Pharmacists working in General Practice

By DDA Chief Executive Matthew Isom

The recent announcement by the Royal College of GPs (RCGP) and the Royal Pharmaceutical Society (RPS) that pharmacists should work in GP surgeries has generated a lot of headlines over the last week or so.

There is an undeniable shortage of GPs and no robust plan to recruit more in time, or any real will from young doctors to train as GPs.  A good friend of mine resigned from his partnership last year, citing a daily workload that was crushing.  It is an all too familiar story and it will take some years to redress the balance.

There will be a considerable excess of pharmacists emerging from Schools of Pharmacy in the future.  Many will not want, or be able, to work in community pharmacies and so there is significant potential for them to add considerable value to the service already offered by general practices.

Dispensing practices are unique in that they provide both medical and pharmaceutical services.  Some dispensing practices already employ pharmacists.  They add enormous value for patients in relation to medicines optimisation and advice; having spoken to a pharmacist employed in a practice, he believes that an hour a day of GP time is saved in this area alone.  Clinical reviews are also being undertaken, in addition to assistance with better prescribing and the elimination of waste.

The DDA believes that pharmacists could add even more value in general practice if they are also able to:

• prescribe
• manage acute illness
• manage chronic disease and polypharmacy (diabetes/COPD/asthma as a minimum)
• provide phlebotomy/ECGs/ administer vaccinations and undertake cervical cytology.

Practices also directly employ nurses and there is a shortage there too.  So the NHS needs to undertake a massive recruitment campaign, backed with appropriate funding and political intent, for both GPs and practice nurses.

In addition, we believe that the RPS should develop a ‘conversion course’ to enable pharmacists to become useful members of the GP practice team by having the skills set out above.  This conversion course should be a masters degree, or vocational training, at a cost which should be borne by the NHS, not contractors.

We envisage that training of practice pharmacists should be similar to that for postgraduate training for GP registrars which is:

• Funded
• Supported through educational department
• Sustainable
• Well governed and regulated.

If a similar scheme to that for GP registrars could be developed for practice pharmacists, it would cover pharmacy registrar pay, premises modifications and training grants; this must be new funding.  There can be no question of using existing primary medical, or pharmaceutical, services budgets to cover the costs; GPs have already seen reductions in funding in recent years.  There must also be a commensurate transfer of funding from secondary care.

Dispensing practices are the ideal place to pilot the introduction of pharmacists into general practice, given that they provide both medical and pharmaceutical services.  A full-scale evaluation should also accompany any pilot, including an assessment of the effects on the demand for services: where capacity is increased, new work is bound to be generated.