In response to record high patient demand and the shortfall of GPs, the NHS has proposed allowing pharmacies to prescribe medicines for certain ailments. The aim is to relieve some of the pressure on primary care appointments, in cases when a GP would have sent their patient to a pharmacy for treatment anyway.
The conditions that pharmacists could diagnose and prescribe for are:
- earache
- sore throat
- sinusitis
- impetigo
- shingles
- infected insect bites
- uncomplicated urinary tract infections (UTI)
What effect will this have on GPs, patients, and primary care in general? It could be an excellent development that streamlines care, relieves the strain on stretched GP surgeries, and dramatically improves the patient experience and health outcomes. Alongside that potential, there are some questions that we should consider carefully.
The positive potential of the initiative
Firstly, it’s important to recognise that this initiative has excellent potential. The Department of Social Care suggested that just by handling UTIs, pharmacies could save 400,000 GP appointments a year. Adding the other six conditions above could well mean millions of appointments saved.
We should also welcome this kind of out-of-the-box thinking to address the challenges in primary care. General practice is in crisis, and complex challenges of patient demand and practitioner shortage can’t be solved by sticking rigidly to tradition and the status quo.
Pharmacists are highly qualified healthcare professionals, and it makes a lot of sense to utilise their experience and expertise fully.
Is the problem more fundamental?
According to the BMA:
- On average, one GP is responsible for 2,285 patients — an 18% increase since 2015.
- GP numbers are falling. In England, there are 0.44 fully qualified GPs per 1,000 patients. That’s down from 0.52 in 2015.
- There were an average of 9,740 patients per practice in March 2023. That’s an increase of 2,275 more than in September 2015.
In summer 2022, Pulse found that 474 GP surgeries had closed since 2013, and hadn’t been replaced.
In that context, there’s an argument that letting pharmacies handle seven specific conditions is a superficial response to a fundamental problem. While pharmacists could save hundreds of thousands or maybe even a few million appointments every year, that’s a small dent in a much larger figure. There were over 31 million appointments in March 2023 alone.
In medical terms, this could be a small sticking plaster on a very big wound. That said, it could be a very important step in the right direction.
What will the patient experience be like?
It’s vital that patients can count on discretion and dignity when seeking treatment. For a pharmacy to be able to offer that, they will need (or need to create) a private area for patients to discuss their symptoms in detail. That would ideally be a separate room, not just a screened-off area.
The reality is that it won’t be practical for some pharmacies to offer that. In that case, a patient would have to risk announcing to a shop full of customers that they might have a urinary tract infection. It’s not hard to imagine that some patients would avoid or delay their visit to the pharmacy if they felt they might risk embarrassment.
Could it place an unfair burden on patients?
One reality of listing conditions for pharmacy treatments is that patients will have to diagnose themselves. Patients could feel that they need to seek help from the correct provider, which means establishing if they have one of the seven listed conditions.
It’s easy to tell if you have an earache or a sore throat, and it’s probably clear enough whether you have sinusitis. However, is it reasonable to ask patients to decide whether their sores are from impetigo, whether their rash is shingles, or whether their insect bite is infected? For that matter, how will a patient know if their UTI is complicated or not?
One risk then is that patients could find themselves passed back and forth between GPs and pharmacies. If the patient thinks they have one of the seven conditions for a pharmacist’s prescription, but the pharmacist disagrees, then the patient will need to book a GP appointment. Chances are the GP will then write a prescription, and the patient will have to return to a pharmacy.
Addressing the primary care crisis
There are complex challenges in primary care, and they require sophisticated solutions. There’s no doubt that pharmacy prescriptions can play a role in tackling the crisis, but only as part of wider reforms. They’re also not without their drawbacks.
Alongside it and other initiatives, we need to address the recruitment and retention struggles in general practice. Part of that is intelligently matching healthcare professionals to the roles and practices that suit them culturally and professionally. MCG Healthcare specialises in matching general practices with GPs, finding the experience, skills, and qualifications for surgeries to fill the staffing gaps, and finding the ideal workplaces for our network of doctors.
Call 0330 024 1345 or email hello@mcghealthcare.co.uk.
