How do you solve a problem like primary care?

I recently had the unpleasant experience of developing an eye infection – acute conjunctivitis.  However, before I had been diagnosed, my immediate reaction wasn’t to go to the GP or A&E (although at 3am in some amount of pain the thought did cross my mind) but to go to the community pharmacist who did a great job of diagnosing and prescribing me the right medication in less than 5 minutes.  This experience got me thinking about the current pressure on primary care and how to resolve it.

In November 2013, the Royal College of General Practitioners (RCGP) and the National Association for Patient Participation (NAPP) launched a campaign called Put Patients First, Back General Practice.  This campaign has called for the funding for General Practice to be increased from the current 8.5% to 11% by 2017.  A big challenge in the current financial climate.

There are increasing demands on general practice which NHS England produced an evidence pack to support in August 2013 called Improving General Practice – a call to action.  In this pack they estimate that for the roughly £8billion of funding there could be as many as 340 million consultations per year with a funding allocation per head in England of £143.61 (http://www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/igp-cta/). 

In this pack NHS England describe one of the biggest pressures on General Practice as being rising patient expectations.  It seems to me that the old wisdoms that you can’t treat the common cold with antibiotics and you need to rest a strained muscle for up to 6 weeks so it can heal appear to have been forgotten.  Patients don’t seem to be happy with the GP appointment unless they leave brandishing a prescription or a referral.  The commitment that you can see your GP within 48 hours or be seen in A&E within 4 hours are becoming increasingly difficult to meet and so patients are feeling frustrated and more people are going to A&E as they can’t get into see their GP.

My recent trip to the community pharmacy got me thinking about potential solutions.  A large proportion of people go to their GP for a repeat prescription or for minor ailments.  These patients would be better off going to a community pharmacy in the first instance.  Many pharmacies have consultation rooms, which are often underutilised.  There could be community nurses or practice nurses available to check people’s blood pressure etc as they do in the GP practice, so that they can safely have their repeat prescription.

According to Pharmacy Voice 1.6million people go to a community pharmacy every day, whether to pick up a prescription or buy shampoo.  This has huge potential to educate the public as to how to best use their pharmacy and GPs should also spend time promoting their use. 

Pharmacists spend four to five years training and have a wealth of knowledge and experience regarding medication, often more than the prescribing doctor.  This feels to be to be an untapped resource that could really benefit from being promoted and is there already so could have a more immediate impact on taking the pressure off general practice.

The financial pressure that the NHS is experiencing mean that in order to increase general practice funding by £3billion this money will need to be taken from somewhere else, which in the current climate is very difficult.  However, we could make better use of their current funding levels by making sure that we use our general practice resource in the best way possible.  The extended use of community pharmacies is a good way to ensure that routine patients continue to get the care they need quickly, easily and locally whilst supporting general practice to see the more complex patients.



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