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Flu jab patients 'threatened' with GP surgery 'delisting'

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GPs are "chastising patients" who admit they may get a pharmacy flu jab

Patients thinking of getting a flu vaccination at their community pharmacy have been threatened with being “delisted” by their GP practice, C+D has learned.

Camden and Islington local pharmaceutical committee (LPC) told C+D it has received reports from contractors of GPs “chastising” patients who admit they may get their flu jab at a nearby pharmacy.

LPC chief officer Yogendra Parmar said “at least one” GP surgery in the area had also “threatened some patients” with being removed from the surgery’s list of patients if they decided not to receive their jab from their GP.

“It’s not pleasant out there,” said Mr Parmar. “It is affecting the number [of people] being vaccinated as it is scaring patients – they don’t want to be delisted or upset their GP.”

Individual contractors do not want to “put their head above the parapet” and expose these practices because they are concerned there will be consequences. “As a local pharmacy, you don’t want to rock the boat in case scripts start drying up,” Mr Parmar added.

“Ultimately it’s down to NHS England to sort this out,” he said. “It’s an outrageous practice that they need to stamp out.”

A Midlands contractor, who wished to remain anonymous, also reported that some patients were coming into the pharmacy “scared” to get their flu jab, as they are “getting told off by GPs”.

“Patients afraid”

Although it is not yet “as bad as last year” – when C+D readers reported GPs placing posters in practices, notes on prescriptions, and even a mention in a monthly newsletter, to discourage patients from getting their flu jab at a pharmacy – there are a “significant number of patients afraid”, the contractor told C+D.

“The practice manager asked me how many of her patients I was going to steal this year,” he added.

A counter assistant from Bolton told C+D that GPs in the area have “really pushed” for patients to go to their surgery for their flu jab.

“I went to see my GP and they didn’t know I worked in a pharmacy – they were [adamant] I would have my flu vaccine there, but I didn’t,” she said.

Thorrun Govind, an independent  pharmacist working in Bolton, told C+D: “Patients have reported they have been questioned why they have gone to a pharmacy for a
flu vaccination.”

C+D has asked NHS England to comment on the latest allegations against GPs, but had not received a comment at the time of going to press.

22 Comments
Question: 
Have you experienced problems with GPs putting patients off a pharmacy flu jab?

Simon MEDLEY, Community pharmacist

If I had a tory brain ( which i don't  thankfully), I don't see why competition isn't opned up across the whole GP sector. In these days of  centrailised computer records and the fact you very rarely see the same GP twice at your local surgery, why not   let  the patient go to any willing provider of Gp services. That would stop them whinging about a little bit of competition for flu jabs ...

 

Chris Pillman, Community pharmacist

Very concerning comment from the Priory Garden Surgery listed above. Has a complaint been made to the surgery or even the GMC?

I would be interested to know the outcome

Hazel McCulloch-Smith, Locum pharmacist

The whole point of any service is to free up general practice time. For my patients to be scared of their doctor. And as a result take a day off work to have to wait to see them rather than walk in at 8pm to the pharmacy and have it done there. It seems only detrimental to the economy and the patient. 

Boom Shakalaka, Locum pharmacist

Macro numbers of jabs required to make a decent few quid. Not worth the time and effort needed imo. 

Jignesh Patel, Community pharmacist

We are all supposed to be working to improve patient access and care.

Transformation of care and integrated care will not happen until everyone works together.  We are all forgetting that NHS is about patient choice and good patient care.

Patients are supposed to be treated with respect, dignity, privacy and care and freedom of choice. Any health professional that does respect these values should be upheld by NHS England and their respective regulatory bodies. Where a professional fails to uphold the professional image of their profession or fellow professionals they should be appropriately dealt with the respective  regulatory bodies as clearly stated in their professional standards and ethics.  Bullying, threatening, lack of patient respect and other health professionals is not acceptable. NHS England, GPhC, GMC and NMC all to  take action now.  STOP interprofessional and patient conflict

Mehmet Fopal, Pre-reg Pharmacist

Well spoken! Patient choice or preferance for treatment shouldnt be an arena for battle.

