Pharmacists are often told of the importance of forming good relationships with GPs. With the emergence of Primary Care Networks, this is even more important - so how can pharmacists bod with their local practices? Rachel Carter investigates.
The NHS Long-Term Plan, published earlier this year, confirmed the direction of travel for primary care - all GP practices are expected to come together in Primary Care Networks (PCNs) by June 2019, covering patient populations of between approximately 30,000 and 50,000.
NHS England has said that community pharmacists will need to have strong links with these networks – and from 2020 it will be a requirement that non-GP providers, such as community pharmacies, are included within them. With this in mind, how can pharmacists improve the working relationship they have with their local GP going forward?
The LPC view: Think about what you can do right now to improve your relationship with GPs
Nick Hunter, chief officer at Nottinghamshire Local Pharmaceutical Committee (LPC), says one of the biggest tensions between pharmacists and GPs at the moment will be stock supply and the problems around availability, with lines being put on quota or disappearing completely.
‘That sort of thing is so hard to explain to GPs. It’s really complicated, but it’s important to try and explain that we aren’t doing it on purpose; we only get paid if we dispense prescriptions,’ he says.
‘I don’t think that dialogue is happening – but it is a crucial piece of dialogue that needs to happen.’
The other issue that often comes up, Mr Hunter adds, is around repeat ordering of prescriptions, which generates ‘a lot of misunderstanding and blame’, with pharmacies blaming practices for not generating the right prescriptions and practices blaming pharmacists for over-ordering medication.
‘It’s understandable why you get into these environments where everyone thinks everyone else is causing the problem, but it’s a little bit of every step of the problem that exacerbates it – and because nobody talks to each other, nobody really understands how to resolve it,’ he says.
So how can community pharmacists work to resolve some of these issues and improve the existing relationship with GPs and surgeries in their local area? We asked Mr Hunter for his top tips:
1. Start a dialogue - communication is key
‘Some pharmacists find it a lot easier to go and have that dialogue than others, and some practices are more receptive than others, but if you don’t go and ask then you will never have that dialogue.
‘I know it’s easy for me to sit in front of my laptop and say this - but if you’re very closely located to the surgery then just pop round and talk to each other. Start with the reception team, because nine times out of 10 they will be your first point of contact, whether that be by phone or face-to-face.’
2. Agree to disagree and find where you can compromise
‘When you start that dialogue, you can work out ways to communicate differently and resolve problems. Work it out between you, what are you going to do for each cohort of patients and each scenario and then keep the conversation going. In some cases, practices will have a non-published phone number for urgent communication, and some practices will give that out to local pharmacies.
‘You won’t agree on everything because the pressures, time and funding constraints on each sector are different - and they are what drive the behaviours - but agree to disagree, negotiate and see if there are some things that you might be able to compromise on - compromise is key.’
2. Brush up on your knowledge of how general practice operates
‘It’s key to try and understand their environment as much as our environment, because then the bits that frustrate us about what they do become more understandable.
‘The Pharmaceutical Services Negotiating Committee (PSNC) co-produced some guidance documents with the British Medical Association a few years ago and have just updated one - one for hospital pharmacy, one for community pharmacy and one for general practice, giving an outline of how each sector is funded and some of the quirks of the different systems.
‘Every community pharmacist should read the one about general practice, because you’ve got to understand what constraints they’re under before you can get them to understand yours.’
4. If you’re struggling, speak to your LPC
‘Some pharmacists will find it really hard to go and have a conversation with the practice and they may need to talk to colleagues or the LPC. We would help any contractors that are having difficulties.
‘We can’t go and do it for them, but we can help with advice, break down some barriers, and have conversations with our counterparts in local medical committees about how best to approach it.’
Community pharmacist view: What needs to change in future to improve this relationship?
Independent contractor Sultan ‘SID’ Dajani says he believes relations between GPs and pharmacists have not been helped by the reforms to the NHS introduced by former health minister Andrew Lansley.
Looking ahead to Primary Care Networks, Mr Dajani shares his thoughts on what needs to change:
1. Introduce a national framework
‘I think to develop any kind of relationship we need a national framework, which goes beyond the primary care network, and incentivises GPs and community pharmacists to work together. We cannot expect everything to happen at local level, there has to be some national involvement.’
2. Create local arrangements that promote joint working
‘We also need to have local arrangements that will enable closer working relationships between community pharmacy and general practice, so that we are encouraged and incentivised to do it.
'For example, if we had incentives where the clinical commissioning group facilitated regular meetings between the LPC, the LMC, the Royal Pharmaceutical Society (RPS) and the Royal College of GPs on a local level, then this could be used to discuss local health needs and joint working.
'This closer working agenda should also not solely focus on clinical services and medicine supply, but also public health and care in the community, and how we can encourage patients to self-care.’
3. Better methods of communication and information sharing
‘We need to be able to more easily share information between pharmacists and GPs.
'For example, we might have access to summary care records, but we don’t have ‘read and write’ access, so we don’t know if any feedback we’re giving is positive, negative, or whether it makes a difference. I know I’ve referred 15 patients to the GP this month, but apart from the patient coming back and saying thank you, I’ve no idea what’s happening - so having that access would be great.
'We also need to think about other forms of sharing clinical information, such as at monthly meetings, and an IT system that allows for a two-way exchange with GPs. I know we have emails, but they rarely reply, so having an online discussion platform with local GPs would be helpful.’
4. Shared education and training is key
‘Having the opportunity to undertake education and training together is immensely important. It would enable us to discuss our differential diagnoses of common illnesses and how we treat those, and come to some common understanding of what each other’s roles would be. This would remove the element of competition and would result in shared respect and consideration.’
Rachel Carter is a freelance journalist