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How to make the future of primary care even more unsustainable

If, like me, you’ve had to curtail your packed pondering-the-imminent-collapse-of-British-general-practice schedule this week to free up valuable time for pondering the imminent collapse of Western civilisation, you might have missed the news that pharmacists are going to start treating sore throats. Only with actual medicine this time, rather than, y’know, Ricola and stuff like they do normally.

I should lay off pharmacists

In a brief break from wistfully envisaging an alternate timeline in which Hillary Clinton had an NHS email account, meaning the FBI didn’t manage to stop her poll momentum because they were too busy wading through myriad reply-all missives from Patient Flow Champions called Pam imploring all the other Patient Flow Champions called Pam to stop replying all, I managed to sneak a look at the paper behind this story. The study was paid for by Boots, who I’m sure wouldn’t be acting solely out of pecuniary self-interest. I’ve been too busy stockpiling canned goods to investigate how the nationwide roll-out is funded, but I wouldn’t be surprised if it ends up being part of the slippery Forward View million bajillions we keep getting reassured are going into ‘primary care’ but never materialise in our practices.

How did the study work? Apparently, anyone rocking up to the chemists with a sore throat was CENTOR scored and then near-patient-tested for strep. This involves an ENT exam, which I wasn’t aware pharmacists were trained in. They must have had to lop off a bit from the pharmacy curriculum to fit that in, presumably the lecture entitled ’When you send a patient back to the GP because a medicine is unavailable, why not tell them what is bloody available? That might help a bit, don’t you think?’, or maybe the one called ‘If you’re so good at science, why do you sell all that homeopathy?’

I should lay off pharmacists, not just because I might need to barter with one in the fallout shelter in which my family will now be spending the 2020s, but because they currently represent an important temporal barrier between the patient and their eventual argument with me about not needing antibiotics. Yes, yes, there’ll be the odd quinsy, lymphoma or resorbed parasitic twin, but let’s face it, most of the sore throats we see are self-limiting viral illness, and the remainder are self-limiting bacterial illness. I want the pharmacist to advise them on appropriate self-care, or, failing that, sell them some harmless jollop that’ll keep them from my door until they get better by themselves. In the study, however, everyone with a positive throat swab got antibiotics. What this does is ratchet up the demand for instant overdiagnosis and overtreatment, making the future of primary care even more unsustainable. Then again, the future of primary care is the least of our worries now. 

Dr Pete Deveson is a GP in Surrey. You can follow him on Twitter @PeteDeveson