Copperfield on the pharmishambles of the Government’s new scheme
Pharmacy First has got off to a flyer, hasn’t it? I don’t know how things are down your way, but here it’s a pharmishambles. The scheme’s only been going for a few days but already from local pharmacies we’ve had ‘No one available to provide service’, ‘We’re too busy’, and ‘We don’t manage shingles’. Plus patients being bounced back to us after they’ve been signposted because the pharmacy insists on an e-referral, which is technically correct but logically insane given that patients can self-refer anyway.
In the time it takes to manage dysfunctional messages, confused receptionists and aggrieved patients, I could have cured the world of cystitis. And if there’s one positive to take from this utterly predictable non-starter of yet another plan to reduce workload which does the exact opposite, it’s that it confirms what we all knew: GPs are brilliant at what we do.
Just take a look at the various protocols for the Pharmacy First ailment list. They’re very good but quite complex. And that’s because the process of managing an apparently minor illness safely and effectively involves a surprisingly complicated mental algorithm. We only think it’s simple and can do it in the bat of an eyelid because we’re really good at it.
But that’s just a part of our typical consultation, isn’t it? No patient worthy of the name brings only one issue. So we deal with their other problems, too. Plus the repeat prescription they need. And the explanation of a consultant letter. And the search for a hospital result. And the chat about their husband who they’re worried about. And their weight. And their overdue BP check. And their dog’s conjunctivitis. And so on. All in ten minutes.
So we do about 100 things at once, well. Those who are asked to manage one aspect of a deconstructed GP role – community pharmacists, opticians running minor eye ailment services, ARRS frontliners – do one thing at a time OK, often with a need for supervision and with a low threshold for bouncing back to us, anyway.
In short, we are moving from a system of efficiently managed order to one of dangerous, expensive chaos. That’s what happens when you run hyper-efficient GP multitaskers into the ground and dismantle their role into tiny, hived-off pieces. I believe I may have said this before, and I suspect I will say it again.
In the meantime, we just have to make the best of it. For the avoidance of doubt, I don’t blame the pharmacists for this debacle. We know whose fault it is. In the meantime, though, I would suggest a rebranding. From Pharmacy First to Pharmacy Very Occasionally, When They Feel Like It and the Wind Is Blowing In the Right Direction, Possible Never, Actually Why Not See Your GP?
Dr Copperfield is a GP in Essex. Read more of his blogs here
READERS' COMMENTS [6]
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Right on the nail as usual. Watch GP go the way of Out of Hours because it looks straightforward to some government penpusher!
I actually disagree
we are using it very successfully. our receptionists have a print out of conditions/eligibility and just signpost the patients as soon as they answer the phone. probably saving us about 5-10 appointments per day. a few have bounced back. we don’t have any referral form to complete at all. there are times the pharmacy doesn’t have capacity but then they just get back to us
Did NHSE follow its own protocol on how to write protocols when making the Pharmacy First protocols? If not, that’s probably where the problem lies!
To be fair, I’m in agreement with Andrew. 8-10 daily appointments saved.
One of the most articulate dismantlings of the current shambles I have read… 👏👏👏
this hiving off of work and services from GPs to others will continue and funding will likely flatline- you don’t get something for nothing in GP – savings will be found from those who shout least effectively