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Is this your area, or mine?

I'm all for other healthcare professionals taking on more responsibility, writes Dr Livingstone, but making POMs available prescription free is just another example of the lines between us being blurred

I hate to be utterly predictable. But the news that certain pharmacists can now dispense 16 POMs without the need for a prescription does rather bump my angst-ometer up to panic level.

This isn't reflex professional indignation or territorial protectionism - as a general rule, I'm all for widening access to medication, within reason (eg adding amitriptyline to the tap water).

But I do feel edgy about some in this list of 16, such as ED treatments, antibiotics for cystitis and psoriasis creams.

GPs are trained to within an inch of their lives to uncover and resolve patient concerns, and to spot the serious needle in the haystack of trivia – and I do wonder if a tick box assessment will achieve this. If it does, then I wonder about something else, too: why taxpayer's money is wasted on training GPs in the first place.

It's impossible to know who's doing what and who's steering the ship

All of which, I realise, does actually sound like professional indignation/protectionism. So let me tell you the main problem. Schemes like this are just another example of how general practice is being deconstructed, bit by bit. We GPs used to know who was doing what and which aspects we were responsible for. Now the lines have blurred to the point that I can't see them at all.

We have nurse specialists dealing with, say, patients' diabetes, a community team looking after their COPD, pharmacists performing treatment reviews and vascular checks, independent prescribers all over the place, and so on. It's impossible to know who's doing what and who's steering the ship.

Yet all these problems, in the average multiply morbid patient, overlap and interact – it's an expensive, time consuming and dangerous folly to think they can be separated out and each dealt with individually. Plus, if something goes wrong – a side effect here, a conflict of information there, a nurse specialist off sick anywhere – then the GP inevitably acts as final common pathway. In other words, we end up responsible for the actions of everybody else.

This is hectic, difficult and stressful, like keeping multiple plates spinning while all the stage hands bugger off down the pub. This new scheme adds another 16 plates. And, frankly, I can see the whole lot crashing down.

Dr Livingstone is a real-life GP lost somewhere in the NHS jungle. A reluctant part of a GP commissioning consortia, he offers his slightly wry look at all things NHS

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