Can pharmacists really absorb GP workload?

The Government’s recovery plan for general practice leaned heavily on pharmacists taking on workload. Eliza Parr looks into whether this is feasible

During Thérèse Coffey’s short-lived tenure as health secretary she made a number of pledges to improve access to primary care. The most memorable perhaps was her instruction to GPs to offer an appointment to everyone who needs one within two weeks. But further down the list was a focus on community pharmacy. 

The plan committed to expanding the range of services from pharmacies by allowing pharmacists to ‘manage and supply more medicines, without a prescription from a GP’. At the time, the Department of Health and Social Care (DHSC) claimed this could free up to two million GP appointments a year. 

Prescribing contraception was mentioned specifically in this plan, and seven months later tier 1 of the NHS Pharmacy Contraception Service launched. Currently, the service allows community pharmacies to manage ongoing monitoring and supply of repeat oral contraception that has already been initiated by a GP or sexual health service. But pharmacists were not queuing up to sign up: two days into the service launch in late April, only around 4% of community pharmacies had come forward.

Now, the Government has made community pharmacy central to its bid to ‘empower patients’ in the long-awaited new recovery plan, published yesterday. It promises £645m to launch a new Pharmacy First scheme, expand the contraceptive and blood pressure services, and invest in IT services to give pharmacies greater access to patient notes. According to the plan, once scaled up this could save up to 10 million GP appointments a year, which equates to 3% of all appointments. 

Pharmacy First

Pharmacy First, due to launch before the end of 2023 subject to consultation, will allow pharmacists to prescribe medicines, including antibiotics, to treat seven ‘common conditions’: sinusitis; sore throat; earache; infected insect bite; impetigo; shingles; and uncomplicated urinary tract infections in women. This will be a new nationwide scheme for England, but similar services are already available in some areas locally, for example Cornwall, and nationally in Scotland and Wales. And while antibiotics were not specifically mentioned in Coffey’s ‘Plan for patients’, it was widely reported at the time that obtaining antibiotics from pharmacies without seeing a GP was in the works. 

In response to these reports in October, the BMA’s GPC warned against making antibiotics easier to access, with deputy chair Dr Richard Van Mellaerts saying this was neither good for patients nor the way to reduce GP pressures.

Dr Selvaseelan Selvarajah, a GP partner in East London and a director of Greenlight Pharmacy, says he is ‘not opposed to pharmacies having a greater role’ but flags risks around appropriate training, antimicrobial resistance and pharmacists’ integration with GP systems.

He also says the 3% reduction in GP appointments will not make a massive difference: ‘My concern is that they are putting around £640m into this scheme – would that money be better spent elsewhere in the health system?’

And it doesn’t seem the Government has done any specific pilots on the Pharmacy First service. When our sister title asked DHSC whether there had been any research conducted, a spokesperson said had not commissioned any research regarding the feasibility, impact and cost of a Pharmacy First Service in England. They stressed they had looked carefully at existing locally commissioned schemes in England and the devolved nations.

Unlike other figures in the recovery plan which appear to have been ‘re-targeted’, the £645m funding pot for expanding the role of pharmacy over two years is new. But the Pharmaceutical Services Negotiating Committee (PSNC) said it is not yet known how the pot will be allocated between services, while many in the sector questioned whether it would be enough to address pharmacy’s funding shortfall, according to our sister title The Pharmacist.

Self referral

Another strand of the Government’s bid to empower patients is mandating ICBs expand self-referral pathways by September this year. The recovery plan itself flags that this instruction has already been published, pointing to NHS England’s Operational Planning Guidance for 2023/24, which came out in January. Here, systems were asked to put in place self-referral routes to: falls response services; musculoskeletal services; audiology; weight management services; community podiatry; and wheelchair and community equipment services.

Some of these services, for example NHS physiotherapy, are already locally available via self-referral, however this new instruction to ICBs should make the pathways available nationwide. According to NHSE figures, more than 30,000 people already self-refer each month, and this could rise by up to 50% by March next year if implemented more widely.

In her response to the recovery plan, RCGP chair Professor Kamila Hawthorne said ‘empowering patients to self-refer directly for some conditions’ was one of the initiatives the college ‘has called for’. But despite being ‘positive steps’, none of the initiatives ‘are the silver bullet’. And in 2019, a study found that while introduction of self-referrals to physiotherapists would be cost-effective, there would be increased demand on general practice. 

So while many of these initiatives may go some way to ’empower patients’ in getting access to health services, it is unclear whether they will help ease pressure on GPs.