The NHS seems to be always chasing pavements rather than getting to the point and sorting things out. It has never been about structure and competition – it has always been about relationships and working together. It cannot be all about illness, but must focus on wellness and health creation. It is not about access it is about demand.
Demand has two elements:
Can we share demand – bringing other players in to share the load?
Can we reduce demand – adopting health creating practice and giving people control, connection and confidence?
GPs will tell you that there is too much bureaucracy, the payment systems are fractured and there are too many boxes to tick and too many meaningless pathways. But they will truthfully say that demand is the killer. More patients, with more expectation, more complex conditions and getting older; delivering care to the quality that they desire and making a decent return on a lifelong investment in their practice is becoming impossible.
Many practices have reorganised, included more nurses and practice pharmacists in the attempt of becoming more efficient and absorbing/distributing the workload. It is working, but nurses are difficult to find and the pharmacist programs needs to be accelerated. I hear that my local CCG wanted 26 and got none from the last round. Too little or too slow or both.
But there is a glimmer of hope. The GP federation is sitting down with the Local Pharmaceutical Committee and laying some cards on the table:
GP – we have too many people entering our service. Many have minor or self-limiting conditions; need some monitoring or a follow up test. The sheer volume and growth occupies increasing amounts of our time. It is great to talk to our practice population, but we need a form of out-of-practice triage.
Pharmacist – we have too few people entering our service. Over the years we have focussed on the dispensing element and then adding value to the safe and effective use of medicines. 90% of our income might be focussed on this element and the NHS has now cut this significantly and told us that we have to change. We need more people that have minor or self-limiting conditions; we can do some monitoring and provide other services. We want to look after more people and service their health needs and help them to create health.
Did the penny drop – the lightbulb come on – eureka – an epiphany? Actually there was a little ‘chin-scratching’, followed by a GP pulling up a note about the Strep A sore throat test and treat service via the innovation network; did you see the research in Eccles on minor ailment services; did you know we could do this test, make that diagnosis, offer these medicines.
Of course the CCG came up in the conversation –“ they want us to stop prescribing these medicines – its difficult – could you help?”.
So the game has started, the relationships are forming, ‘one primary care’ is becoming a reality. I really hope that the Pharmacists are invited to join the federation. I also hope that the CCG will get behind it and NHS England will show some interest – it will be unforgivable if they don’t.
Stage one started – the community pharmacists are going to share the demand and reduce the pressures in General Practice. Stage two – we need community pharmacy to move from healthy living pharmacies to health creating pharmacies. That will come next.
I have no idea where this will go. I do know that the NHS desperately needs community pharmacy to take a bigger role. And my fingers are crossed that people will be interested, very excited and very committed to delivering an answer rather than chasing pavements.