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GMC responds to pharmacists' complaints of GP flu tactics

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GMC chief: We expect organisations and employers to contact us if our standards are not being met

The General Medical Council (GMC) has responded to allegations of GPs deterring patients from the pharmacy flu service.

Doctors and pharmacists “must be open” about the different ways in which patients can access NHS services, including the national flu service, GMC chief executive Niall Dickson told C+D yesterday (October 4).

The flu vaccination service “should not be determined by commercial interest” and healthcare professionals should “not allow financial or other interests to affect the way they treat, refer or commission services for patients”, Mr Dickson added.

Mr Dickson’s comments come after C+D readers shared a number of examples of GP surgeries discouraging patients from visiting a pharmacy for their flu jab, including notices on surgery websites, electronic prescriptions and text messages.

One surgery is reportedly threatening to “delist” patients thinking of getting a pharmacy vaccination, while another has suggested patients are being “accosted” by their pharmacist to get a flu jab.

While the GMC "regulates individual doctors, not practices", Mr Dickson said it "expects organisations and employers to involve the GMC if they consider our standards have not been met”.

NHS England has already confirmed to C+D it will "look into complaints" from pharmacists about the matter.

C+D's bloggers Xrayser and Dr Messenger have both written about the recent GP-flu tensions. Read their blogs here and here.

C+D will be reporting more on this over the next week. If you become aware of any flu diversion tactics, email [email protected] or tweet us @ChemistDruggist.

17 Comments
Question: 
Will you be contacting the GMC with evidence of GP diversion tactics?

Ravi Patel, Community pharmacist

Flu vaccinations should be the perfect example to NHS England that we can take over certain GP services on a national level, to everyone’s benefit. The time we free up for the GP could allow them to take on certain newly commissioned services currently provided by hospitals. Surely once GPs have a service that brings in more money for their time than flu vaccinations they will actively be pushing patients to their local pharmacy, in order to focus on their new service.

Everybody would therefore be happy: a) improved access for patients b) increased revenue / new services for GPs with more free time c) increased revenue for pharmacy d) all whilst saving NHS England money through efficiencies, less hospital visits and utilisation of professional skills. Win-win-win-win?

Ivor Hadenuff, Primary care pharmacist

Good idea but a major flaw is that very few, possibly no, flu jabs are given by GPs - they are given by HCAs, nurses, even practice pharmacists

Valentine Trodd, Community pharmacist

In my opinion an example of a good pharmacy service - it seems the majority of pharmacists support it and patients like it. Aside from the typically overcomplicated proliferation of PGDs, SOPs, service agreements, declaration of competenece, etc. once you're up and running it's pretty straightforward, and reasonably well paid. As already pointed out, one of the few services that people actually come in and ask for. Now compare that with MURs and NMS...

Valentine Trodd, Community pharmacist

What a load of cobblers! The only reason anyone is doing flu jabs is for the money!

Hemant Patel, Community pharmacist

Applying your logic it would seem that the Beatles only wrote their music to make money, Rooney only plays football to make money, Apple only make smartphones to make money, PM only wants to go to work to make money, The rest of the world goes to work for the love of work. How about you?

 

Fire Walker, Community pharmacist

Well said!

John Urwin, Community pharmacist

Yes, both doctors and pharmacists. Also applies to everything done by the NHS.

Ghengis Pharm, Locum pharmacist

 'The flu vaccination service “should not be determined by commercial interest” ​'  This is absolutely why pharmacy companies are doing it !

Matthew Edwards, Community pharmacist

Only reason GPs do it too Darvis

Shaun Steren, Pharmaceutical Adviser

Of course they are, they couldn't care less about anything other than numbers on spreadsheets. However, in this particular case, does the patient benefit? 

Well it costs patients no more, they receive the same quality of service and it increases access and convenience, so this is positive sum. The reasoning is tight. 

