I share the pain of General Practice. An independent contractor small business, dogged by increasing demand and paperwork. Punished by constrained reimbursement at a time when it is increasingly difficult to find GPs and practice nurses to employ with the necessary experience and at a reasonable rate. Pressured by politicians as both the cause of and the solution to issues within the NHS. And then ridiculed by those politicians who dangle a carrot of recruiting thousands of additional GPs when they know that they aren’t there and take a decade to produce.
Many commentators have called General Practice the jewel in the crown of the NHS – they may be right – the envy of the world. But they are experiencing difficulties that we need to pay some attention to. Many people look to their family practice to know them and look after them from birth to death.
The reaction from General Practice, however, is to group together, federate and share precious resources. Is this just circling the wagons? Will General Practice lose the personal touch? Will we all lose our family practice? Will it disappear into private company hands?
There is another way, based on sound military tactics. When faced with an overwhelming force, you divide it up and reinforce your front line troops.
The issue that General Practice faces can be solved by pharmacists.
Workload – the overwhelming force. We hear statistics that suggest that as much as half of all GP appointments may be filled with patients with common conditions that could be suitably managed by community pharmacists away from the practice. But these services (often called minor ailment services) are variably commissioned and often poorly supported by General Practice. A national contract or framework with local support and implementation would work. If these services could take away 10% of the current General Practice workload it would create some breathing space. 20% and the GP practices would have headroom to think, plan and deliver even better care.
General Practice needs reinforcement through skill mix. There is little doubt that the current skill mix must be altered, but the government’s idea of a physician’s assistant is plainly silly. We already have healthcare assistants and we have practice nurses. There are many examples, however, where practices have introduced clinical pharmacists into the team to both improve systems and deliver clinical care to patients. If you need examples there are plenty around. If you need pharmacists there are plenty around – we currently train more than we have jobs for. Yes we need to increase the profile so all GPs see the value or working alongside a clinical specialist pharmacist and yes – the profession with the NHS England management team just needs to get its act together creating the proper support for a career structure for pharmacists in general practice and we could fill thousands of positions in practice.
So my conclusion is simple. If we want to save General practice we need to call in the pharmacists. Divert patients from General Practice who can be suitably managed by clinical pharmacists within community pharmacy and introduce more clinical specialist pharmacists into General Practice to build the workforce in a cost-effective way.