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Xrayser: My GP surgery is refusing to refer patients to my pharmacy

"The LPC thought the chance of saving the GPs umpteen appointments would be attractive"

GPs must trust their receptionists to send patients to pharmacies otherwise the new referral service will fail, says Xrayser

Before we moved into our current house we nearly bought a “gatekeeper’s lodge”, until we read the agent’s details more clearly and realised that, owing to the steep slope on which it was built, the main bedroom was actually subterranean. That alone put me off the idea of being a gatekeeper, but recently I’ve come to realise that gatekeepers are also the reason that many patients can’t get their prescriptions.

There used to be a running theme in comedy about doctors’ receptionists being fearsome dragons, blocking a patient’s access to the GP and all medical services. But that’s so last century, because now it’s actually the repeat prescription clerk. Patient and pharmacists alike come up against these guardians of the script, a combination of Harry Potter dementors and Little Britain’s Carol Beer – who immortalised the catch phrase “computer says no”. They are the latest in a long tradition of the NHS restricting access to drugs.

Repeatedly we pass on requests for urgently required medication only to have them bounce back with the message “too early” or “already issued”. Time and time again we have to go through the performance of explaining that the patient needs another of the “already issued” item as agreed with the GP, or that they can’t go by their computer “usage” data for a drug like warfarin “because it has a variable dose”. Then, just when I thought the structure at the surgery couldn’t get any more perverse, we hit a problem with the new Community Pharmacist Consultation Service (CPCS).

To aid access to healthcare the new pharmacy contract includes the CPCS, so from October we can start receiving paid referrals from NHS 111 of patients with common ailments. Being keen for any new source of income, we persuaded our local pharmaceutical committee (LPC) to ask a nearby surgery if it would trial the paid GP referral. This surgery is coping with an unexpected influx of patients, so the LPC thought the chance of saving umpteen daily unnecessary appointments would be an attractive proposition. Strangely, the answer was “no”.

When asked why, it transpired that they didn’t want reception staff to be “triaging people”, which is a bizarre misnomer, because by nature of the role this is precisely what all reception staff do all the time – hence the ‘dragon’ epithet. The surgery went on to say that they were also concerned about the ethico-legal issues of sending a member of the public to the local chemist for health advice, demonstrating an ignorance of both community pharmacy in general and the NHS self-care agenda in particular.

So, not only are we hampered from obtaining the prescriptions we request, we may not get the paid surgery referrals to replace the income of the lost medicines use reviews and establishment payment, all because receptionists have given away their mantle of gatekeeping dragons to the repeat prescription clerks.

A long-running C+D contributor, the identity of Xrayser remains a mystery, but his irreverent views are known by all. Tweet him @Xrayser


Uma Patel, Community pharmacist

Referal scheme without any provision of supply is not going to be successful

Reeyah H, Community pharmacist

I felt this whole scheme was farcical from the very start. It’s going to fail very miserably!! We won’t get our EP payment back in any form. I will repeat my words.. SHAME ON PSNC FOR EVER AGREEING TO THIS. 

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I get a bit sick and tired of GPs referring to pharmacies those things they can't be bothered to sort out for themselves. I've lost count of the number of people I've dealt with who have been told by their GP to go to a pharmacy to buy codeine for example. I take great delight in telling those people to go back to their GP and tell him/her that they are totally wrong. And don't get me started on those dispensing GPs that send all the MCS items on to us so we can take the flak.

Jenny Etches, Community pharmacist

We had a patient who was told to buy betametasone ear drops to save the GP prescribing it. The palaver to get it sorted lasted over an hour with the patient steaming at me and then no apology from the surgery. The patient was even told I was lying. And the surgery PMR had no record of the GP recommending it. What can I say???

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I can think of several things you could say, except that all of them would result in the sack and quite possibly professional misconduct charges.

Stephen Eggleston, Community pharmacist

"Can I buy some (insert any p-med with licencing restrictions here). My doctor said I could buy it without a prescription" "Sorry, madam but unless your GP is also the Home Secretary, I can't sell it for that" Exit stage left, followed by a bear!

Leon The Apothecary, Student

I think it highlights a certain importance though of any proposed system needs to make itself mandatory at risk of being ignored or abused otherwise.

Tony Schofield, Community pharmacist

Any requests by the surgery for funding or recruitment will be looked at in the light of their accessing available resources. If en masse GPs are expected to reduce waiting times they will be penalised if they don’t. Then your friendly Rx custodians will see the folly in not using your services 

Kevin Western, Community pharmacist

The obvious answer is, for the next month or three, every time someone presents to you with a minor ailment, broken nail, etc..refer them to their gp and claim Medico legal issues force me to do so...
I have also learned the benefit of the speaker phone when talking to the surgery when they were being unreasonable, as long as only the patient in question could hear...
Then there was no question about who was being a problem and the patient could act accordingly.

Jenny Etches, Community pharmacist

Interestingly one local surgery was very happy to send patients to us to be triaged to help make their lives easier - but we weren’t in any danger of getting paid. 

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Did you actually do it? I'd have refused point blank.

N O, Pharmaceutical Adviser

The main reason they don't want to refer is -- we get paid for it!! So, in my opinion the CPCS will neither succeed on paper nor make us the lost revenue. All these GPs are going to do is, just send the patient to the Pharmacy and say the Pharmacist will help you. Ofcourse, we might end up selling some OTC stuff (unless the patient is adamant on getting everything free because they don'y pay for their prescriptions) but then the GPs will make sure the extra cash promised by the Govt through written referral in not gonna happen.

Alexander The Great, Community pharmacist

We have a chemist near us called "yourdoctorschemist" lol, the GPs here have NO problem referring rxs to them!!!That chemist is owned by several GPs who maybe friends with my local doctors.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I wonder how they get around the issue of Rx direction? Oh wait, they are GPs and therefore made of teflon....

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