So will pharmacists save the NHS?

Well maybe, but we shouldn’t get too carried away.

The RCGP and RPS have produced a joint statement of how pharmacists and GPs could work better together and the news media today are talking about an ‘army’ of pharmacists coming to the rescue of general practice. Should we be greeting the cavalry with open arms? Well, yes, but they may not do everything that people might wish.

The first thing is that this isn’t about pharmacists doing more in their shops (which might also be good). This is all about pharmacists doing more in GP surgeries. I’ve worked in practices which have employed pharmacists or had other close working relationships for over 20 years and there’s a lot to be gained. The main thing that pharmacists working in GP surgeries have done has been to monitor repeat prescribing, help with medication reviews, review patients on new medicines, and sometimes accompany GPs on ward rounds to care homes. All this uses the expertise of the pharmacist, is likely to improve quality of care, and probably won’t reduce workload much. Sure, some problems will be averted, but in other cases, pharmacists will pick up things that need to be followed up. So my guess on this type of role is the pharmacist will improve quality of care but have little impact on workload.

The other role that pharmacists could do more of is to see people with minor illness. They already do a certain amount of this in their own premises, and this could be encouraged. The RCGP/RPS statement does hint at potential conflicts between practicing evidence based medicine and selling profitable medicines, and that conflict would be greater if pharmacists started to adopt these roles in GP surgeries. So should pharmacists run minor illness clinics in GP surgeries? Well I guess they could do, but if they’re not going to produce long term increases in demand, they’d need to be saying very clear things about self-care, including the lack of efficacy of many of the products they currently sell in their shops. As the RCGP/RPS statement says: “GPs and pharmacists should be aware of the evidence base and efficacy of the products they promote and supply and be aware of the tension between clinically evidenced supplies and non-evidence-based products”. So pharmacists in GP surgeries could certainly see patients with minor illness (and some pharmacists have prescribing rights), but I think it’s hard to predict whether this would solve the workload problem or just lead to more demand.

I don’t often use these blogs to say ‘We need more research’, but here I think we do. Not so much to know whether pharmacists can be clinically competent and safe (I’d be pretty sure they can) but more on their impact on overall demand. Otherwise we risk another bright idea that improves care but costs more.

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