Pharmacists are just as capable as us at negotiating useless contracts
There’s a new contract in town. This time it’s for community pharmacists, that is those community pharmacists who haven’t already jumped ship to a PCN. And, just in case you missed it, the highlight is a new Community Pharmacist Consultation Service (CPCS), which involves pharmacists taking referrals from 111 to provide same-day appointments for minor illness and being paid £14 a time for the pleasure.
Now, being a stressed GP constantly moaning about my workload, I don’t want to appear ungrateful or cynical, but I am. And that’s because I’ve thought through how this might work, and I can imagine, by way of examples, the following couple of scenarios:
1 A patient attends the CPCS with a mild tummy bug. Because he’s in a shop, he is flogged loperamide, oral rehydration sachets, and, via a three-for-two deal, some vitamin pills to ‘Boost his immune system’.
2 A woman attends the CPCS with thrush. The pharmacist points to OTC clotrimazole, the patient points at the price, and the pharmacist points to the local GP – where, being one of the 80+% of patients who are exempt from prescription charges, she can get her treatment for free.
So what has been achieved here?
I don’t want to appear ungrateful or cynical, but I am
The pharmacist contract blurb highlights that around 20 million GP consultations per year do not actually require a GP appointment. The mistake politicians make is to imagine that most of these people need an appointment with anyone. They don’t. They need a basic level of health literacy, a dose of common sense and, possibly, directions to a pharmacy (though not a pharmacist). So the result of scenario one is unnecessary medicalisation, the fostering of dependence, the promotion of unnecessary or pseudo-treatment and a shopkeeper’s opportunity to make a few quid.
Scenario two illustrates that those minor ailments genuinely needing treatment may well end up on the GP doorstep anyway, simply because of the vagaries of the prescription system. So the result of scenario two is, a delay for the patient, £14 in the pocket of the pharmacist and the conquering of candida requiring input from three separate NHS agencies.
It makes you wonder whether this new contract has been thought through. Now, where have you heard that before?