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