GPs locked the surgery doors on 16th March 2020 and have, it seem, only resumed a basic service. Officially no one is saying so; it’s an uncomfortable truth and GPs are everywhere making the case they work harder than ever. Perhaps they do. When GP spokespersons appear outside practices to tell us how exhausted and burned out they are we might be hearing the truth or we could be witnessing spin at its apogee. Patient access remains constrained to the point of frustration too often manifesting in our pharmacies as abusive patients venting their ire.
General Practice had got itself in a bind before the pandemic and most agree changes in working practices were long overdue. Above all the GP workforce has been decimated with too few entering and too many retiring. But too much access to doctor leads to a perverse inefficiency and the public are increasingly a demanding lot with every; ache, pain and social problem brought to the GP’s door which is not where it should be dealt with. The Bengoa Report is clear on how we improve our health services and now might be the right time to bring about this change. But GPs don’t seem to be able to let go of some things and what I’m seeing is a chaotic realignment unilaterally instigated by General Practice in the hope the wider primary-care system will eventually adjust around it. It might be necessary but there are real dangers in this strategy.
At a practical level, General Practice is making pharmacists’ lives very difficult and is potentially risking patient safety. For not speaking up pharmacists share much blame but we have always kowtowed to general practice in our sycophantic inferiority and our acquiescence in this current crisis is frankly unprofessional. Sick patients are often too frightened to visit the GP and as a result, sinister diseases progress perhaps to a point of no return. At the start of the Pandemic, the game was dispensing to ensure the continued supply of medicines but now that we are returning to normal service most patients and pharmacies still have great difficulty contacting GPs.
Ordering prescriptions, from some surgeries, is near impossible with phone calls taking 8-10 minutes to be answered if answered at all. This is requiring a dedicated phone line in the pharmacy just to manage. Patients who normally order their own prescriptions – and most patients should be doing this – cannot get through and the expectation is that pharmacists have easier access. In spite of work done in April 2020 most surgeries seem to have stepped down the dedicated pharmacy telephone lines agreed back then. Patients are visiting the pharmacy asking for yet-to-arrive prescriptions which is a burden on staff constantly searching for made-up medicines. Often when prescriptions have arrived one or two items are missing and we are forced to waste more time searching for the prescription form to confirm. Recently, a three-way dispute involving patient, surgery and pharmacy got resolved when the surgery telephoned us to state adamantly that the medicine the patient was seeking was indeed on the prescription. We confirmed it was but told the practice that the patient was complaining about another medicine they could clearly not pronounce.
Missing and delayed prescriptions and timely notifications of medicine changes are threatening patient safety. It is bizarre, in this golden age of IT, that a 1950s system of telephone calls and paper prescriptions, is still being employed purportedly to assure safe use of medicines.
There is a crisis in General Practice because in the heart of a workforce crisis it is attempting to change without involving the rest of primary care. Community Pharmacy is such an integral part of primary care that we need to be included in this change taking more responsibility for common conditions and repeat medicines. This could easily be delivered in an orderly way with some strategic vision and appropriate IT investment. Where is the leadership in the Health Board and Department of Health?
I am a pharmacist in Belfast.