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C+D readers share more evidence of GP practices' flu tactics

GP surgeries have been encouraging patients to support their local practice

C+D has received more evidence of the tactics GP practices are using to discourage patients from having their flu jab at a pharmacy

Fairbrook Medical Centre in Borehamwood, Hertfordshire, is using messages on prescription bags to encourage patients to attend the surgery’s flu clinic, rather than going to their pharmacy or “private providers”.

Deputy practice manager Michele Cain told C+D last week the surgery does not view the pharmacy service as “problematic”, but stressed it is difficult when pharmacies do not tell the surgery they have given a flu jab.

“[Some pharmacists] don’t include the batch number in the notifications we receive, so we are not updating a patient’s records correctly,” she said.

Orchard Court Surgery in Darlington, County Durham, has texted patients (pictured below) telling them not to go to their pharmacy for their flu jab. However, the surgery would not comment on the matter when approached by C+D.

Priory Gardens GP surgery in Bedfordshire published a notice on their website – which has since been taken down – asking patients to “support your local surgery” and “decline the vaccination” offered at a pharmacy because vaccination fees are a “vital part of the services we provide”.

C+D was unable to make contact with the surgery.

The flu “cash cow”

Simon Abrams, an Everton GP, told C+D last week the problem with the flu vaccination service is that it is a “cash cow” for GPs. Pharmacies are therefore perceived as “taking work away from us”, he added.

However, Dr Abrams said pharmacy’s flu role “makes sense” as it gives patients “better access” to the flu jab.

The National Pharmacy Association (NPA) said it has learned from the British Medical Association that “some GPs are not happy” about the pharmacy service.

Chief pharmacist Leyla Hannbeck told C+D last week the situation with GPs is “unfortunate”, but stressed it comes down to patient choice.

“One thing that could help is if a pharmacy establishes a great relationship with the surgery and has regular catch ups,” she said.

Meanwhile, a coalition of GPs has spoken out and defended comments made on Twitter deterring patients from other flu jab options.

The GP Survival group – which represents 5,800 members – is encouraging people to “support their GP surgery” by having their flu jab at their practice. It suggested “the lack of co-ordination” around flu services was adding to the pressure on general practice in “the current challenging climate”.

In response to a question on the pharmacy flu service specifically, GP Survival interim chair Thomas Jones told C+D on Tuesday (October 5) that members have expressed flu “concerns on several fronts”.

Have you experienced GPs discouraging patients from a pharmacy flu jab?

Clapton Chemist, Other healthcare profession

Big deal! GPs are greedy, Contractors are greedy. 

Ari Butt, Community pharmacist

I do think NHS England need to go back to the drawing board and get this service agreed by the GP ,s . We cannot go on like this every year with patients at the centre of this " battle " ! The NHS is all about " teamwork !" .

Shaun Steren, Pharmaceutical Adviser

1) It has already been agreed

2) Pharmacists and GPs are independent contractors to the NHS, who in this case are competing in a financially zero sum game - no such 'team' exists. 

3) If pharmacy wants to compete for services that can be carried out by the GP (therefore financially zero-sum), then this will 'go on' every year. 

So what is the tightly reasoned and evidenced argument/solution being put forward by pharmacy? I haven't heard it yet. 

Meanwhile employee pharmacists are trapped between aggressive  corporate flu targets and aggressive overtures by certain GPs. Not that anybody gives a toss about that. 


Clapton Chemist, Other healthcare profession

Someone seemingly as cerebral as yourself  surely has outside interests which you must increasingly be turning too?

Kevin Western, Community pharmacist

"teamwork"??!!!! from GPs?  there may be pockets of enlightenment here and there but the vast majority couldnt give a stuff about us. Think about it as the same as competeing for items from your nearest Pharmacy .

John Urwin, Community pharmacist

If the surgery does not have the vaccine details it makes it more difficult for them to accidentally enter it as one given by them!

Nat Mitchell, Community pharmacist

I don't agree that we should have to provide this information, but it is collected in pharmoutcomes, so you would have to input it anyway (if you are using this system).  It just makes more work for the surgery in all honesty.  As I understood it, I am the data controller and will be responsible for reporting ADR's etc.  The batch and expiry would be in that report and is the only time that it would be needed.

It's probably time to be the bigger man/woman/profession and just do as we're asked and ensure we deliver even greater numbers and patient satisfaction than last year.

Saying that, we will probably then have our fee reduced as we'll be seen as compliant!

