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Pharmacists saving 50 million appointments? It doesn’t add up


Continuity


So walk-in pharmacy services could save 40 million GP appointments per year, say pharmacists. And they should know, because they’re good at counting, right?

But there’s that key qualifier, ‘could’, which I’m guessing means pharmacists ‘could’ save 40 million appointments per year in the same way that they ‘could’ solve global warming through switching inhalers or ‘could’ achieve world peace by slipping anti-psychotics into the tap water.

In fact, the idea to scrap the need for practices to make burdensome formal referrals under the Community Pharmacist Consultation Service (CPCS) ‘could’ spectacularly backfire. A pharmacy free-for-all encouraging attendance for minor ills will simply accelerate the medicalisation and infantilisation of the public to the extent that minor illness becomes a major headache.

After all, the vast majority of these minor ailments are trivial, self-limiting and merely require an authoritative family figure (a granny) telling you, man up, it won’t kill you, and it’ll pass (which works particularly well for constipation) – rather than a health professional (a pharmacist) aggrandising minor symptoms, perpetuating myths about green phlegm and flogging OTC rubbish.

And the problem with flogging OTC rubbish is that it comes with an expectation that it’ll do something. When it doesn’t, the response of patients is that they need something stronger, aka antibiotics, aka a GP appointment. This is one of the two reasons our practice quit the CPCS, the other being that patients told us they simply didn’t trust the advice they were getting (and I still can’t decide whether that makes me think better of patients, or of pharmacists).

 Besides, low tolerance/high neurosis patients can already access pharmacy advice for every cough, sniffle and poop, and probably do. So rejigging the CPCS to walk-in service suggests that pharmacists ‘could’ start getting paid for a service they are providing anyway. Told you they’re good at numbers.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield

READERS' COMMENTS [5]

Patrufini Duffy 4 March, 2022 1:35 pm

Great point. You go in for your dry skin. And you get flogged a private Botox and dermal filler, and bottle of Ralph Lauren’s latest eau de vive. Pick up some B vitamins and some vegan-free hypercollagen retinol cream for your dermatitis too. More respect and lauding than any GP who did nothing, for nothing.

Simon Gilbert 4 March, 2022 2:00 pm

There is an assumption that reasons for attendance to different settings all represent similar sub sets of patients.
In reality the parents bringing their child with a ‘cough’ to a pharmacist, GP or A/E are not all the same set of patients, or parents.
The range of differentials and illness severity in different cohorts may overlap at the margins but are not the same.
If you start pushing patients who self referred to GP as first course of action to pharmacy you are increasing the risk profile of those patients seeing a pharmacist, with a subsequent increase in risk.

Once you have triaged such patients you might as well treat them as it takes seconds for obviously ‘minor’ ailments AFTER a proper triage or initial consultation reveals this.

Patrufini Duffy 4 March, 2022 2:15 pm

The receptionist just received a call from a “patient”. Or lay public; different things. He used his Babylon app for 1 week chest pain.
They said call your GP to be seen today.
We said – why didn’t they see you? -> He said “I don’t know why”.
Well go to A+E then. And figure it out as you wait for your troponins and ECG. Talking to two GPs in a day is pointless.

Patrufini Duffy 7 March, 2022 2:52 pm

When your population can’t solve a teenage break-up, itchy rectum, bloating and hayfever then you will always have an existential crisis.

Darren Tymens 9 March, 2022 10:11 am

There is no good evidence for this approaching successfully reducing GP or AE attendance.
I generally don’t see many problems that a pharmacist could solve in my daily practise.
They see a person with an itchy scalp.
I see someone with a year long history of an itchy scalp which hasn’t resolved after using all the OTC medications, and also struggles with seborrheic dermatitis, has recently lost their job and developed anxiety with depressive features, whose asthma is playing up, and whose son has severe autism.
These solutions are suggested by people who don’t understand what we do, and adopt a simplistic, reductionist view of what general practice is.
Everything complex can be reduced in this way, and make simple people (who cannot understand complexity) think they can understand it and offer solutions: it is called Dunning-Kruger Syndrome.
Brain surgery? You just knock them out, drill a hole in the skull and scoop some of the brain out – what’s difficult about that?
Rocket science? You just put an explosive in a tube and point it upwards with some astronauts on top.
Perhaps our pharmacy colleagues could run neurosurgery and the UK Space Programme as well?