Some pharmacists are urging GPs to return to a higher number of face-to-face appointments to help reduce the increased workload pharmacies have adopted during the pandemic.

It comes after an NHS England letter sent to practices last week – which requested that patients now be offered face-to-face appointments if that is their preference – sparked controversy among GPs, with sector bodies criticising the guidance as ‘tone-deaf’ and ‘badly-judged’.

While GP surgeries have continued to offer in-person appointments during the pandemic, pharmacists have reported that the shift to closed-door working and remote consultations has resulted in them absorbing extra workload – and so for some, a return to more face-to-face appointments would be welcome.

Ash Soni, owner of Copes Pharmacy in Streatham, London, told the Pharmacist that referring patients to a GP is ‘nearly impossible at the moment,’ and said more face-to-face appointments would ‘really take some of the pressure off us and give us somewhere to send patients’.

Mr Soni said he believes changes to GP working have resulted in a ‘huge' increase in patients attending the pharmacy to speak to a health professional in person. He has also seen an increase in demand for emergency prescriptions – on top of the additional Covid-related workload.

‘It is great that more patients are attending the pharmacy — I love it — but there are some things I cannot treat and only a GP really can. For instance, we have had people come in with rashes and UTIs which are not responding to treatments we have given them in the pharmacy and therefore need a diagnosis from a doctor,’ he said.

He added: ‘GPs are [also] not processing prescription requests as quickly at the moment, or they are not being signed off as quickly, which means we are having to sort out lots of additional emergency prescriptions.’

‘Don’t offer free services’

Similarly, Amish Patel, owner of Hodgson Pharmacy, in Longfield, Kent, told the Pharmacist he was concerned that remote working meant some of his patients felt they were not getting the help they needed.

‘Some of my patients have told me that when a face-to-face appointment was needed, general practice had not been very forthcoming, which delayed patients' care and could potentially lead to worsening of patient condition,’ he said.

However, he also stressed the potential benefits of online consultations to patients: ‘It’s great that GPs can now see more people during the day. We have learned through the pandemic when it comes to triaging patients, which is good. However, there are some things which require face-to-face contact.’

Mr Patel also said that GPs have been referring patients to have their blood pressure monitored at the pharmacy, which he did not think was safe: ‘If it is not safe for GPs to take patients' blood pressure, why is it any safer for pharmacies?’

‘We don’t get paid to provide that extra service to patients, unlike GPs who do. There also comes the added expense of having to clean the consultation room after offering the service, clean the equipment and sort out the correct PPE.’

In August 2020, the Pharmaceutical Services Negotiating Committee (PSNC) told contractors to consider not providing patients with free blood pressure checks and other free-of-charge provisions that fall outside of the Community Pharmacy Contractual Framework – advice it said was not given lightly but came as a result of the extra primary care work picked up by pharmacies during the pandemic.

‘We still offer the checks, but now we offer them privately,’ Mr Patel said. ‘This means a lot of people walk away, and we don’t know what happens to them.’

‘Bypassing CPCS’

Meanwhile, Sunil Kochhar, a consultant pharmacist and IP at Regent Pharmacy in Gravesend, Kent, said that he has also had to provide unpaid services throughout the pandemic as a result of remote GP working. He also believes that going forward, general practice should be seeing more patients face-to-face.

‘GPs have been sending patients to the pharmacy to get their blood pressure checked without warning them that the service is private. This causes a lot of friction between the patient and pharmacist because the service is not what they expected,’ he told the Pharmacist.

‘It’s not something that we can do free of charge, especially because of all the Covid protocols. However, I know a lot of pharmacies are doing this for free.’

He added that a lot of the unpaid work comes from people ‘bypassing’ the Community Pharmacist Consultation Service, which opened to referrals from GP practices last November.

‘Patients are getting frustrated with having to wait on the phone with the GP surgery for 40 minutes, to then be referred to the pharmacy via CPCS,’ he said.

‘Many are picking up on the fact that they will just be referred to the pharmacy and are bypassing the long phone call and are coming straight here, which means we are missing out on the funding.’

Mr Kochhar has also seen fewer GP consultations, leading to a reduction in prescriptions: ‘This has impacted our income and is something we hope increases as GPs begin seeing [more] patients face-to-face again.’

'Enormous pressure'

Dr Richard Vautrey, chair of the British Medical Association’s GP Committee, said: ‘GPs have gone above and beyond in the last year dealing with the pandemic, delivering the vaccination programme and trying as hard as possible to meeting the growing demand for their own patients on a day to day basis.

‘With pharmacists also clearly under enormous pressure to meet the growing needs of the population, the Government and NHS England have a responsibility to invest and effectively resource all aspects of primary care.’