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How my pharmacy avoided a flu conflict with GPs

"Our flu vaccination approach has strengthened our relationships with GPs"

It's high time pharmacists and GPs collaborated on the flu service, says Paul Mayberry

After the funding cuts were announced in England, Welsh health minister Vaughan Gething committed to invest in community pharmacy in Wales – and, crucially, to not reduce the sector’s funding. In the longer term, maintaining the current level of funding will be conditional on pharmacies providing a greater range of clinically focused services.

The Welsh government and local health boards are also promoting joint working between community pharmacists and GPs. We need to work better with GPs to deliver better patient outcomes, so we can maintain and improve the funding to our pharmacies.

For my pharmacy business, a good example of collaboration between pharmacists and GPs this year has been the flu service.

The Welsh government and health boards have targets to increase the number of people in at-risk groups who are vaccinated against flu every winter. Last year, the vaccination rates in Wales were less than 67% for over-65s and less than 47% for under-65s in at-risk groups. The target for these groups is 75%.

Community pharmacies are in an ideal position to help increase these vaccination rates, especially for patients under 65 in at-risk groups, because many visit our pharmacies to collect their prescriptions every month.

However, there is often conflict between GPs and community pharmacists around the flu service, when the professions can appear to be in competition over the same patient. This makes joint collaborative working a challenge.


GPs pre-order their vaccines and may allocate blocks of time to vaccinate patients, with projected numbers based on the number of patients they vaccinated in previous years. They have genuine concerns that money and time could be wasted if pharmacists were to “compete” for their regular flu clinic attendees.

Flu vaccine uptake could be increased if community pharmacists worked with GPs to identify which of the pharmacy’s at-risk patients didn’t regularly attend flu clinics. Pharmacists could then vaccinate those patients when they attend the pharmacy.

We produce a report from our patient medication records (PMRs) to list at-risk individuals who are taking medicines from the BNF categories for respiratory disease, diabetes, heart disease and Parkinson’s. We share this report with our local surgeries, who identify which of these patients don’t regularly go to the surgery for their flu jab.

We add a flag to the PMR system that highlights these patients to us when we are labelling their medicines. The flu vaccine is then offered and administered while the patient is waiting for their prescription.

Not only has this approach helped to increase vaccination rates, but it has built and strengthened our relationships with our GPs. By demonstrating clearly that working collaboratively greatly improves patient outcomes, we should be able to build the range of clinical services envisaged by the Welsh government, and secure the future of community pharmacy in Wales.

Paul Mayberry is managing director of the Mayberry Pharmacy Group, based in South Wales

17 Comments

Paul Dishman, Pharmaceutical Adviser

There would be nothing to stop the GPs taking the PMR resport and targeting all the non-attenders themselves

Valentine Trodd, Community pharmacist

Paul, do you ever read 'Pulse'? Have a quick read and see how highly the GPs think of Pharmacy...

http://www.pulsetoday.co.uk/clinical/prescribing/pharmacists-to-hand-out-emergency-medication-supplies-without-gp-approval

A Hussain, Senior Management

From reading other articles about his business, he is clearly very astute.  He will have weighed up the pros and cons of going after flu vaccine business and decided on this course of action.

The sad thing is that I bet he is ten times the businessman his GP colleagues are and probably works much harder for his patients.  The fact that you have to give in to them is a crying shame really.

We all know how to avoid conflicts with GP's.  Do as you're told!

Charles Whitfield Bott, Pharmacist Director

May be you could share with us how many flu vac you have done, I suspect not a lot.
 

A Hussain, Senior Management

Yes I await the article entitled 'I did 800 flu jabs in my pharmacy and my local GP's don't hate my guts'.

Anyone that's been a pharmacist more than five minutes knows that GP's are greedy and entitled.  It's how you manage to not tell them you know this that is the real skill.

Shaun Steren, Pharmaceutical Adviser

How would you meet your head office target if you followed this strategy? Can anybody explain what would happen if head office found out you had been doing this?

Valentine Trodd, Community pharmacist

Sounds like you're bending over backwards for the GPs. I hope they return the favour!

