It’s possible that my local chemist saved my life. I say “possible” because it was a very long time ago in the days before we called chemists ‘pharmacists’. I was a baby and German bombers were attacking the area of Cardiff where I lived. Their targets were the docks and the steelworks but stray bombs sometimes fell on our houses. When the sirens sounded my parents would scoop me from my cot, dump me in a cardboard box and run to Mr Morgan’s chemist shop on the corner to take shelter in his cellar. Mr Morgan – like most neighbourhood chemists in those days - offered other services too. You went to them if you had something nasty in your eye or a splinter turning sceptic or a sore throat.
I recall the wonderful Mr Morgan because the government has announced that we need more like him. Not to offer refuge from German bombers, but to carry out many of the functions for which we now have to go to our GP – with all the hassle and sometimes heartache that trying to get an appointment can entail both for patients and doctors alike.
The first thing to say about is that it’s not a new proposal. It’s been talked about inside and outside Westminster for several years now. What’s different this time is that it has a name – the ‘primary care recovery plan’ – and a budget: £645 million. Among the specific changes it proposes are allowing pharmacists to prescribe antibiotics and antivirals for seven common ailment without the need for the patient to have seen a doctor or nurse for the first time. They include earache, a sore throat, sinusitis, impetigo, shingles, infected insect bites and uncomplicated urinary tract infections (UTIs) in women are set to be prescribed medicine by pharmacists. The pharmacist will also be allowed to prescribe oral contraceptives and carry out blood pressure checks. Pharmacists in Scotland and Wales carry out many of these functions already.
The aim is to free up one million GP appointments a year in England. In the past five months, 24m consultations took place more than a fortnight after being requested by the patient – almost 5m each month on average.
But pharmacists are probably under greater pressure than they have ever been. The financial help they get from the NHS has been effectively frozen for the past five years – and this at a time when their business costs have been going through the roof because of inflation and other higher costs. It’s also meant that many are losing money on most of the prescriptions they are required to fill. All this has led to the closure of many community pharmacists and the qualified staff who work in them have gone off to work elsewhere in the health system
The number of people able to access blood pressure checks in pharmacies will be more than doubled to 2.5 million a year, from 900,000 last year. Half a million women will no longer need to speak to a practice nurse or GP to access oral contraception and can instead attend a pharmacy for it, NHS England said. Self-referrals will also be increased for access to services such as physiotherapy, hearing tests and podiatry without the prior recommendation of a GP.
Thorrun Govind, who chairs the Royal Pharmaceutical Society in England, called it a “real game-changer” for patients. But some experts warned that not all pharmacies would be able to offer all or any of the new services and that could mean frustrated patients being “bumped from pillar to post, only to end up back at the GP”. There are also specific concerns such as whether patients may not be able to recognise the seriousness of some conditions, including whether a UTI can be classed as “uncomplicated”.
Nobody questions the need for the extra cash. Pharmacists are, obviously, vitally important not just for filling prescriptions but for helping take the pressure off GPs. Many of them are struggling to cope. Most of us know that from our own experience. It has become increasingly difficult – sometimes impossible – to get an appointment without a long wait. We are told to call at 8.00 or 8.30am, only to be greeted (if we’re lucky) with a recorded message telling us how long we’ll have to wait before we can speak to a human being. If we are unlucky we’ll simply get an engaged tone. Many surgeries are still in the stone age when it comes to telephone technology. The government says it will shell out £250m to help improve the answering system in those GP practises.
There is a stick as well as a carrot. Under the new GP contract for 2023-24 practices are required to provide access to patients “at first contact”. That means it doesn’t matter whether we contact the surgery by phone or online we will be able to speak to a human being that same day. If it’s urgent we will have an appointment on the day and, even if it’s not, we will be told how our problem is going to be dealt with. In other words we won’t be left in limbo. Or, at least, that’s the plan.
So those are the two weapons being deployed to deal with the crisis facing our primary care system. It remains to be seen how effective they will prove. There are two obstacles. One is obvious. How prepared are we, the potential patients, to accept the changing role of our pharmacist?
The days of my own Mr Morgan, the friendly corner chemist who pulled out your troublesome splinter and dabbed the wound to stop it festering, are long gone. The pharmacist prepared to deal with seven different ailments and prescribe antibiotics is another world altogether. The question is not so much whether they are qualified, it may well be whether we, the potential patients, are prepared to accept them as a substitute for our GP.
At the most basic level there is the question of privacy. It’s one thing to tell the pharmacist you need something for your sore throat or the nasty blister on your heel within hearing of the other customers queuing behind you. It’s quite another to discuss your urinary tract infection. Some of the larger pharmacies may have the space to provide a consulting room, but many will not. The big pharmacy chains like Boots will have no problems. The “Mr Morgans” of this world may struggle to cope.
Another serious concern expressed by experts in the field, is that allowing pharmacists to provide antibiotics without a prescription for certain health conditions is potentially dangerous. One expert in the field is Dr Malcolm Andrew, who was the principal lecturer in pharmaceutical microbiology at Loughborough university. He’s afraid that it might exacerbate the rise in bacteria that are resistant to antibiotics. He wrote to the Times: “Attempts to address this rise led to the Department of Health publishing, in 1998, ‘The Path of Least Resistance’, imploring doctors to exercise restraint when prescribing antibiotics. Not all doctors complied with this advice and the incidence of bacteria resistant to these drugs has steadily grown, with some becoming almost untreatable with antibiotics. I hope the pharmacy students I taught for 43 years will remember my lectures on this topic and use their new powers judiciously.”
For the most part, the new proposals have been given a cautious welcome. The greatest concern seems to be that they don’t go far enough. GPs in England carry out more than a million appointments every day. If the new powers given to pharmacists are widely adopted it’s reckoned that it will reduce the number of people wanting to see their doctor by about three per cent. Better telephone systems will also help but only if the doctors are available to deal with the callers when they finally make contact – and too often they are not.
At the core of the problem is that there are simply not enough qualified people – whether doctors or nurses – prepared to work in primary care. The unprecedented industrial disputes we have been witnessing over the past year are proof of the discontent in the medical profession. The image of doctors and nurses on the picket line was once unthinkable. Now it is commonplace.
Ministers have promised that plans are in the pipeline to tackle the desperate shortage of qualified staff in primary care, but there are reports that the plans have been held up by the Treasury, which wants to see pay disputes with doctors and nurses resolved before the government commits to a plan whose credibility hinges on fixing the crisis in recruitment and retention but which could have long-term implications for the cost of NHS staffing.
So where do you stand? How do you feel about consulting your pharmacist for a condition that might have seen you making an appointment with your GP? Would you be embarrassed at telling the pharmacist you have a urinary tract condition, for instance? And does it worry you that it might become too easy to get hold of an antibiotic? In the longer term should we be prepared to pay more through our taxes for more qualified workers in primary care?
Let us know.