How pharmacy could save the NHS

Graham Phillips argues that the surplus of highly skilled pharmacists could create a unique opportunity to support to overburdened GP workforce.

Blog post

Published: 09/12/2014

I read Amit Bhargava’s recent blog with interest – among many other pieces on the financial pressures facing the NHS, and the recruitment pressures facing GPs. The one that affected me most was a blog by a female GP who faced burning-out under the stress of it all and ended up with a silent breakdown.

I believe a crisis is imminent, if not already upon us. One local GP practice has effectively collapsed due to its inability to recruit doctors. Another has the workload for three GPs but cannot recruit a third partner. The remaining two GPs work 16 hour days: how long before they collapse under the workload or make a serious error due to being over-tired and stressed?

The Royal College of GPs say we need another 16,000 GPs. But it costs around £500k to train a GP; it takes the best part of a decade; and salaries are high. The health service has neither the cash nor the time.

As the financial crisis squeezes GP time and recruitment, another group of highly-qualified professionals are ready and able to start work: recently-qualified pharmacists, like my son, who qualified a few weeks ago.

Today’s pharmacy-trainees have to demonstrate a huge range of competencies before registration and then pass a very stringent professional exam at the end of the final year. As well as current knowledge of the latest drugs and how they combine in people with more than one long-term condition, they receive far more clinical training than my generation did.

Simultaneous with the desperate shortage of GPs, we have more pharmacists than the NHS needs for the traditional 'safe supply' or dispensing role. This represents a unique opportunity.

In a knee-jerk response to the crisis, the government recently announced that the NHS will get at least £2billion extra funding. In the overall NHS budget (£100billion) that’s a drop in the ocean, but a fraction of that investment could transform community pharmacy. For justified safety reasons at least one pharmacist must be based in each pharmacy. But a small investment in staffing would allow pharmacists to conduct home visits, to have sessions with GPs or to provide more services in the pharmacy itself.

Around 57 million GP appointments each year are for common conditions that could be safely handled by community pharmacists - which would both free up GPs and save at least £1billion because pharmacists are less expensive. Yet despite substantial evidence that these 'pharmacy-first' schemes work, patients love them, and re-consultation rates are low, they remain rare.

Meanwhile, a striking 12-15% of hospital admissions are directly related to medicines: half due to complex interactions between cocktails of drugs and diseases, half due to poor compliance. Patients with long-term conditions are reluctant to take the very medication that will help control their condition and, ultimately, improve and extend their lives. This is bread-and-butter stuff for pharmacists.

One need look no further than the “Now or Never” report to see the potential. It all seems like a 'no-brainer' so what’s stopping progress?

It starts locally.

CCGs are GP-dominated and the competitive culture imposed on local commissioners discourages professions from working together. If we want primary care to operate as a person-centred multi-disciplinary team, as Simon Stevens sets out, then we must commission accordingly. 

Commissioners who continue to ignore pharmacy must justify how they are achieving the same outcomes in a timely, cost-effective way. There could be a national pharmacy innovation fund to bid against, with the winning pilots networked to spread best practice.

We should align the GP contract and Quality Outcomes Frameworks (QoF) with the community pharmacy contract. Pay the two professions to work together in the interests, of patients not compete. In the medium term, let’s align the contracts of all the independent contractors to the NHS: GPs; Community Pharmacists; Optometrists and Dentists.

Urgent national action is imperative: Adding more core services to the National Pharmacy Contract would deliver the “pace and scale” of change the NHS needs.  We could use Healthy Living Pharmacy as a template for a pharmacy/public-health QoF.

I’m entirely in favour of 'local problems/local solutions' – but many problems are national and should be tackled as such. It simply doesn’t make sense to have 150 different smoking-cessation services, each with their own individual administration costs and procedures. The same applies to sexual health, alcohol services, obesity and others. Pharmacy could be key to delivering the Five Year Forward View.

Despite the negatives, the NHS makes us proud to be British. Resources are running low, but satisfaction and trust remain high. So I’ll end as I began with a GP story – this time, one of optimism and hope by a trainee who concludes: “No amount of austerity and bureaucracy can take away the simple pleasures of being a GP.

I feel exactly the same about my own profession.

Suggested citation

Phillips G (2014) 'How pharmacy could save the NHS' Nuffield Trust comment, 9 December 2014. https://www.nuffieldtrust.org.uk/news-item/how-pharmacy-could-save-the-nhs

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