Posted by: Adam Pattison Rathbone19 AUG 2014
Do you have problems getting an appointment with your GP? Why don’t you visit your pharmacist and if she can’t help you, you’ll get a referral appointment to a GP within 2hrs.
Exploring some uncomfortable truths about access to healthcare will make us all twitch a little awkwardly. With recent research advocating the essential role of pharmacies in deprived areas, the pharmacy business and primary care model is being brought into question.
Our current primary care model is broken. Advocates state that one in seven GP appointments could be handled by community pharmacy (http://www.bbc.co.uk/news/health-25744060). A pharmacist’s living is made from selling or supplying medicines to sick people; referring a patient to their general practitioner (GP) is non-profitable for the pharmacy, however, encouraging patients into your pharmacy on mass, by strategically offering a direct referral to a GP if the pharmacist cannot help, could be.
The woes of the NHS; hospital accident and emergency (A&E) waiting times, the burden of general practitioners’ workload, the financial misfortune of an ever decreasing dispensing income, the bad-idea that was ‘Walk-in Centres’ and the high demands of the patient public have driven us to a situation where a patient’s first port of call for healthcare is A&E; as their GP can no longer offer timely appointments (apparently).
Imagine if you would, that a very clever community pharmacist made an agreement with an enthusiastic but bogged-down GP who had been overworked for several years, due to high, but widely unnecessary, patient demand for her services that had choked an ancient healthcare system. The agreement would protect an hour of the GP’s time per day (perhaps for a nominal fee) which would be used to see patients that had been referred to the GP by the pharmacist.
Wildly publicised as part of a strategically managed campaign targeting patient populations who often abuse GP, Walk-in and A&E services, patients would flock to see their pharmacist in an attempt to get a guaranteed referral to a GP. By visiting their pharmacy first, GP’s phone lines, waiting rooms and appointments diaries would be freed.
When the patient visits the pharmacy, the pharmacist could treat some complaints or manage medicines problems (side effects, etc.) with advice and guidance, offering pharmacy-only or general sale list items for purchase, when appropriate. If the pharmacist could not offer a treatment or advice, then the pharmacist could refer the patient to a GP practice for an appointment that day. Uncomfortably, benefits for the pharmacist are financial (as footfall usually increases sales), benefits for the GP are a reduced workload and therefore freedom to offer longer patient appointments. The benefit for the patient is a more robust method of accessing a healthcare professional, ultimately giving GP’s more freedom to see patients that really need it. Policy makers and commissioners also benefit in that they can reduce the number of inappropriate attendants to GPs, A&E’s and Walk-Ins.
To initiate something like this would require capital, perhaps more easily available to a multiple pharmacy chain, but equally it could be initiated by a pharmacist or GP who are willing to work with each other as partners and pool their resources. As I understand it (and I’m willing to be corrected) GPs are paid according to the number of patients on their books rather than how often they see that patient, so a GP practice wouldn’t necessarily stand to lose income.
The pharmacist’s income would increase through product purchases initially, but government lobbying could result in a pay-as-you-go tariff for pharmacist consultations – thereby removing the theoretical conflict of selling medicines to sick people.
An initial idea that clearly requires some tailoring by both professions and the public, but one that might have merit?