Primary Care – a closed shop?

As a member of the public I wonder why I am not able to choose and why I am always directed to a GP practice. I am told that they are overworked and busting at the seams. It can certainly seem that way when I try to book an appointment. And there are certain schemes out there that help – but they are just schemes – sometimes poorly advertised and explained – tinkering around the edges that cause me, as a member of the public, confusion as to where I can go for what.

I Can always pop into the community pharmacy when I need some urgent help, but strangely none of them are contracted to provide out of hours services so I am directed back to my GP or to an out of hours provider. I have looked on NHS Choices, but when I need urgent services it only directs me to a hospital A&E – no wonder I go there – does someone not realise this?

Actually I am used to visiting the community pharmacy – some of them have ‘Pharmacy First’ schemes or ‘Healthcare in the High-street’ schemes and can offer me some advice or treatment for a range of common conditions. But my neighbour doesn’t know this, its not advertised on my GP practice’s website and I can’t find it on NHS Choices. She books an appointment at the GP for a whole range of minor problems – its all she knows.

But it doesn’t have to be that way….. there is half a glimmer of hope.

Take vaccination for example. In Croydon and other parts of South London, I am directed by my GP to a community pharmacy for my travel vaccination. I enter into a world where I see a travel expert and given all the vaccinations I need. It is a nurse run service within a community pharmacy – now that’s a thought. But I can’t get the flu jab while I am there? In fact flu vaccine is available from some selected pharmacies in some selected area, but not where I live. So I have to try and book an appointment at my GP.

There are a range of sexual health services around – I can get my Clamydia screening completed in a small selection of community pharmacies, but they do not all have PGDs to provide the treatment. At £20 a pop, off I go to the GP or I do hear that the local GUM will give it out free, but I understand that costs the CCG £140 for the open access appointment – hey no appointments or waiting there.

I see that several pharmacies can offer stop smoking services, but not all of them can offer all the NICE recommended treatments – you have guessed it – off to the GP to get that prescribed as well. I asked whether they could offer me some patches in line with NICE PH 45 – nope not commissioned yet – off to the GP again.

I wasn’t going to talk about optometrists, but they have an urgent care service here – much better than the GP and A&E, they look after patients with ocular hypertension and share the huge and growing glaucoma load.

With rising demand and with the increasing age and complexity of patients attending General Practice – what is the solution?

One obvious solution is to open up primary care. Primary care is not just GP General Practice. I don’t just mean pharmacists, but optometrists and perhaps dentists as well. Commission a range of services and open up the access. Make it clear which provider provides which service and direct patients to them. If we work together we can manage the increasing population demands.





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