Additional NHS capacity at no extra cost

I have been talking about the role of community pharmacy for some time. Mostly people look at me with disinterest. They talk about integration while I talk about co-operation and independence. They talk about shortening pathways of care, while I talk about making them longer and taking them into community. I talk about patient freedom and choice and they talk about control. They talk about spending NHS money and I talk about increasing capacity at no additional cost.

They still look at me as if I have fallen down from a different planet.

So – the simple truth is that there are gaps in NHS provision. That’s nothing new – and we know that unless we do something, people will suffer and ultimately they will cost the NHS and social services dearly.

One area is foot care in the diabetic patient. Let’s be honest we have focussed our attention on multi-disciplinary foot care services – have done remarkably well – and have missed the basics. Everyone needs a basic foot care program and nobody does it. I have watched people talk about it and they labour over products and costs and walk away. General Practice is understaffed and under pressure – sometimes you can’t even pay them to do additional things when they are just trying to get through the existing workload.

‘Why don’t you ask community pharmacy to do it?’ It seems a simple question. There are over 11,000 community pharmacies in England – every one has about 250 people with diabetes – so that makes 6 people a day in a two month cycle to get around to them all, talk about footcare and offer suitable products for sale.

‘How much will that cost?’ is the speedy reply. Of course I don’t know whether community pharmacy will do it or whether people with diabetes would dip into their own pocket to buy a moisturiser each month…. But if they did then the service will cost the NHS nothing. At worse the NHS might pick up marginal costs from those that really can’t afford £5 a month on self-care.

‘Do you think they….. might they…..’ and I answer ‘Why don’t you just ask them’. The worse they can say is ‘no’ – the best they can say is ‘Would GPs and Practice Nurses send the patients to us?’ ‘Be my guest’ would be the usual expected reply.

I should add that some have – and while they have the patient engaged, they have talked about oral health and eye health at the same time – so a triple whammy.

So there you are increased NHS capacity at no extra cost – its not an illusion – its community pharmacy.



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