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‘Diktat’ of in-person GP clinics will strain primary care pharmacists

GHP: Pharmacists have used video appointments to meet their patients’ needs during the pandemic
GHP: Pharmacists have used video appointments to meet their patients’ needs during the pandemic

The Guild of Healthcare Pharmacists (GHP) has joined calls urging NHSE&I to reconsider its position on mandating face-to-face GP practice appointments.

GP practices in England were told they “must all ensure they are offering face-to-face appointments” in a letter sent by NHS England and NHS Improvement (NHSE&I) medical director for primary care Dr Nikki Kanani and NHSE&I director of primary care Ed Waller last week (May 13).

They were also asked to “respect [patients’] preferences for face-to-face care unless there are good clinical reasons to the contrary, for example the presence of COVID symptoms”.

“Diktat” will increase demand

In response to the letter, the British Medical Association GP committee chair said NHSE&I should clarify how GP practices are “expected to meet demand” to offer patients their preferred choice of appointment.

In a statement published today (May 18), the Guild of Healthcare Pharmacists (GHP) has also asked NHSE&I to rethink its instructions on “insisting” that practices offer in-person appointments.

“While we recognise the need for a proportion of appointments to be face to face, we disagree with the diktat that the offer of a face-to-face appointment must be given. This will simply increase the demand on already stretched services,” the GHP said.

Impact on primary care pharmacists’ morale

The NHSE&I letter will have had an “adverse impact on the morale, mental health and wellbeing of the pharmacy team” in practices and further feeds into the “false narrative” that GP practices worked behind closed doors during the pandemic, the GHP added.

This view is echoed by Laura Buckley, a locum and pharmacist at a primary care network (PCN) in East Yorkshire.

“The release of the letter by NHSE&I is demoralising for the teams that have gone above and beyond during the pandemic and the vaccination rollout, and has served only to add excess pressure and undue stress at a time when teams are already on the edge of burnout,” she told C+D.

GP practices kept their doors open during the pandemic to see patients in person “where necessary” and it is “severely misguided” to suggest otherwise, Ms Buckley concluded.

Use of technology to meet patients’ needs

The GHP added that, during the pandemic, primary care pharmacists have adopted telephone triage and video appointments to meet their patients’ needs.

“Pharmacists are skilled healthcare professionals and can be trusted to make appropriate decisions about the best consultation mechanism for individual situations, and we would like NHSE&I to recognise this,” the GHP said.

Danny Bartlett, senior clinical pharmacist for the Coastal and South Downs Care Partnership PCN, told C+D today that “virtual and remote accessibility has its upsides, too”.

“Younger patients and working professionals can now have letters and important counselling information sent to their mobiles. This means our practice is able to be more efficient and fluid and can improve patient outcomes in those demographics that find it difficult to carve out time to visit a practice in person,” Mr Bartlett said.

He agreed with the GHP’s statement that mandating face-to-face appointments when these are preferred by patients will put “pressure an already stretched service, particularly with vaccine clinics on full steam”.

Community pharmacists: in-person appointments should be available when necessary

Amish Patel, superintendent pharmacist at Hodgson Pharmacy in Longfield, Kent told C+D today that in some cases, patients have been denied the opportunity of face-to-face appointments during the pandemic.

“This is not acceptable and general practice needs to be more open to face-to-face appointments when necessary, following an appropriate triage,” Mr Patel added.

Amanda Smith, manager at Heath Pharmacy in Halifax, West Yorkshire, told C+D that “if a patient feels strongly that they need a face-to-face appointment then they should be able to have one unless there are clinical reasons not to”. She added that her pharmacy team sometimes hears of patients complaining about virtual appointment options.

However, she recognises that the NHSE&I advice could add pressure on the already stretched GP services.

“It’s an ideal opportunity for surgeries to make use of the new GP Community Pharmacist Consultation Service and refer patients with appropriate conditions to their community pharmacy. We can assess them, give advice, and refer onwards if necessary, helping to free up appointment slots for more serious conditions,” Ms Smith added.

