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‘How can GPs reopen doors that were never closed?’

"It is a great shame that NHSE&I continues a rhetoric that serves only to widen the deep divisions"

The myth that GPs shut during the COVID-19 pandemic only serves to widen the divide between surgeries and pharmacies – and the NHS isn’t helping, says the GP Pharmacist

Judging by the response to my previous blog, I am sure there will be many community pharmacists who felt a huge sense of schadenfreude when NHS England and NHS Improvement (NHSE&I) wrote to all GP practices telling them to ensure that they offer face-to-face appointments.

I can only repeat what many in general practice are already telling anyone who will listen: we did not close our doors during the pandemic. What we actually did was what NHSE&I asked us to do: accelerate the use of technology in order to offer remote consultations, and to adopt telephone triage as a norm.

In fact, many GP surgeries were already operating a ‘doctor first’ triage approach to appointments before the COVID-19 pandemic, whereby patients had a call with a GP, who would then decide whether a face-to-face appointment was needed – and if so which appropriate healthcare professional that should be with.

The restrictions during the pandemic further enabled us to push forward with new ways of working, and proactively encourage some more reluctant colleagues into using new technologies. We also increased the use of electronic prescriptions and repeat dispensing in order to reduce footfall in the surgery. Put simply, the utilisation of technology in general practice has been adopted at a far more rapid pace during the pandemic than it had been previously.

While there has now been a huge increase in demand from patients to be seen, much of this is a result of many having been reluctant to visit their GP during the pandemic – whether it be for routine care or acute symptoms. We are now facing a backlog of people who are, on the whole, in poorer health generally. The increase in workload is stressful, but for now it is manageable. What is more demoralising is the endless revival of the flawed narrative that GP surgeries closed their doors during the pandemic.

I feel it is a great shame that NHSE&I continues a rhetoric that serves only to widen the deep divisions that continue to afflict our profession, especially across primary care – and that there appear to be many pharmacists who seize the opportunity to widen this division further.

I am now working closely with local community pharmacists to look at ways of incorporating the new GP Community Pharmacist Consultation Service into our triage and care pathway. Local community colleagues are keen engage in this, and to work with GP pharmacists to ensure the seamless referral of appropriate patients.

Those in community pharmacy who would rather knock down any GP pharmacist for disputing the claim that we shut our doors and were just shifting our workload to our colleagues in the community are the same individuals doing those genuinely trying to work across this unnecessary divide a huge disservice.

The GP Pharmacist is a former community pharmacist working in a general practice

21 Comments

sunil maini, Community pharmacist

I am as guilty as all of you.I do not understand why we all post on here tyo vent our spleen.Is it just to make ourselves feel better?I don't know. Because at the end of the day it seems that no one who "matters" reads it;and if they do,they do nothing about it.It all seems so pointless.

Andrew Hersom, Product Development

A few months back a neighbour became unwell and suspecting a heart attack her husband rang her GP - couldn't get an answer, husband drove her to the GP. Receptionist told her they wouldn't see her and to go to local community hospital. He rang 111 - they said go to GP.

Husband drove her to Local Community Hospital which said she needed to go to City Hospital A&E immediately but they didn't have any ambulances so her husband took her there (he was not allowed to go into A&E with her) where she was rapidly diagnosed with a MI (high enzymes, AF and BP 190/90) so transferred by ambulance to an adjacent specialist Hospital where the cardiac unit was.  They wouldn't  do an angiogram until she had been covid tested. Then diagnosed with minor MI, high BP and AF was finally confirmed but she didn't need a shunt immediately. Lots of drugs - beta blockers, blood thinners etc and hopefully see consultant soon (privately). Difficult not to get the impression GPs are not interested in their patients despite what they say.    

Getting Shorter, Community pharmacist

"I can only repeat what many in general practice are already telling anyone who will listen: we did not close our doors during the pandemic. "

Metaphorically: no.

In actual, literal, physcial, real life: yes. The doors were closed, and locked. For a long time.

