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Surgery pharmacists 'not the only model' - Pharmacy Voice

Claire Ward: "We can't have a situation where GPs are running the show"

Plans to employ pharmacists in GP practices must not "chip away" at the community pharmacy network, says Pharmacy Voice chair Claire Ward


Employing pharmacists in GP surgeries must not be "the only model” for the two professions to work closer together,  Pharmacy Voice has said.

The Royal Pharmaceutical Society (RPS) and the Royal College of General Practitioners (RCGP) announced plans last month to employ an “army” of pharmacists in surgeries, but Pharmacy Voice chair Claire Ward said this was just one option for the sector to consider.

It was important that the community pharmacy network was not “put at risk”, because pharmacies were more accessible than GP surgeries, she told C+D in an exclusive interview last week (April 10).

Ms Ward, a former Labour MP and Independent Pharmacy Federation chief executive, stressed that her experience in politics had taught her there was sometimes “a risk in chipping away at things” until a network was “undermined”. She gave the example of post offices as another network that had suffered by having its services offered in other locations.

“Yes, there’s a role for pharmacists in GP surgeries. But the most important thing to underline is that there’s a bigger role for pharmacy to work with GPs, and a lot of ways we can do that,” she said.

Contractors were split over whether the plans were a threat to the commissioning of pharmacy services when they were unveiled last month, and Ms Ward said she understood why some people were “fearful”. “We can’t have a situation where GPs are running the show,” she stressed.

Ms Ward was aware of some pharmacists who were considering relocating to a surgery, while others were considering employing an extra pharmacist to work closer with local GPs, she said. Pharmacy Voice would promote closer relationships between the two professions by supporting discussions between the sector and both GPs and NHS England, she added.

Last month, a federation of 30 London pharmacies sent a joint letter urging the RPS to "seriously think" about the consequences of its plans.

What do you think about Ms Ward's comments?

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Graham Stretch, Primary care pharmacist

We work in 4 surgeries (~40,000 patients). We are not employed by the surgery but have an SLA with the GP partners and agree a rate for the services we provide. We bring the entire pharmacy skillset into the surgery (PhD, IP, ClinDip, PreReg, Techs & Assistants). This works well and reviews at level 2 and 3 are performed face to face, by telephone and remotely. The GPs are enthusiastic and the local pharmacy network, on the whole, is supportive and engaged.

Jo Hudson, Other healthcare professional

Hi graham- can you give me a ball park figure to charge a gp practice who've approached me- I'm an IP, clinical diploma & have worked in all sectors of pharmacy so have a massive K&S base to work from - chhers

N O, Pharmaceutical Adviser

That's the difference Mr. Stretch between the role played by a pharmacist like yourself and the Pharmacist being pipped to be employed by/ placed in-side a surgery. Do you think a Surgery employed Pharmacist will have the same kind of autonomy/ negotiating power like you have ??? NO says no, prove me otherwise.

Graham Stretch, Primary care pharmacist

Do you want to work in a surgery? Go and talk to the doctors, demonstrate what you can do and then you can negotiate your fee. This does not have to be an employed model, one size does not fit all. The three pharmacist IPs I work with all work in different surgeries as ‘contractors’, not employees. We all fulfil somewhat different roles with different hours. All the GPs involved have agreed to these terms, and, incidentally, pay is substantially better than locum rates. I started practice as a locum after leaving academia, at an independent pharmacy and built up relationships and roles with local GPs and other organisations, adding to my qualifications along the way, over the last decade or so. I think ideally you need a diploma and IP, but you can start with a more modest role and build this up over time. I don’t know what you are asking me to ‘prove’, you are, I’m afraid, in charge of your own professional development and career choices.

N O, Pharmaceutical Adviser

Do you know what topic you are currently discussing on ??? We are not discussing on what Pharmacists can do independently with the GPs, we are discussing a wider topic of Pharmacists being employed IN THE SURGERIES, proposed by RCGP and RPS. So stop beating the drums of what you have achieved as an Practice Pharmacist on an individual basis and talk about the implications the Pharmacists will have if this proposal goes ahead !!

Graham Stretch, Primary care pharmacist

One of the IPs (not me) does much of his role from his pharmacy (he is the proprietor). That is what I mean by different models. So he works in his pharmacy and is contracted by GP Practices to perform practice pharmacist duties which he manages as part of his portfolio. His access to medical notes in the pharmacy (which I also do) can only help with improving patient care, accessibility and outcomes together with being one model of delivering closer cooperation across primary care and securing his independent pharmacies financial future.

Nicola Sutherland, Community pharmacist

In GP surgeries there are also salaried GP's who are working for GP's. In pharmacies pharmacist work for other pharmacists. Whilst remaining professionally accountable for own actions, none of the HP's are entirely independent and autonomous as all working to guidelines and directives from all angles. The idea of totally independent professionals working only in the interests of patients is an illusion. I have worked as an employee pharmacist my whole career, in hospital for 20 yrs then primary care as prescribing advisor. There are oceans of patients with medication lists that would benefit from a thorough review, but GP's don't have time and pharmacists don't have access to patients records to properly assess appropriateness. I can see pharmacists in surgeries only as a good thing. The alternative would be a more accessible record which should be available to all HP's to read add to. I wouldn't mind whichever as long as patients got regular thorough reviews. Would save on waste too.