9 Comments
Question: 
What do you make of the GHP's position?

Another Pharmacist, Hospital pharmacist

A friend said to me the other day...and I've come to agree I think...what's the view here?

So a practice has 7k pt list...they get paid irrespective of how many patients rock up. Now with virtual access and WFH, people who pay for care (workers) have the time to access to the services they've wanted to, but couldn't. So now GPs are kicking off that they're suddenly having to deal with the patients they've been paid to deal with for years! thoughts?
 

Pulse website states how practices are kicking off that centrally funded video/econsult services aren't being switched off on wknds so they're coming back to more work. They're err centrally funded and GPs are paid to do the work in their contracted hours! I just think this shows the number of people that actually want to use the health service but have been 'blocked' or found it harder to access! 

and finally, my extra thought...whenever pharmacy, optometry or dentistry offers to take a service off GPs they kick off big time...but now they're (more than ever) over stretched! They're a private commissioned service that gets their rent paid and all sorts in the best contract EVER! Now the public is seeing healthcare like their broadband or Netflix...a service they have paid for! Just because we have a till/card machine on the counter - from basic contract law perspective - we are the same as a GP and have been since 1947! We should be clear what the public have paid for: f2f GP and access to meds (no delivery/dossett's boxes). Sorry to rant but this article and the ones on pulse have wound me up.

Adam Hall, Community pharmacist

At the risk or repeating comments by others - pre-pandemic, f2f was the default for most practices; covid enabled GPs to push patients on to virtual appointments. Now, because they are being told to switch back to f2f, they are bleating on about "already stretched services". Can someone explain that to me? If they have been fending off patients like a maurauding hoard, how have they become "stretched"? And how does this "diktat" impact on GP Pharmacists - unless everyone knows (but won't say) that as many f2f appointments will be pushed on to the GP Pharmacist to avoid actual GPs actually getting within 20 feet of an actual patient, and thereby actually doing the job they are actually paid for? Or am I just being cynical?

Kevin Western, Community pharmacist

“The release of the letter by NHSE&I is demoralising for the teams that have gone above and beyond during the pandemic and the vaccination rollout, and has served only to add excess pressure and undue stress at a time when teams are already on the edge of burnout,” 

seriously? tired of all that screen time from home/ extra pay for vaccine clinics?

DavidJ J, Pharmacy owner/ Proprietor

My comment to Laura Buckley who has been quoted in this article would be to spare a thought for your community pharmacist colleagues who continued non stop with their face to face service delivery during the pandemic and worked tirelessly despite the risks particularly during the first lockdown. You get no sympathy here.

 

 

 

Another Pharmacist, Hospital pharmacist

I can't say I disagree with any other comments here! 
but the article does also point out an issue with our professional representatives (again!).

So the way I read this was that the risk to GPs etc is still high so they should keep video appts. And what our peeps said was, ok so if GPs keep video appts, send Pts to pharmacy. I see their logic, to boost pharmacy income etc. But surely that ALSO says, the risk is too high for GPs, don't worry, no risk is too high for pharmacy staff we represent. It's the same reason why if a pharmacist does the same job as a GP (flu jab of old for example) we get paid less. 

Kevin Western, Community pharmacist

perhaps they will get off their collective butts and use GPCPCS? or engage with NMS?  Surgeries have had an extended holiday with vast overuse of Covid as an excuse for not seeing people... time to get back to work, and do what they profess to be about, patient care... believe it or not..

PARESH shah, Community pharmacist

I think they have already been given more money to add extra capacity for locum hire. No excuses please. 

N P, Community pharmacist

No sympathy here for practice pharmacists or GP's.

Wanting more money for going back to what they were doing and should have been doing and had stopped.

M. Rx(n), Student

This is a bizarre line of retort by the BMA/GPs.

Face-to-face contact have always been by advance appointment anyway. GPs have always had that discretion - increased demand or not each patient would be seen to on an appointment basis, no?

I stand to be corrected. 

Seems more like they are upset at being told by the paymaster to get back into the usual swing of things. I get it... Professional Pride and all that. 

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