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‘The £20k GP-pharmacist partnership bonus is a golden handcuff’

"A full-time GP partnership is a rapid route to burnout"

It’s important to read the small print in the £20,000 payment for pharmacists partnering with GP practices, argues GP Toni Hazell

It seems like only yesterday that I first wrote about primary care networks (PCNs), but it was actually back in June 2019. Controversial from the start, they were formed in a hurry. Many GPs have been dubious about whether they will benefit patients, or just take GPs away from them to network meetings instead.

A draft PCN specification brought out last December was met with universal derision. A group of local medical committees estimated that the average practice would be £100,000 worse off over the course of a year, if the new contract was signed. It was swiftly rejected by the British Medical Association’s England GP committee.

A revised version has now been accepted by the BMA. Reactions from grassroots GPs ranged from ‘it’s as good as we are ever going to get’ to the more robust ‘no matter how many times you cover a turd in glitter, it’s still a turd’. Variants of these are all over GPs’ social media at the moment.

So, how does this new contract affect pharmacists? Given the falling number of GPs, it is vital that we look at how primary care can be delivered using a wider range of professionals. The new iteration of the contract allows for full funding of these roles – better than the 70% initially proposed – which includes provision for pharmacy technicians as well as pharmacists.

The questions of indemnity and responsibility for decision-making remain, as well as whether there are enough pharmacy professionals who want to take on more clinical tasks. It’s important not to diminish the importance of having pharmacists available to safely dispense drugs. I massively value this important safety net and would be worried if the move to get pharmacists to fill holes in primary care clinical provision left the dispensing aspect understaffed.

The £20,000 ‘golden hello’ to new GP partners has been a focus of headlines, and new partners don’t have to be GPs. I know several practices where nurses and practice managers are partners, and there’s no reason why a pharmacist couldn’t do the same under the new GP contract.

While £20,000 sounds superficially very attractive, the small print is that it’s only available for those working full-time, even though full-time GP partnership is a rapid route to burnout. The money is also contingent on a pharmacist staying in the partnership for five years, so it’s more of a golden handcuff amounting to £4,000 per year than a golden hello.

GP partners pay their employer’s and employees’ pension contribution. It’s likely that around two-thirds of the £20,000 will disappear to tax and pension. A cynic would say that the golden hello has been put in there to feed the ‘fat-cat GPs’ stereotype portrayed in the media and make it harder for doctors to negotiate future improvements in terms and conditions.

It’s difficult to cover the whole contract in one short blog, but I must point out something very concerning for the safety of the GPs, pharmacists, nurses, receptionists and other administrative staff who work in practices. Patients who have been violent towards healthcare professionals, which is sadly a common occurrence, can currently be removed from our lists and directed towards special schemes. This is as it should be: We must have a zero-tolerance approach to violence towards healthcare staff.

Up until now, if a violent patient tried to register again at a normal practice, they could be refused. If they were accidentally registered, then they could be removed from the list. But the new contract mandates that GP practices can’t remove violent patients from their register who have been discharged from a special allocation scheme.

Given that some special allocation schemes are expensive, and many intend to return the majority of patients back to routine general practice, it seems likely there will be an ongoing risk of further violence and harm to primary care staff.

It’s unacceptable that practices should be forced to re-register people who have shown themselves to be violent while in primary care. This potentially puts GP partners at risk of legal action from their employees, whom they are now unable to fully protect. That is certainly a risk that no golden hello can make up for.

We’ll have to wait and see how this new contract pans out. If I was a betting woman, I would put a substantial sum of money on PCNs not existing in five years, maybe sooner, and that they will be added to the list of ‘once-in-a-generation’ NHS reorganisations that take money and clinicians away from the front line.

Toni Hazell is a GP based in a practice in London

8 Comments

Leon The Apothecary, Student

"The importance of having pharmacists available to safely dispense drugs."

Pharmacists generally don't dispense drugs. Dispensers and Technicians dispense drugs. Pharmacists clinically assess prescriptions. It's a very common misconception and an important aspect to note.

Kevin Western, Community pharmacist

....I should add that the rest of the article is quite interesting and eye opening... there is obviously a lot going on we are unaware of here in Pharmacy land

Tarvinder Juss, Locum pharmacist

Yes, as has been pointed out previously, Toni does a very good and very needed job in bringing current GP concerns to pharmacists' attention.

 

Toni Hazell, GP

thank you Tarvinder! Kevin that's a good point which I hadn't really thought about - the issue often is when things are commissioned in pharmacies (like MURs) the amount spent for one review can often be something like what we are funded to look after a patient for 3m or so. I doubt pharmacies would be interested in stuff done pro rata on the £120 we get for looking after a patient for one full year.....it doesn't boil down to much for a half hour consultation. But completely agree with you in principle. 

Kevin Western, Community pharmacist

Toni
I suppose the £120 is based on the idea that the majority will never actually visit, a theory which doesn't work so well with an elderly population with multiple disease states as we have here.
I think there are lots of areas we can help each other, - NMS could save you appointments if you push patients to us.
You will be able to use the CPCS service to push patients to pharmacies for minor ailments and we will be paid to see them for you.
There will be other opportunities but
It does need co-operation and I'm afraid to say the limiting factor usually (not always!) Is the surgery. If we can over come this we can get a lot more done and that's without any new services.
I hope we can all work together going forward

Toni Hazell, GP

yes absolutely, and pharmacists working in practices and doing med reviews do work. Personally I've never seen an NMS or MUR report that hasn't duplicated what has already been done/caused me to have more work rather than less. minor ailments definitely - we do phone triage and I send loads of people with URTIs, insect bites, thrush etc to the pharmacy. You're right that those who don't come subsidise those who do but cherry picking of the young and healthy by companies such as babylon is threatening that and in some areas destabilising practices. 

Kevin Western, Community pharmacist

I've never come across Babylon but i can imagine the effect. Did you feed back to the pharmacies involved? Maybe point out what you would like to get from mur's? NMS could actually do some of your work if you ask them to check BP or peak flow etc?
Just a thought.
It's good that you are brave enough to give us your side of things, and I hope you keep it up!

Kevin Western, Community pharmacist

Ther alternative to employing pharmacists in surgeries is to actually commission services via pharmacies. I know that is anathema to most GPs, after all, to many GPs , all the money in the NHS belongs to them, but they cant have it both ways, overworked and unwilling to share the workload AND the spoils or  less workload and miss a small slice of the pie. I have already heard GPs in PCNs say under no circumstances will they spend any money in Pharmacies for services. 

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