‘Pharmacy First’ schemes are not an attempt to replace GPs and should be seen as an opportunity to work collaboratively with other parts of primary care, sector leaders have said.
The pharmacy sector was responding to comments made last week by the chair of the RCGP, that pharmacists are not a substitute for GPs and must not be seen as ‘GPs on the cheap’.
This followed the publication of the All Party Parliamentary Group on Pharmacy’s report, which called for an appropriately funded national pharmacy walk-in service for minor ailments, funded independent prescribing (IP) training for all existing pharmacists, and more clinical services to be commissioned nationally through pharmacies.
And in a letter sent to Prime Minister Rishi Sunak this month, pharmacy leaders said that investment in community pharmacy could deliver ‘cost-effective solutions to patients at pace’.
Professor Hawthorne warned that pharmacists should not be seen as ‘a substitute for GPs’ and added: ‘Pharmacy also has a workforce crisis, and their premises infrastructure will need considerable upgrading to be able to offer confidential services to patients. If implemented, this is not likely to be a money-saving option.’
But Helga Mangion, policy manager at the National Pharmacy Association (NPA), responded: ‘It is a little bit out of date to suggest that pharmacies lack the facilities to offer confidential services, as most now have consultation rooms, and in many cases more than one.’
In a statement to Pulse’s sister title The Pharmacist, she also said: ‘Pharmacists don’t want to be substitute doctors, as we are hugely valuable in our own terms, as accessible medicines experts and healthcare practitioners. Community pharmacists can certainly help relieve GP workload, but that’s not the same as replacing them.
‘With more independent prescribers coming on stream in the next few years, there will be opportunities to think differently about where and by whom care is delivered, benefiting patients. But there will always be room for both professions and their distinctive skills and roles, working collaboratively across primary care.’
Janet Morrison, CEO of the Pharmaceutical Services Negotiating Committee (PSNC), told The Pharmacist that the plans for pharmacists to do more was ‘not an attempt to replace general practice or to pit one profession against the other’.
She added: ‘Many GPs, including their negotiators, now tell us that they support a fully funded Pharmacy First service as they know this will help to ease pressure on them while also making best use of the skills that pharmacy teams have.
‘Pharmacists operating at the top of their professional competency will enable GPs to do so too. Better use of all the competencies in primary care will deliver better access and quality of care for patients.’
Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA) told The Pharmacist that that the CCA was ‘delighted that Professor Hawthorne recognises the excellent work of community pharmacist providing invaluable support to patients in primary care, against a backdrop of huge workload and workforce pressures.
‘We also welcome Professor Hawthorne’s view that pharmacies should be given the support they need to stay viable and available for patients.
‘The CCA and its members do not see community pharmacies as a substitute for GPs. Pharmacies can, with the correct funding, provide invaluable clinical care for patients with minor illnesses and conditions, meaning that they do not need to see their GP. Commissioning pharmacies to deliver such care will help to build capacity and resilience across primary care.’
Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp), said that pharmacists must be paid appropriately for the services they provide, rather than being seen as ‘GPs on the cheap’.
‘Community pharmacy does not want to become the pound shop of the healthcare sector’, she told The Pharmacist.
‘Pharmacies have an important role to play in primary care and their knowledge and professionalism are trusted by the public,’ she added.
‘For many years our sector has been underfunded and our undervalued by those in position of power. Pharmacy can offer many solutions to the NHS and pharmacists as professionals, clearly, will always expect a professional fee for the professional services that they can deliver.’
Stephen Thomas, superintendent pharmacist at Rowlands Pharmacy, said that it was ‘surprising and disappointing’ to hear about the RCGP comments.
‘Community pharmacy has never positioned itself as a “cheap” alternative to GP care. Rather we have said people want, need and value the right care, at the right time, provided by the most appropriate healthcare professional.’
He added: ‘Expanding the role of community pharmacy (with an appropriate, significant funding uplift), which the NHS desperately needs, has always been within the context of professional competency. We are not there to “substitute” for GPs but rather work with them as allied professionals dedicated to patient care. We can deal with minor ailments, but also ‘red flag’ conditions which a GP needs to be aware of.
‘In Scotland we see a pharmacy first approach which enables GPs and pharmacy teams to play their respective and inter-related professional roles in caring for their communities. That is the way forward.’
Professor Hawthorne also said: ‘Our high street and online pharmacist colleagues do an excellent job for their communities and are providing invaluable support to many GP practice teams against a backdrop of huge workload and workforce pressures, so it is right that they are given the support they need to stay viable and available for people with minor illnesses and ailments.
‘Pharmacists are not a substitute for GPs and the services they provide must not be seen as “GPs on the cheap.”
‘While we are keen to see initiatives that will ease the pressure on our struggling family doctor service, pharmacists should not be expected to work beyond their areas of competency, and the Government will find that their role is not a solution to the chronic shortage of GPs as many patients come to see us with more than one problem, and these can be complex.’
She added: ‘Patients should be able to get high quality, safe, and appropriate care when they need it – and in many cases, they will need the expert diagnostic skills and expertise of a GP.’
Professor Hawthorne also called on the government to address the workforce crisis in general practice by increasing recruitment and retention, make GP workload ‘more manageable by reducing unnecessary red tape and bureaucracy’, and said that more funding was needed for the sector.
A version of this article was first published by Pulse’s sister title The Pharmacist