There is no myth - you're deliberately ignoring the simplest meaning of the words "doors closed" to justify the actions taken. I'm not saying that it was necessarily the wrong thing to do, and I was and am impressed with just how quickly GMS switched to new ways of working... but the fact remains that doors were literally physically shut at a time when that pushed an enormous number of people to community pharmacy as the only immediately accessible healthcare source. It's trying to deny that ever happened - even if it was just for a week or two - that causes the hurt to community pharmacy, when we might have expected something closer to "Sorry we had to do that, we responded as quickly as we could, thank you for holding back the tsunami to give us the time to adapt." 

Mark Boland, Pharmaceutical Adviser

Are GP surgeries in a very difficult position? Yes, of course.

Are community pharmacies in a very difficult position? Yes, of course.

However, I dont ask GP surgeries to take on any of my workload and certainly not without payment. Patients are routinely being sent to my pharmacy for things that have nothing to do with me and are totally the responsibility of the GP surgery. This is all day - every day.

Why am I expected to fit in multiple blood pressure measurements because the GP surgery say they cannot? Why is my risk of face-to-face contact considered less important? Why is the blood pressure payment taken by the GP surgery?

Why is this asymmetry in 'shared' workload, payment and risk totally ignored in this article?

Maybe the ignorance of this statement explains it?

"Those in community pharmacy who would rather knock down any GP pharmacist for disputing the claim that we shut our doors and were just shifting our workload to our colleagues in the community are the same individuals doing those genuinely trying to work across this unnecessary divide a huge disservice"

 

 

Paul Dishman, Pharmaceutical Adviser

Do you carry out the b.p. checks,  Mark? 

Mark Boland, Pharmaceutical Adviser

Yes, often I do. 

For much of the last 18 months I have been working in shops with one member of staff due to staff shortages across the area.

Often I work in shops with staff that have been moved around for the day or newly hired and they have not been trained to carry out blood pressure checks. Or staff that are so stressed or just taken a mouthful of abuse that it only seems fair that I don't ask anymore of them.

 

 

Paul Dishman, Pharmaceutical Adviser

So you're actually doing the GP's job, but not getting paid for it? I can understand why you're doing it, but that would be a red line for me.

Angela Channing, Community pharmacist

To coin a phrase from the 80s....re BP checks....."just say No!"

Mark Boland, Pharmaceutical Adviser

For example, they wont issue prescriptions for contraceptives unless the patient has had a recent BP. They direct all these patients to the pharmacy.

They direct patients to the pharmacy as a matter of course, more often than not, relating to things I cannot do anything about.

Apparently during lockdown I should be fully open and face to face all day, the GP surgery however are a special case. The multinational owners of the pharmacies agree this is right.

This is the asymmetry in respect, work conditions and payment that pharmacy deals with everyday and which is never acknowledged.

P M, Community pharmacist

our local dr's are still closed, you can,t just walk in, the doors are locked and only opened for you if you have an appoinment.. calling them is 1hr wait in tel queue

one of them even shut down their email address as it was too busy and they couldnt keep up with the requests and queries

Snake Plissken, Student

Was fortunate enough to have worked across both primary care and community pharmacy until the end of the 1st lock down. Theres certainly is alot of misunderstanding/assumptions made reading the comments that are laughable to say the least.

Well, got to say that I never had and still don't deal with any of the above sentiment from the local community pharmacists I work with around my practices and neither had patients complaining to the practice about the lack of f2f GP appt either.

Must be living in a utopian bubble!

A.S. Singh, Community pharmacist

Pharmacists are unlikely to vent their frustration at the hand that feeds them.

I can first hand see how angry patients are. The surgeries have not been open as normal, its just a way of GPs taking extra time off. 

Pharmacies have been left to deal with a hell of a lot of things we shouldn't deal with. Patients response is normally along the lines of..'I can't get through to them, the video call was useless etc etc'.

Maybe GPs should set up a suggestion box and really see if their service has been good over the last 15 months.

I heard that all GPs got paid £10k to set up a home office at the start of the pandemic last year.

E simon, Community pharmacist

This is what an Anglesey GP surgery posted on their Facebook page on June 2nd 2021:

*******

 

"Unfortunately we are seeing an increased number of patients turning up at reception requesting to book a telephone triage with the doctor.  I understand our phone lines are busy but please do not turn up at reception.  This is for your safety and the safety of our staff which is paramount especially due to the new covid variants circulating

 

If this continues we may have no option but to re-introduce the intercom system and close the surgery doors once again."

