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GPs still unhappy with 'chaotic' pharmacy flu service

Maureen Baker: Pharmacy does not account for shortfall in patients vaccinated by GPs this flu season

The RCGP is unsure if pharmacists are vaccinating at-risk patients or "people walking in off the street", says president Maureen Baker

EXCLUSIVE

The "chaotic" setup of the pharmacy flu service is preventing GPs from ensuring high-risk patients are being vaccinated, according to the Royal College of General Practitioners (RCGP).

GPs are still "very unhappy" with the way the service was implemented, and have no way of knowing whether pharmacists are vaccinating patients in at-risk groups or "people walking in off the street", RCGP president Maureen Baker told C+D at a King's Fund event on Tuesday (November 24).

There is a "big gap" between the number of vaccinations GPs have delivered this autumn compared with last flu season, and the pharmacy flu service only accounts for half of this shortfall, Dr Baker said.

A lack of information about which patients are being vaccinated means GPs are unsure if any at-risk groups are being ignored and "what we need to do" to address this, she added.

Isle of Wight GP Andreas Lehmann told C+D he is “generally happy” with the pharmacy flu service, but warned some GPs are “wary" of "certain services being offered through pharmacies”.

“Sometimes pharmacies take the easy option, and we still get the most complex [patients to deal with]," he added.

Earlier this month, the RCGP said pharmacy is partly to blame for the lower flu vaccine uptake this year. 

 

How has the flu service affected your relationship with GPs?

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23 Comments

Chris Pharmacist, Community pharmacist

GPs bleating because one of their income streams is at risk. Pharmacists have to inform the patients GP within 1 working day of vaccination here in Greater Manchester so vaccinating at random would be easily identified...you would have thought that they would be grateful of some assistance during the busy winter period but no, ungrateful, greedy and constantly moaning, par for the course (pardon the pun) for the RCGPs

Andrew Morrison, Superintendent Pharmacist

The lack of uptake is more likely due to the wrong choice of strains last year as patients seem more reluctant to have them this year due to the "50%" effectiveness. The PGD specifies which patients should be vaccinated on the NHS so there's no way that pharmacists are "vaccinating walk ins off the street" except privately. The whole point is that patients get flu vaccinations from somewhere whether it's the GP or Pharmacy - by providing more opportunities to vaccinate at different outlet can only be good for increasing the uptake nationally.

Sandra Gidley, Community pharmacist

Fair to say, I think, that the problem was the implementation and the late notice which means that GPs are left with stock they might not be able to use. The shortfall this year has probably got a lot more to do with the rather stupid reporting of the relative inefficiency of last year's vaccine. As always, the Daily Mail has a lot to answer for

Z ZZzzzz, Information Technology

I have no sympathy for GPs left with stock this year. According to how ineffective last years jab was and was known about before vaccines were supplied, they should think themselves lucky they got away with getting all the lovely fees last year. I wish they would stop moaning and start to record the number of notifications that each pharmacy has to send to them as part of our SLA.

Kirit Shah, Community pharmacist

I have been administering flu vaccines for the last 6 years, the local GPs are actually grateful to us for picking up those patients that simply do not want to go to the GP, if this means that they miss out on a few that may have otherwise gone to them, it does not seem to matter.,Surely as health professionals we are acting in the best interests of our patients and its not really that important who vaccinates them. I think most GPs do have this point of view as with all professions there are always rogue elements!!

Stephen Eggleston, Community pharmacist

I've said it before - if the GP service hit the numbers required, there would be no need for a pharmacy based service. They've missed the target so the opportunity has been opened up to other qualified providers. It's not about GP income - it's about vaccinating patients!

Colin Mannering, Community pharmacist

Aren't we supposed to refer more complex issues back to the GP? Some patients have not taken the vaccine this year due to poor press reporting last year which massively devalued the effectiveness of the vaccine.

Lauren Keatley-Hayes, Hospital pharmacist

This is so ridiculous. Every flu jab done at a pharmacy must have notification details sent to the GP, which we do! Plus, we're only allowed to vaccinate those within the very stringent criteria according to the area PGDs. The more proffessionals vaccinating, the better we'll all be for herd immunity.

Ben Merriman, Community pharmacist

Unless the local GP has to choose which golf club membership to cancel...

SydBashford Sold&Retired&DeRegistered, Community pharmacist

Never....I have learnt that some do the golf on their "Paid" CPD day !!

Jenny Etches, Community pharmacist

We have the contract to do Years 1 and 2 nasal flu vaccine plus two other Pgds to do both flu and private adult flu. But we can't do other children outside of this group. One parent told me that she had to be done at work as she worked in an NHS hospital, her two year old at the surgery and her Year 1 child with us, her husband could have a private vaccine with us but not at the same time as the child because that could only be done after school. She said it was nigh on impossible to get an appointment at the GP surgery for her toddler so it felt quite stressful getting the whole family done. With only one pharmacist on site it's proved quite difficult to meet the demands of this service whilst delivering standard dispensing services as well as any other extended services. However many patients have told us we are still more convenient than the GP surgeries as they can do other shopping, etc on the high street and they've been unable to book an appointment with the surgery anyway. I'm not sure what the answer is but we have struggled to meet demand and have had to sacrifice Rx waiting times to deliver.