Shaun Steren, Pharmaceutical Adviser

1) Pharmacy administers a flu jab to patient that has always used their GP: 

Pharmacy to GP = zero sum (Pharmacy profits at the expense of GP)

Pharmacy to Patient = Positive sum (Pharmacy profits and patient must benefit as they voluntarily made a preference choice) 

Patient to GP = Negative sum (Patient-GP relationship potentially impaired IF GP takes position described in article)

2) Pharmacy administers a flu jab to patient who otherwise would never have gone to their GP:

Pharmacy to GP: Positive sum (Pharmacy profits and GP makes no loss)

Pharmacy to Patient: Positive sum (Pharmacy profits and patient gains access to potential health improvement that was previously not received)

Patient to GP: Positive sum (Patient benefits through health improvement and GP benefits because their patient is less likely to have ill health) 

* Assumes pharmacy/GP flu jab administration is of equal quality and the same cost to the tax payer. 

So we have one zero-sum and one negative sum. If what has been described in the article is accurate, GPs are responsible for bringing in a negative sum situation that need not exist. Their position in this regard is indefensible. 

The zero-sum situation can only be judged in the context of the otherwise positive sum scenarios. The existence of a pharmacy based flu service creates a financial loss for the GP but greater choice and access for the patient. The greater access may well be debatable - do people who otherwise would not have the flu jab now do so because of the existence of the pharmacy based service? My experience is that they do, but I can't find evidence that they do in significant numbers. Patients without question benefit from the choice, in this particular case how can convenience be argued not to be a good thing? We are left with loss of GP profit. How much do they lose? Fees, expired vaccinations and opportunity cost of waiting round for no-show patients, what is the total cost? 
Looking at it from the perspective of outcomes for patient, GP and pharmacy (albeit without all desirable information and evidence), community pharmacy looks to have a reasonable case. 

Of course, the outcome for a pharmacist working in a corporate sweatshop has not been included, but then it never is. Either way, for once, community pharmacy appears to have a well reasoned case, one that some GPs don't appear to be able to counter other than with anger and threats.

Z ZZzzzz, Information Technology

Shaun, the cost of a GP (practice nurse) administered vaccine is higher than the cost of a pharmacist administered.  More so this year when they received an increase in fee allowance due to them "losing" income last year.  Pharmacists received no such fee increase this year.  Another terrific negotiation by PSNC.  I think that situation set a dangerous precedent and GPs will want more compensation like this as more healthcare is hived off to over-eager pharmacists.

Leon The Apothecary, Student

I wonder what are the legal rights of delisting someone for using freedom of choice in where they choose to have their flu jab from?

Lucky Ex-Locum, Superintendent Pharmacist

It all depends on whose fat cat pocket you want the NHS money to go into. If I believed for one second that the GP surgeries would re-invest any profits made into the practice (I don't - I haven't just climbed down from the christmas tree) I might actually support this. However seeing as the GPs just want to line their own pockets with yet  more NHS money, I don't. It does jar that we are all working to put more money the way of the top brass and shareholders of the multiples but if it benefits pharmacy as a whole by publicising what we can do then I'm in.

A Hussain, Senior Management

Have a look at the bottom of the page in red and bold. ACCOSTED!!!!

http://www.priorygardenssurgery.co.uk/page1.aspx?p=1&t=6

 

Honest Tikes, Sales

Below is what it says.

I am being accosted daily in my pharmacy by patients who cannot have an appointment with their GP for two weeks.

Funny how Flu vacccination can be done by GP's there end then.If they were paid per appointment would patients have to wait to see them?

And they're not motivated by money.....

Patients may be accosted while in a pharmacy and offered a flu vaccine. We ask you to support your surgery and decline as the vaccination fees we receive are a vital part of the funding for the services we provide.

 

Lucky Ex-Locum, Superintendent Pharmacist

That is one of the most unprofessional things I have ever seen. From experience, it is practice nurses if anyone who does the accosting. It actually comes up on EMIS every time you do just about anything to offer a flu vaccination.

