GP referrals: Helping, not hindering

By Alexander Humphries*

We have received a letter from one of the local GP practices bemoaning the fact that we have been referring patients to them who needed to be seen urgently, a pharmacist writes

In his letter, the senior GP talked about how the practice was struggling because one of their GPs was sick, their salaried GP was on long-term sick leave and their locum was off doing home visits.

The practice is in a real mess at the moment but, for some reason, they are viewing the pharmacy as a problem, not a potential solution for their acute issues. Offering flu vaccines haven’t helped because this has unfortunately led to a culture of distrust between us and them – something which didn’t exist until very recently.

I asked my staff if they could recall any specific incidents we had referred to the practice for urgent appointments. The very first person I asked mentioned three incidents in the last week, two from us and one from the practice.

Patient one had a perforated ear drum (there was bleeding from the ear), which we referred to the surgery as there was nothing that we could do over the counter. Patient two had an acute outbreak of shingles so, again, a referral was the only option. The patient they referred to us had developed an eye problem, which resulted in eye pain and blurred vision – both symptoms which require referral to a doctor.

Failing relationships

We can either argue about what we did, or what they did, or we can try and work together to get a better outcome for patients – so I am going to write back to the GPs and offer to help them. I’m not sure if they will accept my help or whether they will decide we are ‘up to something’...

Such is the failure of relationships, which are now happening across the system as, increasingly, it becomes ‘everyone for themselves’. Nothing typifies this as much as stock shortages which, as we all know, continue to be a major problem.

No co-operation

I am seeing more and more practices refuse to co-operate with pharmacies to help resolve problems for patients. They don’t care about dispensing at a loss; they only care about their own workload.

PSNC ought to be working on an offer to Government to give pharmacies more power to resolve shortages, be it simple substitution (e.g. two x 10mg instead of one 20mg tablet or changing from tabs to dispersible tabs or vice versa), with the Business Services Authority paying us for what has been given rather than what was on the script.

Like most pharmacies we’ve been substituting two naproxen 250mg for the 500mg, but didn’t have time to get every script changed. We just sucked it up and hoped that eventually the system would catch up.

This may not be some supersexy clinical service, but it could be a vital Elastoplast on a system that is broken.

Matt the App

It is only because in my pharmacy we’ve ignored Matt “I’ve got an app for that” Hancock’s advice about stockpiling that we have got through the past few months. I don’t know what our supposed leaders are saying about the state of the supply chain to ministers, but does anyone know how many of them work on the front-line on a daily basis?

One thing is sure: they seem to be woefully out of touch with the acute pain that pharmacy teams face. What makes me most concerned is the silence. Pharmacy bodies just don’t seem to be saying anything at the moment.

No change

If I were to dig out something I wrote this time last year, I don’t think any of the issues will have changed. And that is a problem. We may not be fighting tooth and claw with the Government any more (at the moment anyway), but neither do we seem to be taking any steps forward. I’m almost at the point where I’d be ready to pass a ‘no confidence’ motion against the entire pharmacy leadership.

Whatever they’ve been up to behind closed doors (building relationships; eating biscuits?), whatever it is, it’s not working. We either need to change the plan, or we change the leaders. Unfortunately, at least for the time being, we are stuck with what we have. If we are going to change, we need to do it ourselves and not wait for someone with any authority to pull their bleedin’ fingers out.

As we head into the New Year hoping for the birth of a new pharmacy contract, and with it the promised land of a better and more valued future, I am left with the age-old problem in pharmacy – where can we find three wise men (or women) with the vision and acumen to follow the star through to the journey’s end?

* Pen name of a practising community pharmacist. Alexander Humphries’ views are not necessarily those of Pharmacy Magazine. Who would you nominate as your three wise pharmacy men or women? Email pm@1530.com

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