A Hussain, Senior Management

We all know why we were asked to provide Batch Numbers etc.  It's just a lash out at us as the service is going well and is appreciated by both patients and commissioners, and is obviously reducing their income.  Shall I forward the batch numbers and expiry dates for every item I dispense too?

The behaviour listed above is very unprofessional, possibly damaging to the service as a whole and should be punished, even though we know this will not happen.  I would never take this approach and f my staff said or did the things we are hearing and seeing then I would be having words with them right away.  I want to provide a successful service for both professional and financial reasons, but I would not be happy to achieve success in that way.

Z ZZzzzz, Information Technology

FMD in the future will mean you have an up-to-date list of all that info in the PMR in the future.  Perhaps we will see a two-way flow of info - we can read-write to SCR and they can look at our PMR.  Now that would be beneficial to patients I would suggest.

Rekha Shah, Community pharmacist

When a GP practice insists they need details of the vaccine administered eg the batch no we provide the following message:

Please note that for pharmacist administered seasonal influenza vaccine the only information required to be notified to GP practices is:

- Vaccine administered – Seasonal Influenza

- Date of administration

- The patient’s details

- The pharmacy details

- Any particular notes the pharmacist wishes to convey to the practice eg suggest other vaccinations of benefit to the patient

- The appropriate read code as above (the three stated on the notification) for Seasonal influenza vaccination given by a pharmacist

There is no need for GP practices to record data for vaccine administered (brand, batch, expiry date etc), nor site of vaccination in their patient records for pharmacist administered vaccines. 

Shaun Steren, Pharmaceutical Adviser

There will be no resolution to this conflict because it is a constant sum game. When pharmacy administers a vaccine that the GP would otherwise had administered, the pharmacy gains financially at the expense of the GP. Any GP who considers this money a part of their basic funding (and therefore rightfully theirs) will always consider this antagonistic. So we can stop with these awful weasel words of 'working together' or 'compromise', it is logically impossible in the defined constant sum game. 

I know many people struggle with reasoning so let's make this as clear as possible with deduction:

Premise One: Player A does not accept another player sharing their funding for service X

Premise Two: When player B provides service X it is a zero sum deduction from the potential funding for player A

Conclusion: Player A does not accept player B providing service X

So pharmacists and GPs working together is off the table if premise one and two are true - which they are unless GPs decide that flu service funding ought to be open to free competition from other practitioners - which in the described cases they do not. 

There only two valid positions for pharmacy:

1) Surrender the opportunity to provide the flu service to avoid the inevitable conflict

2) Reject the constant sum game proposed by GPs and compete for all potential flu funding on the basis of a variable sum game in which GPs and pharmacy have some complementary interests i.e patient utility

Assuming provision is cost and quality identical and patients derive utility from greater choice:

GP only flu provision: GP (positive financially) Pharmacy (negative financially) Patient (negative utility) 
Pharmacy and GP provision: GP (negative financially) Pharmacy (positive financially) Patient (positive utility) 

If both pharmacy and GP have a common interest in increasing patient utility but an opposing interest in obtaining flu renumeration, we have a variable sum game where both pharmacy and GP would prefer the patient to have the choice of two services rather than the one, but would prefer that the patient came to them rather than the other. If this is the case, then free competition maximises both parties interest. 

So if a GP argues that pharmacy should not be providing the flu service it must be assumed they do not share a common interest in increasing patient utility and only have an opposing interest in losing money. So where is this tightly reasoned case being put forward for pharmacy? Why are logically invalid 'compromises' being offered as solutions? Why is fatuous argument left unchallenged? Is it because they are too scared to put the case forward or too ignorant to understand the strength of their own case? The weasel words we have heard suggests both.

Kevin Western, Community pharmacist

Well said!!

Sachin Badiani, Pharmacy owner/ Proprietor

A bit too much detail Shaun (jokes). I do agree with you we need to put case forward - I think the posters here have put that too (for building our own case).

Shaun Steren, Pharmaceutical Adviser

On the basis of patient utility, the argument against pharmacy providing the flu service is dead. Neither is there any logically coherent compromise or middle ground, no such thing can exist. Given genuine freedom of choice, the end-point could be community pharmacy being the majority provider of flu vaccinations in the next few years. Do you think GPs are going to let this happen? What case is going to be put forward by pharmacy when GPs inevitably try to block this? The typical back of the queue/scrambling for the scraps position? How about the typical weakly reasoned and vacuous 'great work being done' position? How about the now infamous picture of a government apparatchik drinking tea in an unusually tidy and overstaffed multiple branch, sub-titled with a cliche relating to 'future roles'? 

