At a time when the Government is calling for more collaboration among healthcare professionals, is the flu jab turf war between GPs and pharmacists justified? Léa Legraien reports

With its spectacular array of coloured leaves, September marks the beginning of autumn. But for community pharmacies and GP practices, it is the start of the flu vaccination service – a time when both professions engage in friendly – and at times not-so-friendly – rivalry.

With reports of dirty tactics – among them some GP practices encouraging patients to get vaccinated by their doctor in a bid to outdo their pharmacist rivals – has the healthy competition turned into a turf war?

And if so, how did two respected health professions end up fighting over a service designed to improve patient health?


Pharmacists and GPs: a complicated relationship


GPs and pharmacists have a long history of being at each other’s throats.

When NHS England announced in 2015 that community pharmacies would also provide the flu vaccination service for at-risk patients, some GPs felt threatened by the potential loss of income.

Indeed, The Pharmacist reported in September that one Oxfordshire GP practice had texted its patients to remind them to get their jab at the surgery after losing out to local pharmacies the previous year.

It’s not an isolated incident. ‘For many practices, the flu service has been a really important part of their regular income,’ says Claire Oatway, chief operating officer at Devon’s Beacon Medical Group (BMG) primary care home.

‘So when it was announced that pharmacy would do it, there was a lot of suspicion that we wouldn’t be able to compete with a large-scale corporate body [like some pharmacies] that could provide that access and support immediately.’

GPs’ suspicions were later deepened by the former British Medical Association’s (BMA) GP committee chair Dr Chaand Nagpaul, who claimed that there was ‘little real evidence’ that such pharmacy services for patients in at-risk groups would increase vaccine uptake.

Despite Dr Nagpaul later calling for the implementation of ‘proper protocols’ to allow shared records between pharmacists and GPs, the Government did not agree to allocate cohorts of patients in need of a vaccine to each profession.

This has in turn left GP practices and pharmacists fighting each other over the same patients.

Much of this has stemmed from the funding given to both professions for delivering the same service, says Laura Jones, clinical lead at Assured Pharmacy.

‘Many pharmacies are suggesting that the doctor is too busy and there are long waiting times at the flu clinics. This can make the patient feel they are a burden and that they should not bother the surgery,’ she says.

‘However, many GP surgeries are asking patients to support their surgery with funding by not using the local pharmacy as they are “stealing” the money owed to them. Social media has also fanned the flames of this and patients are starting to join the battle.’


A funding issue?


It’s unsurprising that the fighting can become intense given that the service provides much-needed extra funding for both professions.

GPs and pharmacists have both been through their share of tough times of late, including funding cuts, medicine shortages and difficulties in recruiting new staff.

In November, Prime Minister Theresa May pledged to invest an extra £3.5bn in primary and community care by 2023/24 as part of a £20.5bn funding envelope for the NHS.

Despite the cash injection, some healthcare leaders argue that it will not be enough to fill the gaps caused by years of austerity.   

According to Doncaster Local Medical Committee (LMC) chief executive officer and GP Dr Dean Eggitt, finances in both general practice and pharmacy are in such state that everybody needs the money to stay open to care for patients.

‘General practice has been so defunded over the years that we’re fighting over the pennies of the flu vaccine,’ says Dr Eggitt.

‘On one hand, pharmacies being in the  mix [eases] some of our workload but on the other hand, if we allow that to happen we’ll probably have to make staff redundant because of the loss of income.

So we work hard against pharmacy to keep as many patients with us as possible to be able to keep our staff.’

Although both professions deliver the same service, GPs receive a higher fee for each flu vaccination they deliver – £9.80 per administered dose compared with £9.48 for pharmacists.

The Pharmaceutical Services Negotiating Committee (PSNC) points out that the difference in fees lies in the level of responsibilities. Under general practice contractual agreements, GPs have additional duties, which include a call-and-recall system for patients and keeping records for the national programme.


Contract flaws?


Many, including Dr Eggitt, believe that the contractual framework has caused the tensions between pharmacists and GPs.

‘I don’t think the mechanisms are in place to allow GP practices and pharmacies to collaborate to deliver the flu vaccine,’ he says.

He suspects that the Government allows this competition to exist as a means of driving vaccine uptake in patients. ‘Instead, it’s caused animosity and confusion because we don’t know who’s been vaccinated,’ he says.

‘We’re both going after the same cohort, which doubles the workload but not necessarily the output,’ he adds.

However, NHS England is clear that it is hoping for collaboration rather than competition between pharmacy and general practice.

‘The only priority here should be making sure as many people as possible get the flu vaccine, so they can stay healthy over winter, and in doing so limit the pressure on the NHS as a whole,’ it says.

The reality is that rewarding GP practices and pharmacies for collaborative working could not only maximise population coverage but also break down the longstanding barriers between the two professions.

Ade Williams, superintendent pharmacist at Bedminster Pharmacy in Bristol, says: ‘Additional and shared payment for work increasing flu vaccination access alongside payments for delivering the service would mean the culture around the service would change. We would also see models of care that would help us meet public health goals.’

It’s easy to see how the flu vaccination turf war came to be. But ultimately, it is in everybody’s interest, pharmacists and GPs included, to ensure all eligible patients are immunised against the flu virus.

‘Unfortunately, we’ve not managed to think collaboratively about the huge opportunity there is to raise the overall population coverage,’ says Devon local pharmaceutical committee chair David Bearman.

‘If you start thinking in a different frame of mind, you don’t worry so much about who gets what but you think more about how we can grow the pool of people we vaccinate. By working together, there is no reason why anyone should lose out.’