I heard my receptionist say “the pharmacist will see you now” and shortly after there was a knock at my consultation room door. “Come in,” I called, and in came a mum with a small child. “Hello Doct… um, Mr Pharmacist,” she began, somewhat hesitantly. “I called the surgery about Peter because of his rash and they said they’d booked me in to see someone at the pharmacy.” Peter looked bored and fidgety. He wriggled in his mum’s arms. “Sorry about this,” she said, “but there was such a queue to see you this morning we’ve waited nearly an hour…”
As the Digital Minor Illness Referral Service (DMIRS) gathers steam, is this how it’s going to be in five years’ time? OK, from a practical point of view GP referrals wouldn’t require patients to be ‘registered’ with pharmacies, provided we have full read and write access to summary care records. And it would be pointless to diagnose, say, impetigo, only to be unable to prescribe flucloxacillin or fusidic acid. We’d need a proper prescribing formulary, not just some half-arsed combination of patient group directions that are too restrictive.
Of course, we already receive referrals from GP surgeries. A seemingly constant stream of patients triaged by phone or at reception are directed into the pharmacy with their rash or gastritis. Many of these require self-care advice, with little or no medical treatment, and consequently result in time consumed, but no payment provided.
As there really is a shortage of GPs and nurses, a surplus of pharmacies, and an overwhelming imperative to save another £20 billion, which doesn’t grow in trees or on the side of big red busses, what better way of addressing the manpower shortage than by cutting GP appointments?
NHS England’s chief pharmaceutical officer Dr Keith Ridge said last month that up to 6% of GP consultations could be transferred to community pharmacy under the DMIRS. At the NHS England estimate of £30 on average per GP consultation, this is equivalent to £612 million of cost. Move that into community pharmacies receiving £14 per consultation, and should a pharmacist host five consultations per day, six days a week, their business will receive an extra £21,840 annual income.
Such a settlement would keep the Pharmaceutical Services Negotiating Committee happy, save the NHS £595m, and foresee a knighthood for the chief pharmacist who achieved it. This win for everyone is the reason that might just drive this forward, and for once I’m hoping the cynic in me is wrong.
A long-running C+D contributor, the identity of Xrayser remains a mystery, but his irreverent views are known by all. Tweet him at Xrayser