Shaun Steren, Pharmaceutical Adviser

Collaboration or deference? And where is patient preference in all this? 

Clive Hodgson, Community pharmacist

It has always been the case that so many Pharmacists feel the need to be subservient to the GP’s.

Shaun Steren, Pharmaceutical Adviser

Subservient to GPs, surgery receptionists, uncooperative staff, aggressive customers and bullying management. This is not all explained by a system that puts pharmacists in a weak negotiating position. My experience tells me that this 'profession' attracts an unusually high number of individually weak people. I don't know the mechanism of recruitment by which this is explained, but I do have decades of experience of it. 

Clive Hodgson, Community pharmacist

So I wonder if this "profession" attracts such people or whether it comes about later as a survival mechanism / natural selection? For example, a strong, assertive individual Pharmacist would not last long working in Community for one of the Multiples. They would soon be weeded out to be replaced by a compliant automaton.

Shaun Steren, Pharmaceutical Adviser

I think there are few things going on in the pharmacy primordial soup. I think there is the lower-middle class issue of pharmacists generally not being from the traditional private school/grammar school cohort where a sense of status and self-assurance is indoctrinated. There is the issue of those who did not get into dental/medical school self-identifying as being a part of something that is ultimately second-choice. The sense that community pharmacy is often selected for because of its flexibility in childcare must also play its role. 

Of course, Clive, your are quite correct. Anybody of exacting confidence and stridency would be eliminated (or self-terminated) from the automaton culture of the typical dispensary. However, they are such a rarity, that as much as they might be considered normal in high status occupations, in pharmacy they would be considered no more than elitist trouble makers. 

Valentine Trodd, Community pharmacist

I did for a while, then realised 'when's the last time a GP ever did anything for me?' Most of them don't even have the manners to return a phone call. Recently I called a local surgery regarding a potential overdose due to a GP's error, only for the receptionist to inform me - 'He is quite busy you know'...

The only form of communication our GPs seem to be comfortable with is faxed prescriptions marked 'Deliver ASAP'.

N O, Pharmaceutical Adviser

*Wait till you get the heat of the cuts and then you will realise your mistake. Why it has to be us pharmacists licking their back-sides??? Why not the other-way round?? As long as the overall goal (75% as mentioned by you) is acheived, does it matter who did how much?? By the way, with the kind of cuts we English Pharmacists have seen, it is no longer viable for the business to let the GPs have their way and say on each and everything. I don't care if my GP asks my patients to change the Pharmacy, if the patient likes my service he/she would never listen to their GP, as long as you explain in plain words why the GP has done it behind my back. Also there is NHSE area team, go ahead and complain to them for prescription diversion. I'm sure we are in to business to earn MONEY by using our skills and not run a charity !!!!

 

*This comment has been edited to comply with C+D's community principles*

A Hussain, Senior Management

Mr Mayberry is a very good businessman, but I must disagree with the description of what's happening here being collaboration.

Mr Mayberry is pretty much agreeing not to encroach on the GP's flu business and to vaccinate the patients that they weren't reaching.  This stifles his own vaccination numbers, but will protect the relationship with the surgery and therefore protect script business.

In the spirit of collaboration will the surgery and pharmacy swap roles next year, with the pharmacy vaccinating the 'easy' patients and the surgery doing the chasing of 'hard to reach' patients?

If it is the pharmacy cooperating for the sake of it's core business then fine, but collaboration works both ways and this sounds more like cooperation or compliance.

N O, Pharmaceutical Adviser

""""collaboration works both ways and this sounds more like cooperation or compliance."""

Very true about collaboration. But, you are too diplomatic in saying cooperation or compliance, may be to avoid getting edited ;-) I would rather subtly put this approach by Mr. M as -- Give me all your dirty work, i'll do it without any issues and then make sure the scripts are diverted to my Pharmacy in return. A pure business approach, not a  clinical or collaborative approach. Why do you want to give them a list and let them choose?? What about the 65+ eligible patients who don't want to go and stand in the long Que, on a Saturday, and rather come to the Pharmacy and get it done at their own convenience???

Jupo Patel, Production & Technical

*This comment has been deleted for breaching C+D's community principles*

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