Unintended consequences of pharmacists working in GP practices
I was most agreeably surprised when watching ‘Breakfast’ on BBC to learn that the Royal College of General Practitioners is recommending that every GP practice should have its own pharmacist. Also it was good to see the interview with a pharmacist working in such a practice. From what the pharmacist was saying, it would seem to be ideal for all parties with the pharmacist managing many long-term patients. He also suggested that such arrangements would mop up the current surplus of pharmacists.
However, as a former community pharmacist myself, I soon saw that such arrangements could potentially cause disaster for many of my former colleagues who have established excellent working relationships with local GP practices. The Pharmaceutical Services and Negotiating Committee and others fought long and hard to establish services like medicines use reviews (MURs) in community pharmacy and, despite some opposition, have managed to keep the programme alive to the professional and financial benefit of community pharmacies.
One would assume that the whole MUR system would gradually collapse because patients would not want to have two reviews on their medicines. Also it would not make sense for the government to fund the community-based reviews any longer. One member of the public interviewed on the programme apparently thought, I assume mistakenly, that the presence of a GP practice pharmacist would allow his prescriptions to be dispensed on the premises to save a visit to the community pharmacy.
I am not a total reactionary and can see that the proposed scenario could benefit all parties in a large GP practice, which is served by a relatively large number of pharmacies. However, this is definitely not a one-size-fits-all situation. One has to consider those pharmacies established in the same premises as GP practices, where the pharmacist has the opportunity to interact with GPs and nurses. The amount of delegation to the pharmacist to manage long-term conditions and repeat prescribing will doubtless vary widely, but communication and cooperation should lead to a reduction in the GPs’ workloads.
In addition, there are still small, often rural, pharmacies serving a single smaller GP practice. In my pharmacy we developed excellent working relationships and trust with the GP practice, with the result that minor problems were sorted out without the patient concerned being aware. The GPs expressed an interest in devolving care for some patients to us but were inhibited both financially and from the professional indemnity point of view. The way things have moved on would present an opportunity for further discussions. Many patients trust their pharmacist implicitly and would welcome devolution of more aspects of their healthcare.
I would urge all parties to indulge in a great deal of negotiation and discussion before bringing in sweeping changes that could severely damage many good community pharmacies.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20068159
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