Emma Wilkinson finds how GP practices are having to support patients who can’t afford basic medicines
Calpol is the most shoplifted item in one area of East London, the headlines blared, with the cost-of-living crisis leaving people unable to afford even the most basic medicines, a situation the local Mayor described as ‘utterly devastating’.
Indeed, GPs around the country have told Pulse that they are seeing more and more patients coming to ask for prescriptions for over-the-counter (OTC) medicines for minor conditions because they simply have no money to buy them.
From paracetamol to antihistamines, emollients to eye drops, patients who could or have tried to get help at the pharmacy are coming to the GP because they cannot pay for the medicines they are being advised to take.
Patients get stuck in a loop moving from the practice to the pharmacy wasting everyone’s time, say GPs. General practice and community pharmacy are in strong agreement that there is an urgent need to put something in place to help the most vulnerable people manage minor illnesses.
Wales, Scotland and Northern Ireland already have Pharmacy First schemes in place and pharmaceutical negotiators (PSNC) in England have been lobbying hard for a similar fully-funded pharmacy walk-in service.
They estimate there are 36 million consultations in English pharmacies every year where the person would have otherwise gone to the GP or A&E. In a briefing to ministers last month PSNC said they are ready and willing to divert patients with minor illnesses away from GPs who are under ‘unprecedented pressure’ but cannot do it without funding.
Minor ailments schemes
Go back less than ten years and minor ailments schemes were in place across the country. Yet NHS England’s ban in 2018 on spending on OTC medicines led to most schemes being decommissioned as not good value for money.
The Community Pharmacy Consultation Service (CPCS) introduced in 2019 is often no help to those on the lowest incomes because they have to pay for the medicines so end up getting referred back to the GP, notes Dr Richard Vautrey, assistant medical secretary at Leeds LMC.
‘This is a big issue, particularly in the midst of the cost-of-living crisis. It is one of the flaws of the CPCS as patients who would otherwise get a free prescription may be asked to pay for the same item when directed to the pharmacy.
‘Pharmacy First schemes with a clear list of items provided free to eligible patients are fairer and the community pharmacy scheme needs to be reformed so patients get the same free treatments wherever they are seen.’
Post-pandemic the decommissioning of minor ailments schemes seems incredibly short-sighted and GPs in the most deprived areas are seeing the impact every day, says Dr Selvaseelan Selvarajah, a GP in Tower Hamlets, the area where Calpol thefts hit the newspapers.
While patients in the more affluent parts of London may not have even known the minor ailments service existed, more than half the children in the borough live in poverty and people relied on it, he adds.
‘That headline about Calpol being the most stolen item is just so tragic and there is no need for that to happen.
‘We do total triage and often when you signpost patients to the pharmacy you get a message back saying I can’t afford eye drops or Calpol and that is not something we saw back in 2018. I prescribe because it is the right thing to do.’
But he adds the absence of a proper minor ailments scheme – as well as harming patients – costs more in the long run. ‘It is more expensive for the system overall because you get patients just bouncing around the system.’
Tower Hamlets LMC and others in North East London have been campaigning for some sort of minor ailments to be reintroduced and they are having ‘positive’ conversations with the ICB who know there is a real problem but need to find the money.
He believes that NHS England are so distracted by the recovery that it will prove more fruitful to work with local commissioners to get something in place – perhaps even restricted to the most deprived areas.
There are some small local schemes still dotted around. Dr Paul Evans, a GP in Gateshead said patients being unable to afford over the counter medicines is ‘absolutely’ a real problem. ‘We do, however, have a local pharmacy scheme that enables them to get certain OTC meds free.’
But in Sheffield Dr Susie Lupton, a GP in one of the most deprived areas of the city says having a local scheme in place is not always enough.
‘We do have a minor ailments scheme for some patients in Sheffield and have done so for many years.
‘However, it really depends how good your local pharmacy is so patients still ask us and use up many appointments in poorer areas.’
She adds that shortages of pharmacy staff and they pressures those teams are under compounds the problem. ‘If this is say 20 patients a day for us then how can one pharmacy cope with that volume.
‘Pharmacies also often run on locums and some may not have done the training to do minor ailments and then patients we have signposted come back to us, it’s a farce and wastes everyone’s time.’
Dr Lupton says they also see many working people who cannot afford their prescriptions. ‘We have had people who have delayed getting antibiotics and ended up in hospital or stopped chronic disease medication with likely life shortening results. This is not new but it is worsening.’
ICBs decommissioning services
In Nottingham, a Pharmacy First type scheme which had been in place for two decades came to an end in March when the ICB chose not to continue the service.
Local pharmacy representatives warned this had come at a time when people could least afford it and had tried to put forward options for keeping it in place.
Dr Hussain Gandhi, a GP in the city said he had definitely noticed an impact. ‘The number of patients contacting for eye drops for minor irritation, scabies treatments and hayfever treatments has risen significantly and blocking access for other patients.
‘There has also been a rise in those asking for paracetamol and ibuprofen on prescription, especially for children.’
The RCGP say solutions need to be found so that all patients can access the care they need.
RCGP vice-chair Dr Victoria Tzortziou-Brown, told Pulse:‘It’s concerning to hear that some patients are being priced out of being able to look after themselves by taking the initiative to buy over the counter products, instead of going to the GP, but not being able to afford them.
‘This is, unfortunately, becoming the reality for some of the UK’s more deprived communities which have seen worsening health inequalities.’
She adds: ‘GPs are witnesses to the impact of the rising cost-of-living crisis on patients, many of whom are struggling to maintain their physical and mental health with the high prices of necessities like food and heating. It is our most vulnerable patients who are suffering most.’
Read more on our sister title, The Pharmacist: ‘Utterly devastating’: Cost-of-living crisis hits OTC medicines access