Community health
Stay at Home. Protect the NHS. (Save Lives?)

By Graham Phillips - Primary Care Journal

With the exception of the odd high-profile scientific (Prof Lockdown) and political (Mr Cummings) advisor, we have all pretty-much done as we were told. We stayed at home and the NHS has emerged relatively unscathed. However, as for saving lives, I’m not so sure.

During the lockdown period we observed a massive drop in routine visits to GPs, the cardiac and stroke wards lay more than half-empty and untold urgent cancer waits and referrals were delayed. Only time, tide and future ONS data will reveal the true consequences of the Covid pandemic and the unintended consequences of lockdown (did anyone even consider the ratio of harms to benefits?) .

However, one thing is for sure: as GPs return to a ‘new normal,’ they are already being overwhelmed by the backlog of demand, built-up during the last 13 weeks.

The New Normal?

I’m a community pharmacist, my partner is a GP and we often laugh about the “emergency verruca” that appeared recently at her evening walk-in surgery. Readers will be aware that we are at least 16,000 GPs short and, despite endless government promises to the contrary, the number of full-time GPs and partners continues to decline.

So, will GPs simply return to seeing all-comers and providing walk-in surgeries or will telephone triage, online-consultations, and the requirement to take yet more of the strain off secondary care dictate the new normal?

Evidence shows that community pharmacists could safely and appropriately handle at least 18 per cent of GP visits, not to mention around 8 per cent of A&E episodes. How much could this save the system in time and money?

What if GPs and local community pharmacy teams were incentivised to collaborate (not compete) and a national online-triage system was introduced?

In response to Covid, surgeries are already triaging their patients. E-consult, for example, enables patients to pre-frame their GP consultation by completing an online algorithm describing their symptoms as well as the outcome they are seeking from contacting the practice.

The system already has a “refer to pharmacy” option and there’s no reason why both the triage, the referral and the patient’s details could not be forwarded to the patient’s usual community pharmacy (we all have NHS-net emails). The pharmacist would address the issue, giving appropriate advice and prescribing medication only if necessary, according to pre-agreed protocols. The pharmacist would subsequently complete a template summary of the completed patient episode in the patient’s electronic record. Happy patient. Happy GP!

Expanding the scope 

A good start but this is an incomplete vision. Increasing numbers of community pharmacists have prescribing qualifications and, therefore, an increased scope of practice. As this becomes the norm, community pharmacy can take on a lot more work. As GPs come to rely increasingly on community pharmacy (CP) teams, they must have confidence in our work. By following joint protocols, capturing everything electronically and having regular joint GP/CP practice meetings, confidence, trust and communication will all grow.

Community pharmacists see an incredible 1.6 million people every day for health-related reasons. Adding a national common ailment service into the mix (as already happened long ago in Scotland) is surely a “no-brainer”.

There’s more. We community pharmacists are cautious creatures. Whenever we feel the need for a medical opinion, we refer patients to their GP. But what if we also had access to the E-consult system? Together with the patient, we could complete the electronic triage (once again following the same protocols) thereby saving GPs yet more time. In my view, expecting GPs to deal with elderly patients and complex multi-morbidities in a ten-minute consultation in unfair on patient and GP alike. My partner says it can waste five of those precious ten minutes for an elderly person just to remove their coat and get seated.

If you are thinking that’s all very well for young and/or internet savvy patients but what about the rest? ­– community pharmacy to the rescue. We could easily assist patients to complete the same electronic triage on a tablet in the pharmacy, booking the GP appointment and sending the e-referral to the practice at the same time. And, of course, just like GPs, Community Pharmacists can provide online consultations.

Testing, testing, testing

If GPs didn’t lose income, they would doubtless be delighted to shed the responsibility of flu jabs. Like seasonal flu, coronavirus (and its successors) isn’t going away. Given our ready accessibility and long opening hours, community pharmacies are a logical choice for testing, tracing and providing Covid jabs as soon as they become available.

Next Steps?

Going forward, the nation’s network of 11,500 community pharmacies can contribute its unique combination of clinical, public health and social capital value to assist primary care networks (PCNs) in planning and delivering local priorities. A significant contribution can be made in many areas, including:

  • Medicines optimisation (including structured medication reviews)
  • Enhanced health in care homes
  • Anticipatory care (high-need patients)
  • Personalised care
  • Early cancer diagnosis
  • CVD prevention and diagnosis
  • Addressing health inequalities in the local population

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