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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)

  • GPs are experts in diagnosis. I am not a GP so I am not, nor do I claim or pretend to be. As a pharmacist, I am an expert in medicines and their use. How about we start working together for the benefit of patients? As such I'd propose this to be a long term plan...

    GPs remain the first port of call for all long term conditions (with referrals from pharmacy as part of a national minor ailments service where appropriate). Once the patient has a diagnosis, the GP writes a clinical management plan (CMP; I am sure templates would cover 95% of the population so minimal additional work needed) and the patient goes to that pharmacy of their choice.

    The pharmacist (as a supplementary prescriber) would then take charge of that patient’s care, working within that CMP, only referring back to the GP should there be any issues. Simple hypertension, the CMP could specify that the pharmacist could supply anything from ACEIs/AT2RAs, statins, diuretics, dihydropyridine calcium channel antagonists, antiplatelets. Anything outside of this would involve referral back to the GP; likewise, should the BP not be adequately controlled, the patient would be referred back. Pharmacies would be able to either take bloods themselves or have some sort of appointment system with the surgery.

    Warfarin, asthma, COPD, type 2 diabetes, for example could all be managed in a community pharmacy. No more hours of signing off repeat prescriptions. More time to see patients.

    Pharmacists benefit as their skills are better used. GPs benefit as they see more patients. Patients benefit as they can get to see a GP in a more timely fashion.

    Thoughts?

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  • As a pharmacist I agree with the article. However the Company Chemist Association representing the corporate interests of Boots et al and their shareholders, as well as other multiples have a monopoly on the Pharmaceutical Services Negotiating Committee who negotiate funding from central government to disproportionately favours the vertically integrate supply chain models of the big multiples.

    Pharmacy funding needs to be wrestled away from this community pharmacy centric negotiating committee and be distributed to other areas where KPI's that improve care quality for patients can be demonstrated for instance to employing a practice pharmacist. Doctors surgeries should all be allowed dispensaries which is run by a team of dispensers. The Practice Pharmacist, employed by the practice can screen all the prescriptions clinically, with full access to the patient records to see what is actually going on to with the patient and perform all the other roles of a practice pharmacist.

    This will be a much smoother system for the GP's, more money for GP's to re-invest back into the NHS, better utilization of the skills of a pharmacist and simpler for the patient. The NHS isn't then lining the pockets of the shareholders of Wallgreens Boots Alliance and Celesio and co. the system is much more efficient use of NHS money.

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  • what a lot of pharmacists free to write on GP websites in the middle of the afternoon on a weekday - are they all closed for the half day I wonder?

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  • https://pharmacyinpractice.org/2016/05/10/do-we-really-need-community-pharmacies-pulse-misses-the-point/

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  • I think this is an insightful piece and if we could all amalgamate without anyone losing out I am sure we would all agree. In our small rural area we dispense to 80% of our patients apart from a few hundred in a 1 mile radius of a pharmacy. This pharmacy receives 50K per year government subsidy to stay open as it is deemed too small to survive otherwise. I suspect it will survive long after we are no longer viable. It seems a puzzling use of NHS resources.

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  • Anonymous | GP Partner 12 May 2016 11:49am

    In the interest of fairness, you do get more than double their dispensing fee, which in itself is subsidising you.

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  • More inciteful than insightful.

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  • Martin Harris

    As a pharmacist and GP take interest in this story. There was one London area than PCT contracted for patients to seek pharmacist, receive OTC and relieve the GP pressure-it worked. Just want to be careful of falling into the trap: "this one is going to save you time."

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  • Martin@4.52 The evidence from a properly-conducted study shows that a nationally-commissioned, pharmacy-led common ailment service would free up 57million GPs appointments a year and save over £1billion pounds. Would GPs then be sitting around idle? Methinks not! How about using the freed-up time to give 15minute appointments to the complex patients who need it?
    Regards
    Graham

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  • I've retired now after running my own pharmacy for thirty years, but had I the opportunity to work as a pharmacist in a GP practice + pharmacy then I'd have jumped at the chance, but only as a partner, not an employee.

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