To think the new see a pharmacist thing could be a disaster

[Dancebaby1989]

So really unwell yesterday and today- massive swollen tonsils, temperature, headache, red blisters in throat, tonsil stone. Decided to do an e consultation for GP and they booked me into to the pharmacist under the new government scheme- no issues at all.
get to pharmacist and he gets out a book of flow charts and when I explaining my symptoms is sat googling them and words from the flow chart- asked him if he need me to explain anything as am a nurse and he stated he had received no formal training they had just provided the flow charts.
end consultant and prescription complete but he never actually did any observations or even looked at my throat and while I know I need them I feel this is such a poor role out of this (not his fault) and could be dangerous

Lots of the pharmacies where I live have closed (South East) A prescription now often takes several days to be filled. I had to wait a week for antibiotics! Not a chance this will work around here, they are simply too busy. I’ve seen a paramedic at the gp the last three visits (over 18 months). Actually as she’s training to be a gp, she’s v thorough. Wanted to book dh in to see a particular gp as he understands the history of dh’s illness. Seven week wait. Bloody madness.

I think on the whole it's a good thing, pharmacists are very knowledgeable and it'll save a lot of time. Also stuff like last year my daughter was prescribed liquid penicillin which was out of stock everywhere but the pharmacist couldn't give her an alternative without me going back to the GP and getting a new prescription.
At the end of the day you came out of the pharmacy with what you needed, sounds like the pharmacist was just getting to grips with the new system

If all pharmacists were as good as my nearest one, it wouldn't be an issue. I once went in with a very painful wasp sting and she refused to give me anything because it was infected and needed antibiotics, she also spotted when a GP prescribed me something that was incompatible with a medication that I take daily, contacted the surgery and they issued a different prescription.

Sadly, they're not. One elsewhere in town sent my friend home with throat lozenges when she had really bad tonsillitis and she subsequently developed quinsy. But then I've known GPs miss things too.

A good pharmacist may well be better than a bad doctor for many things, but a bad pharmacist can probably do more damage.

@Sunnnybunny72 not sloppy just sensible, if they have earwax an otoscope examination could make it worse, when not clinically indicated. Are you medically trained?

A pharmacist once told me to stop taking my antibiotics and just use a throat spray for my tonsillitis
I'm immunocompromised...

@CormorantStrikesBack thats unfair, the pharmacy first scheme is very formulaic and the pharmacists have to follow a flow chart, they’re not allowed to use their clinical judgement as much as a gp (I think that might be what causes the problems, the pharmacist can see there’s a problem but computer says no). The flow charts and PGD are not simple and pharmacists haven’t had enough time to thoroughly look through them, so a pgd might say don’t prescribe clarithromycin with a drug that prolongs the qt interval, could you name one?
For example I know by looking at someone if they have shingles and whether they need antivirals or not in a few seconds, but it’s going to take me 5 mins to look through the flow charts and pgd to see if I can actually prescribe it or either refer on. In short, its the paperwork that’s the problem

GPs are a glorified referral service.

What an ignorant comment. GPs provide the vast majority of healthcare.

OP, the pharmacy scheme will be tightly controlled, they will need the paperwork to find all the details of the PGD.

And, yes, PP, self management is the name of the game.

Yeah this. Some GPs are fab some not so good and sometimes a pharmacist can be just as good!

As for the 'GPs are a glorified referral service,' comments (as a pp said,) that's a bit rude. Yeah there are some GPs that aren't great, and do miss some things, and seem to google half the stuff! But a good GP - and there are many - are worth their weight in gold.

I am part of a large practice in a market town that covers 20,000 people, from that town, and 9 surrounding villages up to 5-6 miles away. (Including mine,) They have audiologists there, womens health clinic, mens health clinic, a dentist, ante-natal clinic, chiropodist, eye clinic, and all sorts. Around 20 GPs. You can ring at 8.30am on the dot and usually get an appointment that day. It's only for emergencies though. And you come to a sit and wait clinic and can wait 2 hours. It's often less. I have been twice - and waited an hour one time, and 25 minutes the next.

OR you can go online/to the reception, and book an appointment for 3-4 weeks time if it's not a huge emergency. Face to face, or phone call.

I love my GP (I have a favourite,) and DH is the same - he has a different favourite, and the receptionists are lovely and kind, but strict with 'awkward' patients. They also provide invaluable kindness and peace of mind for the over 65s - many who get stressed and panicked over their health.

I am fully aware that not all people have my experience though.

However, the people bashing GPs would probably not be so quick to do so if they lost their medical practice.

