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Pharmacists are just as capable as us at negotiating useless contracts

Dr Copperfield

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?

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Readers' comments (10)

  • Well said TC
    In my opinion they do generate work for us (medicines management and community)
    worried about litigation,complaints etc
    Until they can no longer pass the buck to us(including lots of other so called professionals) and act as true independent professionals responsible for their own opinions/actions etc
    our work will not decrease..............
    When will Boris privatise us and free us?

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  • Agreed Hawkeye, an element of privastisation is the key

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  • Pharmacists only increase work for GPs - 2 patients go to pharmacist to try to self manage, first to buy some antisan stuff for insect bite, pharmacist says 'oh I can't sell you that it's infect see your GP urgently'. It wasn't infected. Secondly mum wanted cough syrup for snotty child 'oh he has green snot so he needs antibiotics - see your GP urgently'. He didn't need antibiotics.... This will be a disaster, it just opens up a suggestion to see a GP to a bigger audience!

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  • They are paid per appointment. A novel idea. Could work in general practice. Why don't we try it?

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  • bma is the problem for doctors--useless gong chasers

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  • Óral rehydration sachets when reconstituted taste like Ribera and salt. Drinking ordinary tap water is another good way to become rehydrated - when your pee looks the same colour as the tap water you have rehydrated.

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  • Here's an idea - let people take some responsibility. If you think you don't need a medical opinion, and just want to buy some medication then see a pharmacist. They can only give you something deemed appropriate for a pharmacist to issue. If you think you need a medical opinion then see your GP, who is medically qualified, and has trained for years. The GP will advise on management, and will not profit from what they recommend. Don't waste money that should be coming into GP on poorly thought out schemes like this.

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  • Dear All,
    Advising Dioralyte is bad enough, but many of our colleagues actually prescribe the stuff. That really is a scandal.
    Regards
    Paul C

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  • @ Paul Cundy : NHS regulations requires us to prescribe dioralyte, on pain of striking off!

    But at £14 for 10 minutes, even without sales kickbacks, it would appear they will earn more than me!

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  • Payment per patient seen or dealt with should be the way forward, just like lawyers. They even charge you for preparing and reading. Imagine reading on diabetes and charging for that and the time taken to see the patient. The lawyers really milk people.

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