Virtual GP appointments: ‘More patient care in pharmacy must be matched with funding’

Last week, health secretary Matt Hancock announced that unless there is a 'compelling clinical reason' to see a patient face to face, all GP consultations should be carried out remotely going forward.

It comes after the Covid-19 pandemic has seen most GP practices switch to a closed-door working policy, with consultations carried out over the phone or online – a change that Mr Hancock deems to have ‘transformed’ the NHS for the better.

But what impact will making this change permanent have on community pharmacies, who have remained open through this period and shouldered significant increases in demand?

Mark Lyonette, chief executive of the National Pharmacy Association (NPA), said the move could have a ‘significant knock-on impact’ because it would likely increase the number of patients opting to visit their pharmacy first to speak to a health professional in person.

He added: ‘The community pharmacy sector needs to be ready for that eventuality, while also stepping up our own capacity for digital delivery of care.’

‘Access to patient records’

Ade Williams, superintendent pharmacist at Bedminster Pharmacy in Bristol, told the Pharmacist that the only way pharmacies can cope with this potential influx of patients safely is if the ‘digital transformation is made across both general practice and pharmacy’.

‘Now more than ever we need to be given read-write access to patient records so that when we do see patients who come to us instead of their GP we can offer them the best care possible,’ he said.

Back in March, before the peak of the pandemic, the National Association of Primary Care (NAPC) called on the Government to provide emergency funding to give pharmacies this access and help them to provide a seamless service to patients while GP surgeries closed their doors.

But it didn’t happen – and Mr Williams is concerned that until it does ‘gaping holes’ will be left in the primary sector, which ‘vulnerable people will fall through’.

He added that this was particularly likely to impact older people, who are not always as well-equipped to use technologies, and people from minority communities, for whom English may not be their first language.

‘These people – who might struggle with face to face consultations – are probably going to find it much more difficult to have a virtual one,’ he said.

‘Fair funding’

Another key concern for pharmacies will be whether an increase in workload is matched with extra funding. To date, the Government has made £370m available to community pharmacies to help alleviate the pressures of the pandemic – although this is still expected to be paid back. The Pharmaceutical Services Negotiating Committee (PSNC) is also seeking a ‘long-term increase to total pharmacy funding in recognition of the unprecedented challenges pharmacies have faced’.

Claire Anderson, chair of the English Pharmacy Board, said that the pandemic has shown how the whole of primary care needs flexibility in how it delivers consultations to patients safely going forward – but warned that as pharmacies deliver more patient care, they must be supported with fair funding.

This was echoed by Amish Patel, owner of Hodgson Pharmacy, Longfield, Kent who said he feared that community pharmacies will be expected to provide additional services, which remote GPs can’t offer, but without being paid for doing so.

‘Throughout the pandemic I’ve had patients come into my pharmacy sent by their GP to go and get the blood pressure taken from their pharmacist. What makes it any safer to visit your pharmacist rather than your GP to get your blood pressure taken?’ he said.

‘We don’t get paid to provide that extra service to patients, and on top of that, there comes the added expense of having to clean the consultation room after offering the service, clean the equipment and sort out the correct PPE.’

‘A transformative experience’

In his speech, Mr Hancock said that pharmacy had shown 'how much more it can do' during the pandemic. He added that switching to remote GP consultations will free up clinicians to ‘concentrate on what really matters’ and that it was time to break down the barriers between healthcare providers, including primary care and pharmacies, which are ‘decades old and don’t work now’.

The health secretary has also recently suggested that 20 million GP appointments could be referred to community pharmacies each year, as more clinical services begin to take place in pharmacies post Covid-19.

Rebecca Fisher, a senior policy fellow at the Health Foundation and a part-time GP, told the Pharmacist that understanding the consequences – good and bad – of the new ways of working created during the pandemic will be ‘absolutely vital’ to ensuring healthcare professionals continue to practise safely and that the response to Covid-19 doesn’t inadvertently contribute to widening health inequalities.

She added that while it was sensible that GPs to try to manage patients remotely to reduce the spread of Covid-19, it was also important to be aware that switching to predominately phone consultations may have unintended consequences, such as missing things, or making it harder for certain patients to access general practice.

Mr Williams added that community pharmacies, while continuing to offer face-to-face consultations, will also have to offer some elements of digital too - and it will be important that the public understands that it’s not just face to face consultations in pharmacy and only virtual in primary care.

‘The move must be a transformative experience across the whole of primary care and not just innovation in one area [GP] - this would just create more work and put more pressure on another area, like pharmacy,’ he concluded.

‘Pharmacy is perfectly placed to make sure no one gets left behind during this change - but to do that we do need enablers, and we need to be included in the change.’