Time for eggshells

Front Desk

Time for eggshells

By Rob Darracott

Leela Barham’s piece about the incentives (or lack of them) supporting the Community Pharmacist Consultation Service got me thinking. Are we missing something better because we’re not thinking outside the pharmacy box?

There’s a lot of muttering about the CPCS right now. Roll out is slow – only 800 GP practices had signed up by December. Community pharmacies, who were promised a game changing new service are, if they’re lucky, seeing a few referrals a week. Doctors are muttering too. In an interview with my colleague Neil Trainis for Independent Community Pharmacist, former GP negotiator Dr Richard Vautrey said time-consuming administration at practice level was making GP-CPCS “a missed opportunity”. 

The new secretary of state for health keeps saying he’d like to see a ‘pharmacy first’ scheme. His junior colleague Maria Caulfield made positive noises too recently. PSNC says it is “pushing for a ‘sensible’ walk in option”, but I’m not holding my breath for any government allowing literally anyone in England to walk into a pharmacy and get free stuff. England is the one part of the UK that still has prescription charges. I’m not sure the NHS is up for trusting pharmacy as a whole yet, either, even with its stellar pandemic performance and the relationship rebuilding work of the now departed Mr Dukes. 

Perhaps pharmacy should stop holding its breath for central largesse, and make more of its own running? Primary care currently has access to two pots of cash – the short term Winter Access Fund (WAF) and the longer term, and larger, Investment and Impact Fund (IIF). For hard pressed GP practices, community pharmacies can certainly improve Access for patients who might otherwise have to wait a fortnight for an appointment. And if community pharmacy services could be structured to provide guaranteed capacity, that would definitely make an Impact on primary care locally. 

I think Cornwall LPC is onto something, therefore, with its CCG-commissioned walk in community pharmacy service, which is funded from the WAF. Chair Nick Kaye sees the service helping to encourage more of the county’s GP practices to engage with the GP-CPCS. Where next, as people get experience of doing things differently? 

In a column last year Newham GP Farzana Hussain told us she has a dedicated appointment slot in her clinics for a patient who bounces back after triaging in a CPCS referral. Might that work in reverse, with pharmacies formally adding appointment capacity for local practices, so GP receptionists have more slots to fill when the phones start ringing?

Tweaks, expansions, reinventions that turn good ideas into great ones are always more likely to happen locally, as trust between individuals creates an atmosphere where people work together to create better. They have also found ways to short-circuit cumbersome paperwork in the interests of patient care. 

CPCS is supposed to help integrate community pharmacy into primary care. Primary care networks are meant to bring together the health economy in a locality to work together in a more integrated way. The pots of cash give power (and resources) to local systems to find solutions that improve access and relieve pressure. They come with rules and regulations too, but nobody ever made an omelette without breaking eggs.

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