R A, Community pharmacist

Funny thing about community pharmacy is the only people who profit from the current model is the contractors, not the pharmacists, employees and the customers. With the new model it may inadvertently cause a fall in prescribing because if in house pharmacist start reviewing medication and reduce unnecessary prescribing it means a loss of revenue. But I wont be crying given how badly the multiples treat their staff.

Zegai Ermias, Community pharmacist

very well said my friend, that is why almost all the contractors are opposing this new scenario.who should all stand with RPS, otherwise the more pharmacists on the marker the worse the treatment from some oweners like multiples

Mike Hewitson, Superintendent Pharmacist

"Funny thing about community pharmacy is the only people who profit from the current model is the contractors, not the pharmacists, employees and the customers." Don't pharmacists and employees benefit by being employed rather than unemployed? My staff certainly benefit from secure employment - they share in the benefits of the success of the business through improved pay and conditions. Risk and reward are two sides of the same coin. As for the comment about reduction of prescribing = reduced revenue. Try understanding how the contract works. In year, maybe, but any under delivery of agreed funding is delivered by uplift to fees in the following year.

R A, Community pharmacist

Hi Mike, I can appreciate your comment but if you look at the activities of contractors on a national scale most are concerned with squeezing more out of staff/locum for less so you probably fall into the minority. I personally think in the UK we over prescribe often we fail to take into consideration whether it is appropriate and secondly if the patient will actually take the medication. If these factors were taken into consideration then prescribing would probably fall and the only party which would lose out from this would be the contractor.

Gerry Diamond, Primary care pharmacist

anyway don't see what being an ex abour mp has got to with anything. omg they nearly had the country on the rocks and even worse they may pair up with snp do drive us deeper into oblivion after 1st may. When labour get in they always leave the country bankrupt it's goin to end in tears again

Prafulkumar Soneji, Locum pharmacist

What is happening on 1st May Gerry?

Gerry Diamond, Primary care pharmacist

sorry 7th may labour gets back into government with the backing of the scots nats. hell on earth

Gerry Diamond, Primary care pharmacist

Well it will depend on the skill set, experience and training too. Will the GP or community support pharmacist be clinically qualified with a PG Dip in clinical pharmacy, will they be trained in spirometry, long term disease management, are they prescribers. Have they done audit, service evaluation and so on.

Peter Clarke, Pharmacy

Claire is 100 % right so says Graham Phillips and I fully agree butt when he says our future is assured then I am not so sanguine. I am a pharmacist retired to France where pharmacists and doctors have in the main shared classes with one another at medical/Pharmacy school I simply cannot imagine that either profession would agree with one being employed by the other. Of course politically in UK the theme will be what is good for the patient goes, whatever the consequences of one profession, in this case pharmacy. It is wrong if the clinical pharmacist for example, is in the pocket of the GP, another association even short of partnership must be the aim. I am saddened when I see comments totally based on how much money is in it, rather than the future of the profession if it is a good professional association then adequate returns will be the norm. Of course we may have already reached the stage when it is far too late to remedy the situation vis à vis pharmacy GP working together much more as equals. Pharmacists in UK , compared with their equivalents across the water, are in many ways in my view , certainly as good as their continental " oppoes". However, we lack so much confidence building from politicians, medical managers, some GP's and the media and that we are not thought of as professionals - t we are too easily thought of as just pill counters and so commercial. This planned working association with GP's needs a very close examination. History during the past 100 years in our profession is full of thoughtless pitfalls, some of which could have been feared. We will be told over and over again "it is good for patients" therefore why aren't you thankful? Will it be good for the profession of pharmacy?

Graham Phillips, Superintendent Pharmacist

Claire is 100% correct. If we get this right, the future of the profession is assured, but if not we will be between a rock and a hard place. Don't run away with the idea that GPs are a model of benevolence who will pay you a fantastic salary. Some may, most won't! We need to find a way to join the dots between the community pharmacy and the GP network; to do this we need funding to provide two pharmacists (at least some of the time) per pharmacy. That will mop up the XS pharmacists and salaries will rise. IAN: feel free to make as many snide comments as you wish-but will it get you anywhere? Regards Graham

Ian Kemp, Community pharmacist

"We can't have a situation where GPs are running the show". lol Who does Ms Ward think is running the show? Don't tell me she was a Labour MP when they thought they'd show GPs who was running the show by withholding payments to those GPs who didn't want to provide an out of hours service, A and E departments are still living with the fall out from that one! Mike Harvey is dead right about supply and demand. Pharmacists more supply than demand, GPs more demand than supply, basic economics.

mike harvey, Community pharmacist

the locum pay rates for pharmacists have reached an all time low ..£18-20 per hour -what will be the pay for GP practice pharmacists and will they be able to prescribe ? There is a supply and demand problem here...

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