A Long term solution to A&E

Throwing money at A&Es? What are Dave and Jeremy thinking about? Not only will it not solve the problem, but it will make things worse. It is a sticking plaster at best. But why on earth do we throw money at bad behaviour? And then look surprised when behaviour gets worse?

A recent assessment of patients in A&E tells us all that we need to know. 1 in 4 patients could have been adequately managed in a community pharmacy. A further 1 in 4 patients could have been managed in general practice or a walk in centre. So at least half of the patients should not have been there in the first place. The number of red light patients has not increased, but the number of ‘walking-wounded’ is increasing at an alarming rate.

If 25% of patients in A&E could have been managed by community pharmacy – why were less that 5% of NHS direct callers referred to community pharmacy – just an observation.

When asked about community pharmacy and in particular ‘Pharmacy First’ or ‘minor ailment schemes’ the majority of patients admitted that they didn’t know about the schemes.

When asked about General Practice, some said that they couldn’t get an appointment, some didn’t want to bother the GP, some hadn’t phoned, some said the GP was closed and some simply believed that the A&E was more convenient. So a really mixed bag of answers here that clearly means that GPs are not really to blame for the current predicament.

So opening a new ward in A&E, putting a GP in A&E or creating new walk in centres will not work!

If we want this system to work better then we need to change the direction of flow for most patients. We need to make sure that appropriate patients access community ‘pharmacy first’ schemes. This would have a direct effect on A&Es and an indirect effect on general practice by freeing up some space. Naturally the space will be rapidly filled, but if this was filled by patients who would have gone to A&E, then we have succeeded. It is all about communicating better options and providing different services within existing providers. It is not about commissioning new providers and applying sticking plasters.

Community pharmacy often has longer opening hours when compared to general practice. There are many (and I mean 2,000+) that are contracted for 85 to 100 hours a week within their dispensing contracts – so access is much less of a problem than you might think. All pharmacies have counselling and / or clinical consultation rooms. And with the current supervisory regulations, a qualified pharmacist is on site and on duty most of the time.

There are, however, four issues within this plan that need urgent attention:

  • Community pharmacy minor ailment or Pharmacy First schemes should become common place. We need a national contract or national framework that can be administered locally
  • These schemes should be supported by giving pharmacists better access to medicines. Naturally pharmacists can sell medicines, but supplying medicines on the NHS to patients on low income is an issue. Pharmacists either need PGDs or a restricted formulary prescriber status to do this, with progress to full independent prescriber status associated with appropriate contracts.
  • These contracts should be transitioned into proper out of hour’s contracts with a required level of service delivery. A small number of geographically appropriate contracts should be enhanced by, for example, the provision of minor injury cover during specified hours
  • The public should be made aware of these services, through national and local campaigns. This service should form part of the doctors on call answerphone message, GP and community pharmacy websites, NHS choices website and a bigger part of the NHS 111 protocols.

It does seem to me that the solutions are not far away. Just need some thought, some planning and throwing the available money at the right place.


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