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Pharmacists are not 'cheap' substitutes for GPs – we are so much more

Stephen Thomas probes the professional friction between pharmacists and general practice following recent comments made by a top GP

Recent comments from the chair of the Royal College of General Practitioners (RCGP) that “pharmacists are not a substitute for GPs" and the services they provide must not be seen as “GPs on the cheap" are shocking to many community pharmacists.

For me, Kamila Hawthorne’s comments are tantamount to describing the the sector as a cheap substitute to general practice, which is both inaccurate and insulting.

While her comments do not recognise the exemplary professional care that pharmacy teams deliver, they also beg the question: how has an environment been created where a senior GP feels it is appropriate to refer to pharmacy care as “cheap"?

Read more: ‘GPs on the cheap’? Pharmacists must not be seen as GP substitutes, says RCGP

Undeniably, there is a professional friction at play here. GPs have traditionally been seen as gatekeepers to the NHS but this is being frustrated by the current difficulty patients many patients have in getting an appointment at their local surgery.

NHS 111 is sending more and more patients to pharmacy as a first port of call and an increasing number of pharmacists are being trained as independent prescribers.

A combination of these factors may have just culminated in a concern from GPs about the growing importance and necessary presence of the pharmacy sector.

As pharmacists take on more responsibilities it will take time for some GPs to adjust to the new healthcare demand realities that the country now faces.

Read more: Primary care recovery plan: Barclay wants pharmacists to do 'even more'

Pharmacy is not – and never was – second best or a cheap alternative to GP care.

All of us need to use language that reflects cross-professional collaboration and coordination to help people make educated choices about their healthcare.

Healthcare demands are not only increasing, but they are more complex than ever before and require holistic solutions that span primary and secondary care providers.

From illness prevention to long-term condition management, community pharmacy is playing an increasingly important role at the centre of patient care.

Inevitably, some issues will see GPs and pharmacy teams overlap, so a guiding principle for all should be that the patient is treated by whoever is the most appropriate healthcare professional or, importantly, at the place of the patient’s choosing where this is an option.

Read more: Taking the pressure off: What do pharmacists want their future to look like?

To achieve this collaborative approach, there needs to be a joint understanding from leaders within the industries, as well as those leading the charge in local communities. We need the Royal Colleges and professional bodies to come together.

We need local GPs and pharmacy teams to work harder to understand each other’s services and pressures.

We have to make it clear that we are not there to substitute for GPs, but rather to work with them as allied professionals dedicated to patient care.

We are well equipped to deal with minor ailments, help patients manage long term conditions and flag conditions that GPs needs to be aware of.

This partnership-led approach is being achieved in Scotland with the Pharmacy First Plus strategy, enabling GPs and pharmacy teams to play their respective and inter-related professional roles in caring for their communities.

What’s more, the Welsh government is adopting a similar approach and in Northern Ireland, despite current funding disputes, the sector has adopted its own Pharmacy First Service.

If such a service has been achieved in Scotland, Wales, and Northern Ireland, then it is surely time for England to also step up to the mark.

Read more: ‘Massive Achievement’: Pharmacy First service hits 3m consultations

Ultimately, it is vital that those in the healthcare sector in England respect each other’s strengths and champion each and every piece that makes up the entire jigsaw.

It is through this collaboration that each profession will survive the challenging year ahead.

But, of course, as much as the pharmacy sector can push for earned respect from its fellow healthcare providers, without NHS England respecting us and investing in the future of community pharmacy, it can seem pointless.

The government’s own figures indicate that funding should be £750 million annually or higher if it had kept pace with inflation.

The network is contracting, as recent consolidation plans from Lloydspharmacy, Asda and Tesco, among others, go to show.

It’s clear that the pharmacy contract is economically illiterate, expecting pharmacy teams to deliver more patient services for no more money.

All this at a time when more and more patients are also looking to us for help.

The Pharmaceutical Services Negotiating Committee is currently undertaking work on a pharmacy vision.

One of the things that I hope will come out of this work is the need for complementary contractual structures to be created to avoid the current situation, where providers are clashing over service delivery – as is the case with the flu vaccination programme.

Read more: PSNC kicks off ‘proper discussions’ on Pharmacy First with DH

Through the development of a package of interconnected fundamental reforms that state a clear plan for service provision over the next decade in England, GPs and pharmacy teams can come together to understand the practical and professional realities of the years ahead.

This strategy would see pharmacy secure its status as the third pillar of the NHS and, ultimately, improve patient care across England.


Stephen Thomas is superintendent pharmacist at Rowlands pharmacy

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