Is it time for GP and pharmacy contracts to make friends?

Editor Sofia Lind reflects on how GPs and pharmacists are being unfairly set up to compete, following Pulse publisher Cogora’s recent joint conference

I’ve just spent the last couple of days at the first-ever Community Pharmacy and General Practice Conference.

Run by Pulse’s publisher Cogora and the National Pharmacy Association, it was aimed at fostering collaboration amid the shift to ‘neighbourhood health’. I’ll admit that I went into the conference knowing that there some were gaps in my understanding.

By this point, I know the GP contract inside out. The community pharmacy contract however, not so much. And if I’m totally honest, I had occasionally fallen into the same trap that I suspect many GPs have, of seeing pharmacists as being after a share of GP funding.

After two days listening to pharmacists, though, I think that line of thinking rather misses the point.

What struck me most was how little each profession really understands about the other’s contract and working conditions. Pharmacists seem to think general practice gets all the money. GPs think pharmacists are after theirs. And yet both are operating under contracts designed entirely separately, with separate incentives and – too often – competing for the same bits of work.

But it wasn’t GPs or pharmacists who created this situation, and I don’t think either profession will benefit from more of the same.

Primary care receives a miniscule proportion of NHS funding while handling the overwhelming majority of patient contacts. Yet instead of encouraging different parts of primary care to work together, the system appears to pit them against each other.

As Steve Taylor from DAUK pointed out to me inbetween sessions, childhood vaccinations are a perfect example of this. Instead of focusing additional effort on the proportion of children who are not getting vaccinated, the system increasingly encourages pharmacies and GPs to compete over the chunk who would have been vaccinated anyway. In effect, this traps GPs and pharmacists in a system that seems to assume competition is always preferable to collaboration.

And under those circumstances, it isn’t hard to see why mistrust sometimes develops.

GPs’ concerns about pharmacists taking on more clinical work are not irrational – they are expert generalists with years of training and a very understandable focus on patient safety and continuity of care. GPs worry about fragmentation and about what happens when responsibility becomes increasingly dispersed. Equally, pharmacists are understandably frustrated by the assumption that they are somehow less clinical, or that every expansion of their role is a land grab.

After listening to both sides, the reality is that they have far more in common than either perhaps realises. Both complain about workload. Both complain about funding. Both complain about being expected to do more for less. Both think somebody else is getting a better deal. Neither of which is entirely accurate.

One thing I would caution against, though, is the idea that community pharmacy should become the new front door to the NHS. In the same way you can’t just move hospital care into general practice, you also can’t just turn pharmacies into GP surgeries. General practice’s greatest strength has always been continuity and the ability to manage complexity over time – but in order to do so they need to see the patients.

One thing that was perhaps lacking from the conference was the voice of the Government – but not for a lack of trying. Primary care minister Stephen Kinnock sent a video message but could not attend in person. Andy Burnham, who had also been invited, had other last-minute commitments… Yet if politicians are serious about moving care into the community, they will eventually have to answer the difficult question of whether funding and decision-making will genuinely follow their shift to neighbourhood health.

As Sir John Oldham cautioned, if it goes wrong this may be the end of the NHS as we know it.

But perhaps the biggest takeaway from the conference was also the simplest. Although some people brought up conflicting contracts and unfair funding, many were stressing another first step. As RCGP chair Professor Victoria Tzortziou Brown and others suggested: go and say hello to your local pharmacist. Many speakers pointed out that having been stuck in structures that encourage suspicion and competition, the two groups have forgotten they are colleagues, not rivals.

And if, like me, you came away from the past couple of days with assumptions challenged and a better understanding of what life is like on the other side, I can confirm that the Community Pharmacy and General Practice Conference will be back next year, on 27 and 28 June.

Save the dates. You may learn something – I definitely did.

Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn