Editor Jaimie Kaffash says the new scheme that allows pharmacies to prescribe for seven common conditions and the contraceptive pill could help relieve GP workload if implemented successfully
I don’t know if it is the longer nights or this stinking cold that I have had for a week playing havoc with my mind. It might be that I have a subconscious desire to be an NHS England press officer. Or it might be that, deep down, I am so impressed with new health secretary Victoria Atkins’s ability to compartmentalise her conflicts of interest that I am looking more favourably at the Government. But I think Pharmacy First might actually… be a good idea?
My hesitancy is understandable. The devil is not only in the detail, but also in the implementation. And the litany of failed implementations suggests that my positivity is misplaced. But on the face of it, I quite like the idea of Pharmacy First.
I’ve argued many a time that we do need new ways of relieving workload, because we can’t magic up thousands of GPs. So shifting the treatment of common conditions to fully qualified pharmacists seems pretty sensible.
I’m not ignorant of the potential drawbacks, the most obvious of which is antimicrobial resistance. GPs have traditionally been (wrongly) accused of increasing antimicrobial resistance. Yet GPs are, in fact, best placed to reduce antimicrobial resistance. By transferring their workload to pharmacists, there is no doubt a risk that they will rely more on antibiotics.
Our sister publication The Pharmacist points out that a lot of work has been done with pharmacists to reduce the harms, and there will be monitoring of what happens with antibiotics prescribing as part of the Pharmacy First scheme.
This is by no means perfect. But we need to balance this against the potential benefits – taking workload off GPs. There does need to be proper monitoring of pharmacists’ antibiotic prescribing but, even if we do see a small spike in it, this might be worth it if GPs no longer have to deal with a raft of sore throats, coughs and earache.
The other major criticism is in terms of funding. I know the Doctors’ Association UK (DAUK) have done some sterling work looking at the cost of a consultation. They say that pharmacies can potentially be earning £48 per consultation. This is through a £15 per consultation fee, plus a monthly fee of £1,000 for a minimum of (eventually) 30 consultations. For those who undertake only 30 consultations a month, this will prove very lucrative per consultation.
But I disagree with their conclusions. Pharmacies won’t be providing exactly 30 consultations – it wouldn’t be in their best interests as they will be missing out on money overall. The more consultations they provide, the closer they will get to £15 per consultation, which seems a fairer fee – especially compared with the £23 DAUK says a GP practice is paid per consultation. In an ideal world, practices would have their funding increased, which would raise this figure. But any NHS initiative is constrained by the funding the Government is willing to provide, and we know this isn’t much. Within these constraints, this seems a decent use of money.
But I could just be delusional. Best go see a pharmacist about this cold.
Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at editor@pulsetoday.co.uk
READERS' COMMENTS [5]
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‘Pharmacy First’ is a brilliant idea if you want to eradicate all those soft GPs who keep issuing prescriptions for everything, when people can be persuaded to just go to a SHOP and pay for stuff.
We urgently need a vaccination against gullibility! And it should be mandatory ! (especially for Health workers)
Either they will prescribe lots of abx and we are protected or patients won’t be happy they haven’t had their abx and will come and see us.
There is no way this will implemented equally across the country.
– Workforce (gp and pharmacy) challenges tend to be more prevalent in rural areas and areas of deprivation.
– Consultation rates tend to be higher in areas of deprivation.
The practices that need the most support are the least likely to benefit.
PCNs have already recruited pharmacists en masse and practices have invested in their training and supervision. Investment in pharmacy may now see them return to work in pharmacy settings seeing minor illness cases when they could have been operating at a higher level of complexity in GP.
You can’t compare funding this easy work vs overall cost for GP consultation. Sore throat and earache vs dizziness and suspected cancer are apples and oranges. We would happily take the pharmacy level of funding to deliver these services ourselves.
Replacing GPs with Pharmacists is not a ‘good idea’. Its just another bad idea from a larger pool of bad ideas along the lines of flogging a dead horse.
What planet are you on? As a locum GP I can absolutely confirm that GPs are (at least partly) responsible for anti microbial resistance. Many are prescribing for coughs and colds and sore throats unseen. If you don’t acknowledge the reality, how can you address the issues?