Do you have the argument perfectly reasoned in your own mind? Have you, in your own mind, preempted every logical fallacy against your own case that will be inevitably put forward? Have you scrutinised all the data and are therefore able to instantly identify any misuse of empirical evidence? I've never seen this once in community pharmacy, why should we think this will be any different? Im putting my money on a GP win.

Clapton Chemist, Other healthcare profession

You are way too detailed and technical for community pharmacy. Community Pharmacy workings are not too dissimilar from back street mechanics. Before much of it was shrouded with mystery but now the veil has been lifted by DoH the true keystone cops nature of the industry is evident. In short there is only a point to community pharmacy if you are a contractor and can suck out reasonable( taxpayers)money from the operation. The rest are pi55ing in the wind.

Kevin Western, Community pharmacist

unless you are happy working for nothing as, presumably, you are? what do you expect.

GPs , Nurses, Opticians, Dentists etc all obviously work from a sense of altruism and Public Service, refusing to take up valuable taxpayer resources and can be easily identified , sitting outside supermarkets with their begging bowls beside them.....

Clapton Chemist, Other healthcare profession

Happy? Depends on your definition. Down to 2 days a week in pharmacy and counting. Pharmacy could be just a memory this side of Xmas.

Nat Mitchell, Community pharmacist

I think I agree with Shaun, but I'm not sure!!!

Claire Anderson, Academic pharmacist

I had my jab in a pharmacy and was told to tell my GP I'd  had  it even though private jab not NHS and my own  decisionto have it. If only pharmacists  had read write access to records this part of the issue would be solved.

Valentine Trodd, Community pharmacist

If the NHS got the finger out and implemented a proper IT system for recording jabs that updated the patient record, instead of lumping everything into Pharmaoutcomes, then there wouldn't be an issue.

Matthew Edwards, Community pharmacist

No current IT can update GP records and it's not an NHS issue as currently most GPs and their system providers do not want write access to their records.

Valentine Trodd, Community pharmacist

EMIS web is advertised as providing the facility to "update multiple patient records - perfect for flu clinics." As I understand it EMIS is funded by the NHS?

Valentine Trodd, Community pharmacist

“[Some pharmacists] don’t include the batch number in the notifications we receive..."

What does the batch number have to do with it? Anyway, on Pharmaoutcomes entering the batch number is mandatory - you can't enter the record on the system without it. If it's not on the system you don't get paid - why would anyone not enter it? Sounds like a cop out to me. Not the first time lies would have been told by the surgery...

Matthew Edwards, Community pharmacist

Pharmoutcomes is not the only method of recording flu vaccinations nationally.  Also the reason for us recording the batch numbers is that it was requested by GPs and it's in the SLA

Valentine Trodd, Community pharmacist

Matthew, a national GP Practice Notification Form has been agreed by the PSNC, NHS England, PHE and the Department of Health to notify the patient’s GP practice of vaccination - nowhere on this form is recording of the the batch number specified. The EMIS web clinical system (used by most GP practices in the UK) does not require details beyond those that are contained on this form to record pharmacy administered flu vaccinations. So in short, GP surgeries have no reason nor right to demand details of the batch number of vaccines administered by pharmacists.

It's all explained at...

Recording of the batch number is indeed mandatory for OUR OWN records, as part of the service specification - but not to share with GPs.

So, for a GP surgery to fail to update patient's record because a pharmacist didn't provide them with a batch number is at best just plain ignorance of the service specification and in my opinion, is probably closer to negligence.

Matthew Edwards, Community pharmacist

Sorry Valentine, missed the fact that the batch number is missing from the notification form but as I dont use it because of pharmoutcomes emailing everything to the surgery it never entered my conciousness. However providing the information isn't that taxing.

Valentine Trodd, Community pharmacist

Agreed. I'd imagine most of us would supply it anyway.

John Urwin, Community pharmacist

This is a re-run of one of their moans from last year. We did not submit batch numbers because we did not have to. Even if the GP did not have the info, it was and remains, retrievable if necessary. This year, as Matthew says, it is part of the SLA. If GPs want their staff to spend time recording batches fine, what might their staff be better employed doing, or indeed our staff keying in to Pharmoutcomes etc..

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