Don't blame Pharmacy first

Copperfield argues that GPs should think twice before directing their frustration over Pharmacy First mishaps at pharmacists.

I know you’ll find this hard to believe. But apparently, antibiotics have been supplied ‘inappropriately’ through Pharmacy First. And we’re not just talking about unnecessary Pen V caused by a punter who can say ‘I know it’s tonsillitis’ and a pharmacist who can’t say, ‘It’s a virus’.

No. The GPhC has cited an example of a patient on methotrexate who was inadvertently given an interacting antibiotic. Cue lots of sanctimonious harumphing and ‘I told you so’s’ from us GPs.

Hang on, though. I don’t know much about pharmacists, but I suspect they’re not aliens, or androids, or AI-generated. In fact, they may well be human, and therefore prone to human error. The reason this never happens with us GPs is, of course, because we’re superhuman. That’s why various colleagues, over the years, have never prescribed four times the recommended dose of a gliptin, nor amoxicillin to the penicillin-anaphylactic, nor the aforementioned methotrexate daily rather than, ahem, weekly.

So thank God for us, right? Except we are still prone to mistakes. The relentless churn of online requests is so onerous and brain melting that, even if we don’t quite lose the will to live, we do lose the ability to be safe – not least because it’s nigh on impossible to properly check the records for every request. Which is precisely why an immunosuppressed patient on methotrexate might get inappropriately triaged to Pharmacy First in the first place.

So who’s making the mistake here? The GP for being cavalier? The pharmacist for not following protocol? Or even the patient for not having ‘I’m on immunosuppressants, you morons’ tattooed on her forehead?

All of the above. Or none of the above. Because, ultimately, this is about Government and policy. Neglect general practice, plug gaps with the underqualified, and arm that system with a creaking and disintegrated digital system. Then stoke demand through access initiatives because quantity speaks with vote-catching numbers whereas quality is a mumbled, you know, whatever.

So accidents will happen. But once we’re done with the hand wringing, remember where to point the finger.

Dr Tony Copperfield is a GP in Essex

READERS' COMMENTS [5]

Please note, only GPs are permitted to add comments to articles

Douglas Callow 4 February, 2026 9:04 pm

Other countries are already spending and
investing more in their health and social
care systems. The true obstacle is that the
state taking more responsibility for
healthcare delivery in the UK would cut
the demand for private healthcare.
Shortages, rationing and the back door are
the features of the UK system and
Streeting is not going to change that.

So the bird flew away 4 February, 2026 10:53 pm

Too right, DC.
And after a bit of hand wringing, a lot of neck wringing of health ministers would be in order!
Talking about mistakes: innercity locum home visit yrs ago to “29 King St” to non-English speaking Mr X (not his real name…)
“Hello, I’m the doctor, where’s the patient?” Woman, ?Mrs X, takes me to sitting room.
“Tummy pain, is it?”
Mrs X and the man sitting on the sofa look bemused. So…
“Let’s feel your tummy then”. Point, gesture and get man to lie on the sofa. Start palpating his abdomen. Mrs X calls teenage son downstairs.
“Hello, who are you?” says he.
“I’m the doctor…” says I, beginning to sense something amiss. “You called for me…?”
“No, we didn’t call the doctor.”
“This is Mr X, 29 King St?”
“No, he’s Mr Y. This is 39 King St!!!” 😳
Cue cringing and apology!! But oh how the practice staff laughed when I told them.

Vicky Cleak 5 February, 2026 12:44 pm

This is a consequence of parcelling out different parts of healthcare to varied health professionals without any coherent or clear oversight or any benchmarking.

In hospital, some vague oversight of staff. In GP land the same. In private sector, (in the past) only consultants could see people privately and at least they were trained to the top so some vague expectation of safety and competence.

Now it’s literal free for all. No one knows who they are seeing, who supervises them and thus whether they can trust the advice.

If you write a letter to a GP, you knew that the GP would read it; now could be anyone who completely misses the point.
If a patient was seen privately, you knew of the Consultant and could phone them up directly if needed.

Now, could be a pharmacist, a psychologist, a nurse. All apparently competent to give a medical diagnosis and formulate a management plan and risk assessment. Because after all, it’s piss easy; you only need ‘experience’ , a one day course ( usually run by a doctor but not necessarily so) a research project and paper to become a ‘doctor’ and no one outside of a medical doctor seems to know the actual difference.
The more I find out about how the medical profession has become undermined and deprofessionalised the more sad and anxious I feel for all of our futures. Look on LinkedIn and all these allied professionals are convinced they are able to make a diagnosis but absolutely none of them have been able to point me to a curriculum or otherwise to show me that they can.

I feel like I can see it so clearly but everyone else has turned the other way.

Doctors need to take back diagnosis as their job that they are trained for and is a legally defined skill to getting a medical degree. That is the only thing that would stop this.

Rebecca Lewis 5 February, 2026 2:41 pm

I think the above comment adequately sums up some of the RTC ADHD/autism clinics no?

Shaun Meehan 6 February, 2026 2:29 pm

So the answer is more doctors always as we are the best of the best and nothing gets past us….until it does, regularly as your MPS annual outlines annually. The problem is ‘doctors know best’ ( and we use that!)- that makes us conservatives and frankly dinosaurs. Wake up GPs your receptionist and computer see the patient first and by the time you get involved the petechial rash has ( possibly) evolved. What we need are well trained computers/ receptionists etc in supportive teams that look after our patients and each other. Some recognition of the other members of primary care would be appreciated and their skills encouraged not demeaned.