Using Additional Roles Reimbursement Scheme (ARRS) funding for GPs would be ‘ridiculous’ given the difficulty of recruiting doctors and the efficiency of utilising other roles within the surgery, a pharmacist partner in a south coast general practice has said.
Shilpa Patel, lead prescribing pharmacist and partner at WellBN health centre in Brighton and Hove, spoke to The Pharmacist as general practitioners threaten industrial action as their contract demands – including calls for GPs to be included in ARRS – look unlikely to be met.
‘They want to use the funding for GPs. The whole reason why the ARRS funding came out was because there is a lack of GPs. And so, we've put a lot of effort into training non-medical staff to take on those roles. So, I actually think that part is completely ridiculous,’ Ms Patel told The Pharmacist.
She said that in her practice, ARRS funding is used ‘cleverly’ to deliver ‘much better patient care’, even allowing GP vacancies to be replaced with pharmacist roles.
‘Because [the pharmacists] are dealing with all the diagnosed cases, the doctors are available now to take on new patients. Whereas if we weren't there to take all that workload off them, they wouldn't be able to do that side of things,’ she said.
In particular, Ms Patel said that pharmacists had taken on workload around services such as mental health medication and menopause clinics.
Once patients are diagnosed by the GP, a pharmacist can manage ongoing medication and safety checks.
‘When I first came in here nine years ago, I saw people on antidepressants who hadn't been reviewed for, seven, eight years, and they just carried on taking them,’ Ms Patel told The Pharmacist.
Now, practice pharmacists review antidepressants every six months, ‘we have a lot of more conversations with them, and we've got the time to actually provide better care’, she said.
And she added that the practice saw time and cost savings as well as better patient care due to the safety measures embedded by pharmacists working in the practice.
‘We are predicting things that can go wrong, and we're making sure everything's monitored. For example, if someone takes a very new medication, we're making sure that they have their kidney checks. And if we hadn't been there to do that, the patient would end up with kidney failure, go to hospital, and it just causes so much more work for the GP,’ she said.
Although pharmacists do a ‘totally different role’ to GPs, and in Ms Patel’s surgery do not get involved in diagnosis beyond simple issues like hypertension and urinary tract infections, she estimates that they can take on around 40% of a GPs workload.
‘We've got 102 staff, because we're a really big surgery. I think we've got about eight part-time doctors left,’ Ms Patel said. The practice also has 10 pharmacists, as well as paramedics and advanced nurse practitioners.
‘Those eight GPs are doing the really complex stuff and all the diagnosis, but as soon as the patient's been diagnosed, we all take over everything after that,’ she told The Pharmacist.
‘And it's just it's worked brilliantly,’ she added.
‘The only reason why we would recruit a GP now is because the contract states that we have to have a certain amount of GPs, or the partnership also states that we have to have a certain amount of GPs,’ Ms Patel told The Pharmacist.
And she suggested that issues around GP shortages were not related to funding or salaries but to a lack of doctors interested in the role.
‘I definitely don't see how ARRS funding would help us to recruit a GP when we just can't get the GPs anyway. We're happy to pay them the going rate, but even then we just can't get them,’ she said.
She told The Pharmacist that the GPs working in her practice welcome the additional roles.
‘They say themselves that it's just made their prescribing much safer. And their consultations are more kind of what they should be doing,’ she said.
Ms Patel added: ‘We've got 25,000 patients, it’s a massive surgery, but we are able to deal with every request that comes in within 24 hours or 72 hours, [depending on] whether it's urgent or non-urgent.
‘We never leave people to wait. And we ourselves feel so proud of it.
‘The staff are enthusiastic. They're passionate about what they're doing. So they're not just there to come into work. They're actually growing and learning and they're so super keen [to do that],’
Ms Patel warned that stopping ARRS funding for the pharmacists that are already in practices ‘would be completely detrimental’.
But she acknowledged the knock-on effect that ARRS recruitment has had on vacancy rates in community pharmacy.
‘I wouldn't be completely surprised if they just stopped increasing the [ARRS] funding, [and] carry on funding the pharmacists that are there,’ she said.
The funding structure for community pharmacy ‘definitely needs looking at’, noted Ms Patel.
‘It's not even that they're not making a lot of money, they're just not able to keep the staff, not having any kind of job satisfaction,’ she said.
Ms Patel also expressed hope that Pharmacy First would be ‘the first initiative that could actually work’, allowing community pharmacists to do more clinical work ‘and actually get reimbursed for it’.
‘I think Pharmacy First could really, really work and I'm all behind it,’ she said.
Read more from Shilpa Patel about pharmacist efforts to tackle winter infections and improve anti-microbial stewardship.
I’m not sure whether pharmacists doing ‘more clinical work’ is the way forward. None have gone through medical training. None know how to examine a patient. Pharmacists are given a single 35min online module and then expected to look into ears to diagnose ear infections. GPs have spent 5 years + in hospitals looking at patients, examining patients, looking at ears, listening to chests. On top of this, I believe there will be a rise in antibiotic prescribing as Pharmacists have not had adequate training, have not been to medical school and have not had sufficient clinical training. The whole thing is bollocks.
Utter nonsense - It shocks me to read you are a partner and you come out with trope like this. If the ARRS funding included GP's and their salaries kept up with inflation you'd have an influx of GP's into surgeries. You don't need pharmacists replacing GP's because pharmacists can't diagnose. GP's can diagnose, deal with complexity, treat AND do medication reviews. It is much better to improve the workload, benefits and environment for doctors and train more doctors to do these jobs because they do them best. Pharmacists are an allied professional and have an important and set role in practices - they are NOT a replacement for GP's. You state you only have 8 part time GP's left - good luck to them and your patients in the future.
Such a terrible take. If I was unwell with mental health conditions requiring a GP, why would a pharmacist review be of any benefit? With GPs in such short supply the ARRS funding should absolutely be used to fund GPs, especially sd the government is pushing a MAP agenda without properly funding trained doctors.
Reading the comments above, I feel that Shilpa's comments have been greatly misunderstood. I am also a clinical pharmacist working in general practice for several years. Prior to joining my surgery, we struggled to recruit a GP - not a single applicant in over a year. When I joined and brought a new perspective on how we can change to benefit patient care, it was an eye opener to the GPs. I acknowledge that we are not GPs, but as independent prescribers, I can diagnose, examine patients and safely prescribe within my competency areas. We understand drugs better than any healthcare professional, and routinely intervene where some interventions can be detrimental. We are not doctors but we can make a huge contribution to patient care and work postively with our GP and nurse colleagues. We have been fortunate in that we have managed to recruit 3 GPs who are excited to work with us and see further potential. I would agree with Shilpa that the ARRS funding was not meant to fund recruitment of GPs. There have been many incentives to recruit and retain doctors in general practice. What was the success of these schemes? As a past ambassador for clincal pharmacists, I have supported and continued to support their role in general practice. The purpose of the funding was to provide training over 5 years to skill them up to be competent skilled professionals in general practice. This has happened, however, it has come at a cost, that being destabilising community pharmacy. Hopefully, in time, this will stabilise. It is not the first crisis faced by community pharmacy; however, as mentioned above, the funding in community pharmacy needs to be addressed. I am optimistic for the future .