Says it all, really....

Bob Dunkley, Locum pharmacist

 People want to see a fully paid up member of the GMC, ie a GP. They do not want one of the myriad "wannabe doctors"  who infest surguries these days, or interact via a video screen. The GPs are going to have to convince a LOT of people that they weren't closed during the pandemic. The irony is that we pharmacists knew they that they were open all along, but pharmacists, huh what do they know?

Angela Channing, Community pharmacist

My surgery has practice nurses, advanced nurse practitioners, practice pharmacist, healthcare assistant, physician associates, phlebotomist, counsellor, podiatrist, CPN, drug and alcohol nurse counsellor.......oh and a rare species.......3 GPs!!! One of the receptionists told me you had more chance of finding a Willy Wonka Golden ticket than jumping through all the hoops to see one of the GPs in person before all of the others AND..... then a telephone, then a zoom consult, then finally you may be granted a socially distanced full PPE meeting. I kid you not!

Leon The Apothecary, Student

My own experience has been quite different to what has been written here. I have found many GPs very often unable to attend many patients. Housebound patients have been of particular concern of mine, as many have not had the required check ups for their various ailments which has ultimately led to emergency response and a hospital admission that maybe did not need to occur.

Telephone triage also has it's limitations. Speak to anyone who has ever had to work with NHS 111 for any length of time and I am sure they will appreciate the sentiment.

So the workload shifts.

GP, you may consider the doors are open, but they are very much under lock and key.

C A, Community pharmacist

"What we actually did was what NHSE&I asked us to do"

"NHS England and NHS Improvement (NHSE&I) wrote to all GP practices telling them to ensure that they offer face-to-face appointments."

Welcome to the world of pharmacy, do what the NHS asks and still get an earful.

"There will be many community pharmacists who felt a huge sense of schadenfreude"

No, I think the people at the community pharmacy coal face will be, to a degree, sympathising with you for having to deal with the foibles NHSE.

Uma Patel, Community pharmacist

Obviously you are in your little ivory tower.

Just go on in any pharmacy and ask any patient of their experience over the last 12 months

Alexander The Great, Community pharmacist

Oh my.... I love your articles as it gives me opportunities to do some GP bashing. This may not apply to you in particular, but I'll let you know what I have seen and done during the pandemic when NONE of my patients could see a GP.

Patients are told to see the pharmacists for BP monitoring. Patients are told to see us for skin complaints, conditions that yes we may know what they are, but we cant treat! Patients who have lumps and bumps, worried about cancer, have infections, they are all panicking, want some reassurance from a GP, but cant even get passed the RECEPTIONIST.

GPs maybe triaging, but you have to go through the receptionist triage who has no medical training (correct me if im wrong).

Dr's not doing b12 injections... makes me laugh cos I get millions of scripts for B12 tablets ranging from 50mcg to 1000mg tablets. They can send you for blood tests but wont do injections lol. Obviously Drs know that a lot of people cant absorb b12, but just give these out to shut patients up.

I personally had a lump in my throat that was very painful, couldnt swallow. GP didnt examine me. Just gave me antibiotics to try (which didnt work), told me its very unlikely to be cancer if i were concerned. When I went to my chiropractor for my routine appointment, he told me I had strained muscles around my hyoid bone (which I didnt know existed).

Anyway, you cannot do physical examinations - see colours of people skin, feel for lumps and bumps, look into ears, nose, throat - and other orifices without face to face consultations. I'd be happy to bet, that during your "telephone consultations" - your rate of misdiagnosis will have shot up!!! You probably wont even have noticed, cos these people might have died from giving up trying to see you.

Anyway, hope you are enjoying your new found cosy GP life, and look forward to your next troll at us suckers who still open our doors to the public - that includes supermarkets, hospitals and police who stayed open to serve in close proximity.

Angela Channing, Community pharmacist

Still waiting with baited breath for her reply. The silence is deafening!

Michael Mustoe, Community pharmacist

Very well put, and very accurate

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