A Hussain, Senior Management

accostverb [ T often passive ]

UK ​ /əˈkɒst/ US ​ /əˈkɑːst/ formal

to go up to or stop and speak to someone in a threatening way:

I'm usually accosted by beggars and drunks as I walk to the station.

Stephen Eggleston, Community pharmacist

We are attached to a GP practice but independent of it. Neither tries to poach the others flu patients but work on the basis that I will offer NHS flu vaccinations to anyone eligible (and privately if not) an, thansk to getting stock in early and the service paperwork being properly organised, I've already completed 1/5 of my anticipated total in the first week and the GPs aren't even started yet. The key is timing and organisation. There is no threatening of patients or undue pressure - that is dispicable and, I would suggest, unethical and would hope all incidents be reported. Patients like the convenience we offer - it's that simple

GARY BROWN, Community pharmacist

I echo Stephen's comments - I have been informing our patient's (little notes in their prescription bags/polite conversations here and there) since the start of August - if patient's tell me that they are having the flu vaccination via the GP's I say "that's good" and leave it at that - if they say they've made an appointment for a few weeks time I (again) say "that's good" and leave it at that UNLESS they ask if it can be done in the Pharmacy when I will oblige and inform them that we will let the GP's surgery know that they have been vaccinated. The feedback we've had has been very positive & the vast majority are likely to return to us next year!

Gerry Diamond, Primary care pharmacist

I must admit that as a GP practice pharmacist that I give patients their flu shot during my clinics if it is convenient and more so because a local chemist is doing it in competition with the surgery. But I view it as friendly competition as on occasion working in retail I'm always happy to do a flu shot too. We just decided to step up our game so the patients are the real winners lol x

Ava Denuff, Locum pharmacist

I have experienced this at a number of sites where I have offered the Flu Service. Patients declining because they dont want to upset the GP or worse, patients being warned that because they are taking money out of the surgery, there is the risk of the surgery closing as a result. Disgraceful scare-mongering by so-called professionals. How would our professional bodies or NHS England respond if we were found guilty of such bahaviour ourselves. I sincerely hope that the appropriate people take action as has already been described in NHS south west.

Maybe next time I work near to a dispensing Drs.......hmmm.  The Doctors need to give thought as to why the service has been put out to pharmcies and the increased accessibility and convenience for patients instead of selfishly concerning themselves with income. On the plus side for me- I have 'recruited' many patients who had already got an appointment booked!! But our immediate service, instead of an inconvenient appointment to a cattle-market for a mass jabbing session was more attractive.And ALL my patients have praised the service and are very happy about its convnience.

Another thing too, all my patients so far have said how much more info they get from me during the service. They get NOTHING at all from the surgery. The local surgery near us today...one of the nurses says that she has a window of 1 minute per patient! Ridiculous.

Pillman Uk, Non Pharmacist Branch Manager

comments on Facebook pages from surgeries about the impact on services if income is reduced by patients not having their flu vaccination done there, along with comments about vaccines being wasted if patients don't have them.

Also one surgery being quite short with patients who have used pharmacy and then accusing pharmacy of bullying patients in to having one.

On the plus side, lots of GPS being flexible and more proactive in when they do vacs.

Dhruva Kumar, Pharmacy

This is the message being sent to patients by our local surgery

PLEASE SUPPORT YOUR OWN GP SURGERY and have your flu jab here NOT at a local pharmacy.  Our next walk in clinic is tomorrow, Wednesday 21st September from 8.00am - 6.00pm.  many thanks. Surgery

Janet Newport, Pharmaceutical Adviser

NHSE, South (South West) are taking action agaisnt GP practices that undermine the credibility of pharmacies or the rights of patients to choose which provider they would like to receive this service from.  We are strongly encouraging collabarative working and making sure that the patient comes first.

Kevin Western, Community pharmacist

not yet.. but on the plus side, instead of relying on cattlemarket mass vaccinations, my local surgeries have started earlier and are doing opportunistic vaccinations to catch the people they normally wouldnt - strange that isnt it... 

All in all if the pharmacy flu campaign achieves nothing else, it has woken surgeries up to the fact they need to do things at  their patient's convenience not the surgery's - maybe the message will be applied to other areas...

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