We all know about the difficulties the NHS faces with regard to funding. The health service is expected to do more and more with less and less cash and not a day goes past without this strain making headlines.
Sooner or later the only answer becomes making serious changes to the way that healthcare is delivered, resulting in a system that is not always as efficient as it should be. The NHS is buckling under the weight of all that it’s expected to do, and it urgently needs some help in taking the strain.
What’s to be done? A lot of political rhetoric blames GPs. It’s their fault, so some claim, that there are pressures in A&E because people find it so difficult to get appointments with them, so they go to A&E instead. GPs simply need to get their act together and see more patients and this will solve the pressure in both primary and secondary care.
The situation is far more complex. If anything, they should be applauded because they are seeing more and more people each year, despite diminishing resources. Figures from last year showed that, on average, each GP in the country is providing an additional 1,450 consultations per year compared to five years ago. That’s a productivity increase of about 10% – pretty impressive, especially when you consider that nearly 11% of the NHS budget was spent on GP services in 2005/6 and only 8.5% by 2011/12. That’s a cumulative loss of about £9billion in real terms.
Access to GPs is still unacceptably patchy but GPs are working flat out. The problems are there, but it’s not simply the fault of the GPs. No, the spiralling crisis that we see in winter A&E departments, for example, is partly to do with cuts to emergency services, partly to do with poor out of hours access to GPs, partly to do with increasing population and changes in demographics. And part of the problem even lies with changes in immigration policy, which has seen it harder for doctors from outside the EU – such as India – come to work here.
But while there is no doubt that a mix of political factors have contributed to the current problems, there are also social and cultural factors too, not least the public’s belief that they need to see a doctor for every little ache and pain. Speak to any GP and they will tell you how much time is wasted by people seeking help for minor ailments.
Part of the problem, I think, is that we are now a society for whom the vast majority has known nothing but a national health service, free at the point of access. One of the downsides of this is that people have a sense of entitlement without appreciating the cost of the service they are demanding. According to research conducted by the Self Care Forum, there are 57 million GP consultations a year for minor ailments that do not need the input from a doctor. This equates to about 1 hour of each GP’s time per day. Imagine the impact that freeing up this time would have on GPs ability to see those that really needed medical input.
Research looking into why people visit the GP when they don’t need to have identified a number of reasons: people not understanding the natural progression of symptoms, for example that a cold can last for several weeks; that they perceive symptoms to be more severe or concerning than they are; that they want a ‘cure’ for the problem, when over the counter remedies are equally effective. They also often want reassurance that nothing more serious is wrong.
Where pharmacists come in
The fact is that many pharmacists can provide this service, and if people understood how they can help and felt emboldened to visit them, instead of the GP or A&E, then pressures on these services would ease. Pharmacists are a wonderful resource that are woefully underused in this country. Unlike GPs they are not limited in the time they can spend with patients and are perfect for popping in for a quick bit of advice or reassurance.
They are now able to provide more than just over the counter medication, with many being able to give certain prescription-only drugs too. They can check people’s cholesterol, blood pressure and give vaccines. They can discuss people’s medication and advise whether someone should see a GP or not.
For this to work fully, though, they do need access to patient records. Understandably, some have expressed concern over this. Pharmacists in shops do not work for the NHS, so this means opening up private, confidential records to external organisations. Of course there’s a serious issue about confidentiality. I don’t see why, though, with certain safeguards in place, it can’t happen.
The records, for example, could not be used for any commercial gain – so pharmacy chains would be banned from accessing them in order to undertake marketing research, for example. Only pharmacists directly involved in a patient’s care and with their explicit consent could access a medical file.
It’s important to remember that pharmacists who work in hospitals already have access to patient’s routine medical records. Indeed, it would be considered unsafe practice if this were not the case. It’s therefore somewhat of an anomaly that pharmacists in the community don’t get the same access, especially given that the vast majority of prescriptions are given in the community rather than hospital settings.
This is one more step in starting to integrate pharmacists into the way people manage their health. We need to move away from seeing the GP as the sole person who can help us hen we’re feeling unwell. This is what happens in other countries – such as Ireland – where people pay to see the GP and so tend to find alternatives such as pharmacists for minor things.
‘Self-care’ – managing common, non-serious conditions ourselves with over the counter remedies or with advice and support from a pharmacist – is not a magical cure for all the pressures on the health service, but it’s a start. A paracetamol from the local pharmacy and bed rest could be just what the NHS needs in order to keep going.