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Xrayser: Pharmacies could make £22k from the DMIRS

"Pharmacies already receive a constant stream of referrals from GP surgeries"

GP referrals to community pharmacies may be a win-win situation for everyone, despite creating queues and requiring a prescribing formulary update, Xrayser says

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


Claire Slater , Community pharmacist

"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.", how does that balance with the loss of £11800 pa from the MUR and another  approx £11000 establishment payment....Take from one hand and return less with the other....

N O, Pharmaceutical Adviser

There is a great difference between "COULD" and "WOULD". I will sign-up for this service when the "WOULD" factor is evident, with little disrurbance to the normal day to day Pharmacy activities. Otherwise we WOULD end up losing more than £22k from existing customers leaving us due to delays in getting their scripts done on time.

Leon The Apothecary, Student

I quite liked Healthera, currently being trialed by Paydens I believe. It allows people to use a WhatsApp style service to leave a message with the Pharmacy to ask a question that can be directly responded to.

Rajeshvari Patel, Community pharmacist

So far, DMIRs service has been a waste of time for us. We have wasted valuable time in chasing the patient with several phone calls ending in no  shows, navigating the tedious Sonar platform for  recording and getting nothing for the time spent in doing all this when the referral stays ‘uncompleted’.  Out of 5 referrals only one  patient turned and paid for the cough medicine and left saying he could have come straight to the pharmacy if he had been explained the  service better.Patients are not being informed that they have to pay for the medicine. Another one with a child with a high temperature not being relieved with Calpol being referred at 10pm when we were shut.The  whole service needs revised to be more useful to the patient as  well as the GP and cost effective for the pharmacist. By the way it seems that it’s mostly the independants who have signed up for  it! 

ABC DEF, Primary care pharmacist

This will only work if patients are willing to pay for their otc meds which we all know they aren't. Everyone are so spoiled that they think they are entitled to have everything and anything for free. Another problem is 90%+ GPs have not a single clue what one can buy otc and their respective indications and exclusions. It won't be long until someone is referred to get hydrocortisone for the face or genitals, chloramphenicol in <2 or for stye, avamys or fexofenadine, flixonase for polyps, beconase in <18 etc etc. 


SP Ph, Community pharmacist

Heard from somewhere, Alexa is getting ready to sort out the problem of giving a proper advice.

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