Networks are the current hot topic in primary care – it’s impossible to miss them. The outcome of the GP contract negotiations for 2019-20 encourages all practices to join with others to form a primary care network (PCN). These networks will each cover 50,000 patients and funding will flow through them.
I qualified as a GP in 2004 and moved to my current practice under a scheme designed to counteract difficulties in GP recruitment. 15 years on, little seems to have changed, with GP numbers falling and ongoing recruitment difficulties. In the context of these difficulties, and with many presentations to general practice being for minor ailments – for which a pharmacist’s expertise is valuable – NHS England has pledged to “further upskill” pharmacists to provide care for some patients who would have otherwise presented to general practice.
PCNs all over the country are advertising for pharmacists to fill these roles. It makes sense for some patients who would have presented to a GP to be seen by a pharmacist instead. Pharmacists are highly trained and capable of managing minor illness, while also being able to spot patients who actually need to see a doctor.
So far, so sensible. But, there are two main issues. The first is that it is all being done in a huge hurry. Traditionally, changes in the GP contract have been announced a year or so in advance, giving GP principals time to plan. All of the network-related administrative work has to be done in the time when GPs aren’t seeing patients, time that is generally already filled with paperwork and practice development.
In this instance, PCNs were announced in early January and are meant to be in place by July.This is a much shorter timeframe, one that has left many GPs feeling they have to make important decisions in a rush. This means that PCNs all over the country will be looking for pharmacists to fill these roles, and they are often struggling to find them. After all, the job centres weren’t previously full of pharmacists twiddling their thumbs.
NHS England and the General Practitioners Committee are working together to plan a new course that will better equip pharmacists for these roles – but with the first cohort of pharmacists potentially starting their five-year integrated education programme in March 2020, this isn’t a short-term solution.
The second problem is the perennial one of who takes final responsibility for the decisions made by non-doctor healthcare professionals. The extra roles that are coming along with networks are meant to reduce workload pressures on GPs, which is a laudable aim, and one that a prescribing pharmacist can certainly achieve.
But with a shortage of staff who are trained to prescribe, there is a significant risk that pharmacist consultations will end with a long list of things for the GP to do. If I’m signing the prescription, and taking the medicolegal responsibility for it, then I have to review the decision-making process, and all of a sudden the new member of staff has increased my workload rather than reducing it.
It will be interesting to see how this pans out over the next few years. As the GP recruitment crisis seems unlikely to abate, this could be the start of a new age of primary care, where each patient is seen by the right healthcare professional, who makes their own decisions and takes ultimate responsibility for the consequences of those decisions. Or, it could be the start of a disastrous era of healthcare professionals being asked to work outside the level of their competence, and GPs being expected to be a risk sink for all their decisions.
Let’s keep our fingers crossed for the former and try to avoid the latter.
Toni Hazell is a GP based in a practice in London