I had an interesting discussion with a GP. How do we differentiate General Practice and Community Pharmacy in a patient’s mind? It is not easy when the services delivered in community pharmacy are variable. The politics are also variable – we are told to visit community pharmacy for common ailments and then we are warned about cancer and told to see a GP.
So I said – it all depends on whether you are healthy or ill. If you are essentially healthy you should visit the pharmacy and if you are ill, you visit the GP. In the backroom you join them together and then you create a compatible contract with elements of profit share and joined records.
So when do you visit the pharmacy and what services should they provide. Think about it – when you are essentially healthy you go to the pharmacy. This might mean:
- Common minor conditions
- Routine immunisation
- Travel health
- Obesity, smoking and exercise management
- Emergency hormonal contraceptives and general contraceptive services
- Child health
‘Hold on a minute – all immunisations’ – yes these patients are not ill and the whole point is to tell patient to only go to their GPs when they are ill – really ill and the GP practice will look after them. When you are not ill then you go elsewhere – to the pharmacy.
You aren’t ill when you need a contraceptive – you aren’t ill when you go on holiday and children aren’t ill.
‘But how would you deliver this’. Community pharmacy can employ nurses if that is appropriate or use pharmacists. We are well used to this mix of staff delivering good care. It would just need the contracts to force working together with some cross management of resource.
‘What do you mean – cross management of resource?’ The community pharmacy may contract nurse support from you and you may contract pharmacist support from them. When you both have access to the medical records, it matters less where you practice and operate the services.
‘But will we lose money?’ That is the whole point of shared contracts – so the delivery becomes a shared responsibility and you are jointly paid for delivering outcomes. It is not beyond us to develop something like this is it?
The whole point is that we have to simplify the message to the population in a manner that they can understand. If you are ill go to the GP, if you are generally well then see the pharmacist.