The evidence is there (although incomplete): Is it more convenient and accessible? Where else can you get an immediate walk-in 9.00 til 6.00 flu jab service? Is convenience and accessibility important? Nearly every study concludes patients/customers rank convenience and accessibility at the top of their preference list. Is the cost to the patient reasonable? If you were to deliver 100 vaccines, minus costs, maybe the pharmacy makes £800 for the whole season, that is a low net profit for delivering what is optimally a macro service being delivered in relatively micro numbers. Pharmacists incorporate the work into their current schedules, there is no extra cost being passed onto the consumer through imported costs. Is the quality acceptable? The quality standards are uniform and require practice and theory training. Is it the patients preference? It is one of the few pharmacy services which people voluntarily request, how do you unknowingly force a patient into a flu jab, stab them when they are not looking? The tens of thousands of people receiving the flu jab is evidence of patient preference. It is a service in its infancy, each year the service becomes more established, the numbers increase, possibly becoming the established route for the public in the near future.

Maybe corporate owners are doing the right thing for the wrong reasons, but this is much better than the typical wrong thing for the wrong reasons. How has community pharmacy projected this very strong case? With typical weakness, sloppy reasoning and without use of empirical data. 

 

 

Dave Downham, Manager

Surely the point is that the remuneration should promote positive behaviour? That is not a "wrong reason" but a steer to desired results, i.e. more jabs administered, cheaper.

Shaun Steren, Pharmaceutical Adviser

Renumeration for whom? Whose behaviour? There are two agents - the pharmacist and corporate manager and so there are two rewards and two behaviours. The range of pharmacist renumeration can be very narrow for a large number of pharmacists but within that band there is a very wide range of behaviours and performance. The behaviour of corporate managers is nearly always identical in my experience. How do financial incentives explain this?

As Mr Edwards points out, pharmacists do appear to enjoy the flu service, but it is easy to see why:

Unlike most other services, patients actively request the flu jab, even in preference to the GP service. It feels good to provide something patients actually want.

The service can be delivered to the highest standards. Everything has been designed in to allow the pharmacist to deliver and record a consistent quality standard. It feels good to do a proper job.

There is solid reasoning for delivering the service. If you consider the patient, GP and pharmacist playing an n-person constant/variable sum game, you end up with a positive sum result. It feels good to have an intelligent water-tight argument for your position. 

The evidence base is easy to collect and accurately record. Flu numbers represent patient voluntary choice and therefore preference. Cost looks reasonable. Remuneration is not opaque and certainly not excessive relative to GP delivery. There is no evidence that outcomes are any different through pharmacy delivery. Cost-effectiveness ought to be easy to establish. It feels good to provide good value to the NHS.

The delivery of the service is efficient. Pre-vaccination questions are short and simple, as is administration, leave the patient to fill out their form, finish off with short advice, minimal paperwork. It is flexible enough for pharmacists to time manage.

An enthusiastic, ethical and interested pharmacist requires a minimum level of renumeration beyond which they will not behave in anymore a positive way. What can you say about the relationship between the behaviour of corporate managers and their benefits and opportunities for promotion ? Many thousands of employee pharmacists can use their decades of experience (sufferance) to answer that. 

Matthew Edwards, Community pharmacist

For once I agree with Shaun.  Yes there is a financial consideration but its not costing the NHS more and I rather enjoy doing this service. I hope that pharmacy is tasked with providing other services along similar lines including shingles and pneumonia vaccinations.

Shaun Steren, Pharmaceutical Adviser

.

Really? Wow, Superintendent Pharmacist

There is a little bit of a disingenuous​ tone from Mr Dickson, nearly all GP practices are partnerships which means that all the doctors are equally liable for anything the practice does. In other words, everything the practice does, each individual doctor is individually liable, thus saying the GMC "regulates individual doctors, not practices" is an misplaced comment in this context.  

Stephen Eggleston, Community pharmacist

Very true, Super Pharmacist - but, equally, is says that GPs may not use financial impactof patients having flu jabs in pharmacies as a method of "persuading" them to come to the practice. Mr Dickson is not reported as saying that it should be about patient choice but I woul hope that is behind his comments

Super Pharmacist, Community pharmacist

In other words, no action will be taken :)

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