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‘Chaos’: GPs to ‘signpost’ patients to pharmacies from tomorrow

Pharmacists have warned that a new GP contract coming into force tomorrow that sees GPs incentivised to redirect patients to pharmacies will cause “chaos”.

Under the new GP contract announced earlier this month, GPs will be backed by funding to make improvements to patient access.

From April 1, patients must either be offered an assessment or signposted somewhere else if they are unable to get an appointment the first time they contact a surgery.

Read more: New GP contract marks 'another blow for primary care', says PSNC

An NHS England (NHSE) letter announcing the 2023/24 contract – which GP leaders said was “an imposition forced on the profession” – did not make clear which services GPs should signpost patients to.

But new guidance documents published yesterday (March 30) – just days before the contract comes into force – stipulated that patients may be signposted to pharmacies.


New guidance


The new NHSE guidance said that patients “can expect a response on the same day they contact their practice”.

“This response may include information signposting to another service, for example a community pharmacy, based on an assessment of need,” it added.

Community pharmacy is the only alternative service mentioned in the guidance.

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

Previously, NHSE had said that “patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice” and that GPs could no longer “request that patients contact the practice at a later time”.

The measures will be backed by £172.2m in “unconditional payments” to GP practices, as well as £73.8m based on achievement, it added.

At the time, the pharmacy negotiator described the new GP contract as “another blow for primary care” after the contract was “imposed” on GPs.




Now pharmacists have raised concerns over the workload implications of the plans, as well as the lack of clear reimbursement in place for pharmacies receiving referrals.

“I think it will be chaos”, owner of Sabel Pharmacy in Chiswick Rachael Patel told C+D.

“I don’t think pharmacies have a lot of capacity to do this,” she added.

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

And Ms Patel questioned whether NHSE plans for GPs to refer patients via the community pharmacist consultation service (CPCS) or on an ad-hoc basis as “free signposting”.

“They’re probably expecting pharmacies to do this for free,” she said, adding that her pharmacy doesn’t receive any CPCS referrals from local surgeries.

She told C+D that pharmacies “don’t mind doing services but we need to be able to invest in the staff to do them to be able to do the service”.

Read more: Pharmacy First service ‘most likely’ route to new funding, PSNC boss predicts

“If you were getting paid and doing enough of them that you could afford to invest in staff, then it’s viable,” she said.

“[But] if we’re expected to do free consultations and we’re inundated, it becomes impossible,” she added.


“Workload will definitely increase”


Jaffer Alibhai, pharmacist at Medicare Pharmacy in Coventry, told C+D that the stipulations of the new GP contract mean that “workload will definitely increase”.

He also had concerns about how the referral system will work, with no official pathway set out in NHSE’s guidance.

Read more: AIMp boss hits out at ‘agenda to destroy’ community pharmacy

The move could be an “opportunity” for pharmacy “if reimbursement is increased”, but not if referrals are “informal and unpaid”, he said.
Mr Alibhai also questioned who will make referrals and whether staff signposting patients will be “adequately trained, so as not to refer complex patients”.
And Dimple Bhatia, superintendent pharmacist at Tollesbury Pharmacy in Essex said that the CPCS has “been a complete flop” in his area. 
“Pharmacies are being sent patients without the correct referral and therefore increasing community pharmacy workload without the money to follow it,” he told C+D.
Pharmacies “should not see patients that have been referred to us without the correct referral being received”, he added.


Pharmacies being “squeezed”


Meanwhile director of the Pharmacists’ Defence Association (PDA) Paul Day told C+D that "all parts of the NHS including community pharmacy" must be funded "sufficiently”.

“Pharmacy employers can be squeezed by inadequate funding arrangements and we support their efforts for fair funding”, he said.

Read more: Government in ‘total denial’ about crisis in community pharmacy, Lords warn

However, he stressed that employers have “a legal responsibility for the health and safety of their workforce”.
C+D approached NHSE for comment.

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