there is no doubt that with the NHS facing a £22bn black hole we so have to think differently about how our resources can be used for maximum effect.

We can see the effects where GP practices and pharmacies compete for resources in the (inexplicably) recommissioned pharmacy flu vaccination service; uptake rates in all target at-risk groups fell this year. So perhaps it is time to think more radically and break down the barriers between pharmacists and GPs for good. Perhaps one way is to stop supporting the pharmacy model?

Nigel Praities is editor of Pulse

Do you agree with this idea? Or do you see the value in retaining community pharmacies? Please leave your comments below

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Readers' comments (34)

  • Unlikely to survive legal challenge ala Feed in Tariff changes though. More likely GP-land will be consumed by the VC funding giants behind the major pharmacy chains than that GPs will suddenly find space to do this.

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  • Or train pharmacists as independent prescribers so patients can get what they need without a month long wait

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  • Anon@4.10 - go for it. Do you have any idea what indemnity costs?

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  • Colleagues- if we are going to debate this PLEASE let's do so in a spirit of professionalism and mutual respect.

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  • We could say this about many professions that are around today. Community Pharmacy is a specialism of a pharmacist, if the NHS ends (note Mr Hunts past publications) Pharmacy would thrive like it has done in the US with ever more services. Suppose what I am saying time will tell.

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  • Because pharmacists rely on the private retail income to boost their pittance of an NHS income. If the private retail transferred to practices, the profits will go to partners- who are mostly GPs.

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  • Anonymous | GP Partner09 May 2016 4:40pm

    Surprisingly small actually.

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  • Yet more ignorance from a physician about pharmacy, Shaba. Some 90-95% of a pharmacy's income is from NHS dispensing. Less than 5% is from OTC sales.

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  • "if you designed the NHS from scratch I doubt anyone would invent pharmacies. Pharmacists – yes. Pharmacies – no."
    I would also suspect you would not invent private GP practices either.

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  • The model has not been fit for purpose for years.. but good luck taking on the wealthy pharmacy multiples and their cash cow.

    Thought we would have had at least some GP engagement in this debate.

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