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Tis the season to be flu jabbed€¦.tra la la la lah €“ just as long as you don't have it done in a community pharmacy, according to the chair of the BMA's general practitioners committee in Wales

ACCORDING to Dr Charlotte Jones, pharmacies are €creaming the easy patients off the top€. According to pharmacists, Dr Jones is creaming the hyperbole from the bottom. Despite arguing on the one hand that general practice is €on its knees€ in Wales, Dr Jones sees no place for community pharmacy in the provision of flu vaccinations, a flagship public health campaign.

Given the need for a fundamental change in the way the NHS works €“ and the huge challenges facing the NHS in Wales in particular €“ the comments from a senior medic are astoundingly naive.

Change of mind

To be honest, I was never all that interested in flu vaccination as a service. What changed my mind was a self-employed man who wanted the vaccine because he couldn't afford to be off work. That's when it dawned on me €“ pharmacy was about the only option he had. Perhaps this points to the real problem; namely that working people work and have children and commitments. It may not be convenient to book an appointment or to wait in line for a couple of hours in the rain (as patients at one of my local practices had to do recently).

At no point in the past seven years of being the only provider of flu vaccinations has general practice got close to the targets set by the Government.

The €easy patients€ to which Dr Jones eludes are clearly the over-65s who are prepared to wait in line because their doctor has asked them to. One patient I know referred to being €treated like cattle€ at her local practice because of this mass approach to immunisation.

Disappointing

Pharmacy has a way to go before it can truly claim to be increasing uptake in the hardto- reach groups, but it is very disappointing to see the BMA criticising any attempt to increase vaccination rates. Maybe if the BMA supported the pharmacy service, rates would be even higher.

Being cynical, the real reason the BMA is so vitriolic about the pharmacy service boils down to money. Flu vaccinations have been a bit of a cash cow for its members, earning (with a bit of discount and service fees) around a tenner a jab. They can get practice nurses, even district nurses (who they don't pay for), to help them line up the ten pound notes, sorry, patients.

The BMA contends that it is unfair for GPs and pharmacies to be paid the same for providing the same service. I couldn't agree more.

So many of the GPs' costs, such as premises, IT, clinical waste disposal and stationery, to name but a few, are reimbursed centrally by other parts of their contract, while pharmacy has to pick up training costs, clinical waste costs as well as promoting the service €“ all this out of the item of service payment. Meanwhile the GPs pick up the lion's share of the 'cream' that is the over-65s.

There is also a suggestion that pharmacies would pick and choose the patients to vaccinate €“ but why would we do that? It takes me no longer to vaccinate an asthmatic than it does a pregnant lady.

It is very disappointing to see the BMA criticising any attempt to increase vaccination rates

Protectionist

So worried are GPs about the threat of pharmacy vaccination schemes to their earning power that they have started to resort to some desperate protectionist measures.

One NHS area team in Shropshire agreed to delay rollout of a pharmacy service in the wake of GP criticism. In my own area, practices have spoken to local pharmacies to warn them not to deliver the flu service. This is incredible and is tantamount to a visit from When pharmacies are absolutely reliant on the prescription output from practices, they are being denied potential income and patients are being denied choice because GPs are behaving like the mob. This is before we even consider what goes on when GPs are involved in local commissioning decisions.

Finally, we have to come back to the capacity issue. Dr Jones says in an interview she gave to the BBC that €the workload demands in practice are ever increasing, the complexity is ever increasing and the workforce is shrinking year-onyear€. So why is she so keen to avoid giving away work that could free up her time to meet those demands? Could it really be about the money? Surely not...