As I gazed at the shelves stocked with antibiotics, Viagra and both oral and topical steroids, I realised all of these medications were freely available to buy alongside the toothpaste and shampoo.
It was 2008 and I had just started working as a cruise ship doctor. We were docked in the port of Cozumel in Mexico and I was in a pharmacy there.
These are medications that, as Brits, we are used to the pharmacist guarding behind their counter, but here, they were all openly available for anyone to purchase without a doctor’s prescription.
Crew members could buy antibiotics – for their self diagnosed skin infection – and discover when they eventually consulted a doctor weeks later, that they actually had shingles, and had been spreading it around the ship.
I’m all for self-care, but there are reasons medications are regulated and seeing an experienced GP cannot be safely replaced by a Google search or a tick box of symptoms.
That’s why I can’t get behind the Government’s plan to solve the GP crisis – not with more funding for our jobs – but by transferring the work to pharmacists.
Last week – as an overwhelmed NHS buckled under pressure – the Government launched its primary care recovery plan in a bid to end the ‘8am rush’ for GP appointments.
A central part of this plan involves expanding community pharmacy services to enable them to supply prescription-only medications – such as antibiotics and antivirals for common conditions like sinusitis, sore throat, earache, infected insect bite, impetigo and shingles.
As a GP, I’m only too aware that we need all the help we can get right now. It’s never been so busy.
Each GP in England saw an average of 8,534 patients last year. In March this year alone, 31.6million appointments were booked.
GPs are working 12-hour days to deal with the demand, yet – despite the deluge – we have over 2,000 fewer full-time equivalent fully-qualified GPs than we did in 2015 – and we have lost nearly 600 of them since February 2022.
However, I’m not entirely sure shifting this workload to the similarly pressured community pharmacists is the solution. Shuffling deckchairs on the titanic springs to mind.
I should mention that the new plan the Government has proposed will include more safeguards than the free-for-all I experienced in Mexico and pharmacists are trained professionals entirely capable of taking on this work. Not to mention, a similar scheme has already been running successfully in Scotland since 2020.
However, it is not a replacement for a GP and it shouldn’t be dressed up as a solution for our current crisis.
It is protocol driven, transactional medicine, which – for some straightforward problems – can work well. For example, enabling women to access contraception more readily can only be a good thing.
I harbour concerns, however, that seemingly ‘simple problems’ may not be simple at all, and that certain conditions could be missed without a holistic consultation by a GP.
Our health is not just a shopping list of our ailments. GPs have specialised in being generalists and can often link the shopping list together and deal with it all in one consult – whereas non GPs are likely to focus on the one problem they can manage, meaning the patient will end up being directed back to see their GP down the line anyway.
For example, symptoms of a ‘simple’ UTI (urinary tract infection) can be similar to those of bladder cancers, STIs or atrophic vaginitis of menopause. Giving antibiotics based on a checklist may potentially miss all these conditions.
We need to recruit and retain more GPs, then provide the infrastructure to make the job sustainable
Not to mention this plan misses the continuity of care that seeing a doctor who knows us and our community provides. That simple UTI presentation may be the tip of the iceberg for a patient to open-up to a GP they know and trust about deeper problems.
There is also the worry the scheme may generate yet more work for general practice. GPs will undoubtedly be expected to sift through the reams of paperwork created by the pharmacist consults to ensure things haven’t been missed, taking yet more time away from direct patient care.
The patient is the one left cycling through the system, when GPs should just be given adequate resources so we could do it ourselves in the first place.
It’s not a cheaper solution either – £645million is being offered to community pharmacies to provide this service, with the aim to free up 10million GP appointments – at roughly £64.5 per appointment. GPs run their services on a fraction of this.
If we take a crude look at the funding for GPs – in 2021/2022, NHS GP practices in England were paid £163.65 per registered patient for their care for the year. This sum is fixed, regardless of how many times each patient consults with their GP.
Instead of cherry picking the ‘simpler’ work off to an expensive alternate provider,fund GPs to provide the care patients are crying out for.
Recruit and retain more GPs, then provide the infrastructure to make the job sustainable, including reducing bureaucracy to give us more time with patients. On top of this, invest the money in IT, so hospital prescribers can send prescriptions to community pharmacies without delegating this work to GPs.
Listen to the profession and work with our leaders.
Medicine is a global market and NHS staff are leaving to better salaries and conditions elsewhere in the world.
The biggest asset the NHS has is its workforce and we need to invest in that.
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