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Blog: Out of hours and community pharmacy

14 June 2013

I must say that I have never been so disappointed. We are talking about out of hour’s provision yet again. Not tier 1 emergency blue light stuff, which has not increased in this area, but the tier 2 and 3, walking wounded and worried well which is increasing at an alarming rate. I am not being disparaging here, but much of the growth is in patients who are migrating away from existing services to A&E. Yes, we have done GP triage within the A&E and opened up three treatment centres – so we have done the usual stuff – and we are back around the table again.
We have the usual ‘chat’ – access to general practice – but most now have extended opening times and are falling over backwards to accommodate patients with increasingly complex needs. It is just ‘patient choice’ to go to A&E – although it can hardly be convenient with a long journey, expensive parking and a four hour wait almost routine. But, someone asks, is it really the choice that they want at a time that they want it – my head hits the desk.
So we battle on looking for quick-fix solutions and actually considering hideously expensive options.
My main disappointment is that there are no community pharmacists sitting around the table. If there were then they might say:
“I wouldn’t want to remind you that we already diagnose and offer treatment to many of the local residents who choose to visit a pharmacy rather than a GP or A&E. It is simply that you build new fancy services to tempt them away.
“Well most of the community pharmacies are open to 6pm with a walk in appointment system. So if you don’t feel it is appropriate to visit your GP or you can’t get an appointment, you can visit one of the 68 community pharmacies in the area. We all work on an ‘advise, treat, refer’ basis and with a little thought, some educational support and some PGDs we can expand this into something really helpful. We already run a ‘minor ailment’ scheme and a variety of other services in the area so we are half way there. There are ‘ask your pharmacist’ and ‘pharmacy first’ campaigns, but, to be honest, your walk in centres are our main competition.
“Did you know that there are some pharmacies that open extended hours? We have a couple open 85 hours (8am to 9pm) and one open 100 hours. The 100 hour pharmacy is quite near the centre of town (actually within 200 yards of the one that you opened in the walk in centre) and we have extended opening hours pharmacies to both the north and the south of the area – both with really good (and free) parking.
“If you wanted to be really inventive, you could ask the pharmacy to recruit an independent prescriber pharmacist to their shops and allow them to practice as an advanced practitioner.
“Do you want to have a look around a few? Not to criticise, but to consider the potential. It would not be very expensive to convert an area of a pharmacy to create an advanced service, perhaps with nursing or GP cover. You could even call it a ‘walk in centre’ if you want.
“The community pharmacy is already there. It is already doing some of the work that you need. They are healthcare professionals on the high street – one of the wider team within primary care.
“Did you ever stop to think that a proportion of patients seen in GP triage and walk in centres were being managed in community pharmacy and you have sucked them out into a new system that costs you new money? In some way you compound your problems?”
I often think it is helpful to say things out loud – so:
“We plan to take patients from community pharmacies that deal with them at no additional cost to the CCG and now manage them in a new walk in service and GP triage service that we have to pay for.”
“We are planning to increase the scale and depth of provision of services within our current community pharmacy assets, to reduce the number of people accessing our GP triage services and walk in services at a relatively reasonable cost (well probably half of what we spent on that last walk in centre)”
I think I will end this discussion right now. Do I really need to say more?

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