This year it is more important — perhaps more than ever — that the pharmacy sector works cohesively with general practice, despite their differences, writes Ashley Cohen.
Every year the message is the same. The NHS is under immense strain due to winter pressures. In the 25 plus years I have been working as a practitioner I have never known a winter that didn’t need the call out for more staff and more resources. Therefore, this feels more like a system problem not a seasonal issue.
This year it may be different, or more potent. We have the biggest flu vaccination programme in history; the Covid booster rollout in progress, and a significant backlog of appointments within primary care and procedures and operations in secondary care. It will not take much to tip the NHS into breaking point yet again.
However, unlike in previous years we can’t simply rely on the goodwill of the NHS staff. We now have a workforce who are physically and emotionally exhausted, sectors of the NHS are feeling demoralised through lack of recognition and investment. How can we provide the service and quality assurances required if the investment required is not forthcoming?
Community pharmacy teams should be working together with our general practice colleagues. General practice is also under pressure due to the reduction in GP numbers and backlog of appointments. Announcements targeted at specific sectors and ‘new money’ being announced to help tackle specific areas need to be better thought through as it sometimes is felt like a knee jerk reaction or in response to some political announcement. Sometimes throwing more at an already stretched sector does not create the increased capacity it requires.
Community pharmacy teams have proved their value during this pandemic. Over 1,300 community pharmacy sites are now providing Covid vaccinations to speed up and maximise uptake. To date over 12 million Covid vaccinations have been performed by pharmacy teams. This year to date, pharmacy teams have vaccinated 30% more flu vaccines that at this stage in previous years. In 6 weeks, pharmacy teams have vaccinated 1.8m people, and this is despite it being difficult to obtain stock this year.
There is no doubt that with better supply channels and more integrated workstreams and collaboration with ICS, PCNs and general practice this number could be much higher still.
If only we could find a solution to provide better triaging of patients through primary care; provide some backlog support to primary care colleagues to help shift some consultations from already stretched primary care teams, and help prevent unnecessary visits to urgent care centres and A&E.
The answer to this year’s winter crisis, and perhaps all future crisis, is to ensure that the GP Community Pharmacy Consultation Scheme (CPCS) is fully (and I mean fully) utilised.
This service has been available throughout most of the pandemic accessed either via NHS 111, OOH centres, and now more recently GP practices. It would seem the logical choice for increasing capacity.
But, only about 10% of general practices in England have signed up to be participating in GP CPCS. This was picked up last week in the ‘Plan for improving access for patients and supporting general
practice,’ published on 14 October. More practices are being ‘encouraged’ to sign up, but will this mean a fundamental shift in consultations being triaged?
From conversations with colleagues, it seems that the uptake has been very slow and patchy. Pharmacies are not seeing the Pandora’s box of consultations that was initially expressed to move away from dispensing volume to clinical services. GP CPCS should be part of our core service, receiving several referrals daily. Some pharmacy colleagues have literally had one or two GP CPCS referrals in six months.
These are a few of responses I have heard from general practice teams as to why the uptake is slow:
· Too much red tape in the referral from GP practice to pharmacy
· We (general practice) may lose income ourselves if this shift becomes permanent
· Lack of time within the practice to ‘train’ up administrative staff to undertake the referral process
· Why bother with the formal referral process when we can simply tell the patient to contact their local pharmacy.
We have a sector that is crying out for investment having had significant reductions in income over the past five years. A pharmacy sector which has been promised a direction of travel to more clinical services; a general practice that is having significant capacity issues and requiring support to help work through the minor ailments and spend more time on the complex cases, and a government providing some new cash to relieve the pressure.
It surely cannot be that difficult to see how CPCS can support these capacity issues.
It is already set up, ready to go, and just requiring the appropriate referrals from our primary care colleagues.
And that’s how you solve the winter crisis. QED