Marc Brooks, Community pharmacist

Many surgeries in our area have one or two Saturday mornings in September when they vaccinate their patients. I have seen them queue up like cattle waiting for their turn. There is little privacy either. Does Mrs Baker think this is acceptable? There is also more convenience for the patients as they can attend at other times than the alloted two mornings!. There was very little time for pharmacies to get organised this year and we have done very well in a short time span. Next year it will be more publicised and patients will understand the process better. As long as the pharmacy informs the GP practice, then what is the problem?

Gareth Crawley, Community pharmacist

IMHO - pharmacists are vaccinating those who can't make it to the Saturday 'cattle-markets' that some surgeries offer - sometimes to the exclusion of offering timely alternative dates during the week. We get the patients who hate having to queue with 'sick' people, those who are a bit squeemish and take time, and those who didn't know they were entitled! We have to send full notifications within 24 hours as part of the service level agreement, so where the RCGP's get their information - or lack of information, I do not know. Could it be the surgeries not coding our notifications? No - of course not! They'd lose QOF points then, and that would never do!!

Hayley Johnson, Community pharmacist

Well, I don't know about anyone else, but I'm vaccinating both those at risk AND people walking in off the street. The difference is that I use a separate PGD for each one, and I charge those that aren't listed in the NHS PGD. Simples. I'd completely agree that the setting up of the service was chaotic, but that doesn't stop me from being able to effectively question a patient and determine which bit of paper to use for each one. Grrrr.

Ben Merriman, Community pharmacist

GP's are unhappy as they "have no way of knowing whether pharmacists are vaccinating patients in at-risk groups" - as the pharmacy notifies the GP of the vaccination being done, I'd hope that the GP would be able to work out whether the patient was eligible or not by using their own records. That's how they'd work out whether or not the patient was eligible for a vaccine, isn't it? On the (hopefully) odd occasion that they have reason to doubt a patient's eligibility, they should speak to the vaccinating pharmacy and ask for clarification. If they are still unhappy, they should contact NHS England ask them to investigate both the administration of a POM outside of the PGD (and therefore illegally) and a fraudulent claim for NHS funds. We should only be vaccinating eligible patients as part of an advanced service. Anyone acting outside both the PGD and service specification is doing our profession no end of harm. It only takes one person to ruin the reputation of a thousand.

Kevin Western, Community pharmacist

Some surgeries seem to see the service as a legitimate one and have no problems but some are rabidly against it and certainly GP representatives are showing their true colours. I think the key sentence in your reply is" they should speak to the vaccinating pharmacy and ask for clarification." - what, stoop to speaking to mere Pharmacists - the world would end first for some GPs. and of course GPs would never bend a rule to get income/quoff points - health checks on patients already diagnosed etc. would they... (to say nothing of flu service - who monitors their service?)

N O, Pharmaceutical Adviser

Also, could someone please pass on the PGD for Flu Vaccination through Pharmacies, to these highly qualified intelligent people to read and know for themselves "if there is an option for pharmacies to vaccinate PEOPLE WALKING OFF THE STREET and not the AT RISK GROUP"

sibonginkosi moyo, Community pharmacist

Is it possible that we pharmacist are so stupid as to just randomly vaccinate people without following protocol? If one or two people decide to lie about their eligibility that cannot be helped. After all patients are told the information would go to their GP. I doubt anyone would want to rob the system!

N O, Pharmaceutical Adviser

So you are unhappy that Pharmacies are doing the easy ones, leaving the tough ones to you ?? Well if pharmacies did not offer the service, then who would vaccinate these tough ones?? Please talk some sense !!!

Pharm Owner, GP

If pharmacies did not vaccinate the easy ones - then the funding provided by the easy (profitable) flu jabs would help pay for the more difficult (unprofitable) flu jabs. For all the goodwill in the world - nobody is going to volunteer to just do flu jabs by travelling to each persons home - without being paid more than the standard fee. As far as I know, there are no pharmacists travelling to patients homes to give the flu jab to those housebound patients (that we deliver to for example). Until we start doing this we cannot really argue against their point.

N O, Pharmaceutical Adviser

So Maajeed you agree that GPs are more concerned about their profits than actual outcome of vaccination. Right???

Pharm Owner, GP

I agree that GPs are not going to allow people to abuse their goodwill and do the flu jabs for a loss. There is nothing wrong with running a business and making a profit. That is what every pharmacy contractor and every GP tries to do. The health authority though (in this case NHSE) has to make sure that those difficult to reach patients have their needs met. Opening up the service to pharmacies and GPs together has not achieved that. I do not think pharmacies should just be ignored (my pharmacy has done over 600 now). But there should be funding tied to making sure the total population (of eligible patients) is covered. It is fairly simple - Current price + 20% if 95%+ of eligible patients vaccinated. - Current price if 90-95% vaccinated - current price - 20% if 80-90% vaccinated - Current price -40% if <80% vaccinated. Then just give the contract to 1 provider per area. That could be a GP (or group of GPs) or that could be a pharmacy, chain of pharmacies etc. It could even be the district nurses or a private company. But someone has to be charged with making sure that the overall numbers are high enough. The current system does not allow for that.

Marc Krishek, Pharmaceutical Adviser

Put it in the SLA and pharmacists will be allowed to do it

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