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by Alexander Humphries*

It may just be me, but has anyone else noticed that relations with GPs are getting trickier by the day?

Across the seven GP practices that I have day-to-day contact with, I think it is fair to say that, sadly, relations are gradually getting worse.

Whether there are problems with the medicines supply chain, or the recent kerfuffle over Lyrica, it seems that pharmacy is increasingly on a collision course with general practice. It's not even that our relationship with GPs themselves is fraught (from my perspective at least), but practice staff, including practice managers and receptionists, appear to be less helpful than they once were.

We are all painfully familiar with being told: €I put the repeat slip in last week; it should be back by now.€ I must hear it at least 10 times a day. While this in itself is not a new development, there does seem to be more delays, and the public increasingly keen to point the finger €“ at the pharmacy, the practice or whoever.

This might be down to an increased expectation about the sort of service patients should receive, but it could also point to the fact that surgeries are creaking under the strain of the repeat prescribing system. Already today, as I write this, I have apologised to three patients whose repeat prescriptions have been at the practice for nearly a week, including a man with epilepsy who has run out of his phenobarbitone. (AAH saved the day by rushing a phone order through.)

When this sort of thing happens, like many other pharmacists, I help the patient out where I can, often taking it on the chin even when it isn't our fault, and never blaming the surgery (for fear of repercussions). What has really annoyed me recently, however, is the introduction of a new system for collecting repeat prescriptions at one of my nearby surgeries. My member of staff collecting the prescriptions now has to sign to say that they have picked up each patient's script.

This might not seem like a big deal, but the 30 minutes it is taking to sign the list is compounded by the fact that I have two other members of the team standing around waiting for the prescriptions in order to begin the afternoon dispensing. Such a system undermines trust as it feels like the practice is accusing us of 'losing' scripts.

Another GP practice insists that we can only phone with prescription queries between 12.30-2pm, while two others will simply refuse to fax prescriptions. All we can do is comply with this bureaucratic nonsense, and try and help our patients.

Tensions high

Tensions are also a little high with GPs in general following the recent NHS England Lyrica fiasco, which they see as 'pharmacy's problem'. While this probably has very little impact on our day-to-day relationships with GPs, it is a source of friction nevertheless.

Likewise, every year we get the usual rant from general practice about pharmacy-based, flu vaccination programmes €“ this year probably more so, as for all intents and purposes the pharmacy flu scheme in London demonstrates that we can provide the service at scale.

Mis-direction

One final, but significant, irritation is the flagrant and continuing direction of prescriptions by GP practices. Whether it is to a pharmacy they own or to any other contractor, there is something deeply wrong about GPs using their influence over patients in this way. I have been both a beneficiary and a victim of prescription direction.

At no point have we ever asked a doctor to direct a script or patient to us, but we've heard it said that 'the doctor said I should come here'. This influence is one of the main reasons why we cannot stand our ground on the other issues because, if we do, we risk turning the prescription tap off. So what options do we have to improve relations with general practice?

Are practice pharmacists the answer? I don't think so, because this will only distance our relationship with GPs as they will defer all medicines issues to the pharmacist €who will be there a week on Wednesday€. We need to have a round-table discussion with general practice to see what work GPs are willing to relinquish €“ although, in my experience, they are not willing to relinquish anything.

Contrast that with a dangerous view within our own profession that pharmacists should €let go€ of dispensing. Anyone who champions this view is, fundamentally, wrong. Yes, we must use our skills better.

We should use our team better as well. But why remove one of the USPs for community pharmacy when it is the main reason for patients to come through our door, as well as to access our other services. Without the supply function, the network, and with it community pharmacy, will surely wither away and die.

* Pen name of a practising community pharmacist. Alexander Humphries' views are not necessarily those of Pharmacy Magazine. What are your thoughts on your local GP surgeries? Email pm@1530.com