I do agree with pps though, that many Pharmacists are also great, and can be a substitute if you can't get to the GP. It would be handy to just be able to pop in to a pharmacy and get your issue sorted, without having to wait for a GP appointment/potentially wait several hours in the waiting room. (That's if you are lucky enough to get a GP appointment!)

I do worry though, for the pharmacists/pharmacies, as they already seem to struggle with the huge workload. EG, we only have 2 in our little market town, and they already have a massive workload.

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Most pharmacists are incredibly experienced so I personally think it's a great idea.

We all know it's a nightmare to get a GP appointment so hopefully this will ease the strain.

Sadly some people are a huge burden on the NHS because they simply don't bother to help themselves so all the help we can get to ease this strain, the better in my opinion.

Currently on screen in my pharmacy there are 176 un dispensed prescriptions. Not because we are lazy or can't be bothered but because most other pharmacies are closing. This doesn't include walk ins or 111 referals.

We would love to have it all ready when you arrive. Especially if your GP has told you it will be waiting for u when u get to the pharmacy?!?! They can't see there are people in the queue before you or what stock we have avaliable. We physically can't hold everything. And even the regular "fast lines" will get used quickly. We typically have 1 or 2 counter staff. 1 dispenser and 1 pharmacist each shift. Every prescription has to be printed, picked, labeled, first checked, then second checked by the pharmacist.

Each item has to be done individually and if any item needs to be ordered it has a "owing" label printed. This takes time. People assume we just look at the prescription and pick the item and pop it into a bag......

And if even 3 prescriptions are in front of yours they may have 8 items on each so there will be a delay. We try and give half hour wait times but in the mean time while also doing second checks the pharmacist may come to the counter to help advise. Or need to be on the phone to a 111 call which then needs computer access to check patient records. This again takes time from your half hour wait.

And now with the pharmacy first it takes more time away from the basic task of dispensing medication. People are being told by 111 to just come to us for anything. Not the criteria for pharmacy first. So we have very upset people genuinely needing help that we cannot give. And it's frustrating and upsetting to see this. We also can't change what a Dr has prescribed. Even if that is out of stock or written wrong. Its a legal document and has to be correct. It isn't us being awkward.

We also don't have access to other pharmacies stock levels. There are multiple suppliers and not all places use the same.

It's physically impossible to do all this every day with not enough staff. And GPs and 111 sending wrong referals to us. We can't prescribe controlled drugs even as an emergency.

So please when you come for a prescription please understand we are not magical and are not being rude asking you to come back in a bit and even then it may not be ready due to circumstances out of our control. And yes pharmacies are getting extra money for these services but the money doesn't go to us minimum wage counter staff who tend to receive the abuse from the public. Ps I do love my job

However, the people bashing GPs would probably not be so quick to do so if they lost their medical practice.

People make such comments because they see the service that they receive/is available to them as inadequate, often woefully so. Your comment 'well, they'd miss this if they lost even that!' is absurd. It's like saying people complaining about (more minor medical ailment) wouldn't do so if they had (more serious medical ailment). 'You wouldn't complain so much about the pain of untreated tonsillitis if you had throat cancer!'

This is a brilliant system once all the teething troubles are over but once again there will not be the funding available to make it work properly or enough trained staff available to continue to do the bread and butter dispensing while the pharmacist is setting a patient (and filling in the forms and then has to check all of the prescriptions)
Just like the 30 hours free nursery places and local authority social care and ehcp support which doesn't cover the cost of an assistant and NHS dentistry £20000 over three years

@Berlioz23 they really aren’t that complicated there’s a set list of conditions with clear inclusion and exclusion criteria and any community pharmacist should be able to recall medication that prolongs qt and they aren’t prescribing medication they are issuing a set list of common medicines within a set protocol. The issue is whether they have enough experience to do the clinical assessment in the first place

@Wishiwasatailor thats exactly my point though. These conditions aren’t complicated but the flow charts and pgds are too restrictive. So you’re having to look through reams of paper to check you can actually prescribe the thing you know the patient needs and it’s been rushed through so pharmacists who work full time haven’t had the chance to remember them from memory.

@Wishiwasatailor i know pharmacists should know what medications prolong the qt interval, I clearly reference a pp who said if pharmacists only follow a flow chart any ton dick or Harry could do it. I clearly meant a member of the public couldn’t and shouldn’t do it.

@Berlioz23 the reasons that they are so restrictive is to minimise the risk of misdiagnosis as pharmacists don’t have the clinical training to know the differentials or a more serious ongoing problem. For example a recurrent uti that has been treated twice needs to be investigated further.

@Wishiwasatailor great example! So I could give nitrofurantoin to a woman who’s had 2 in 6 months and 1 week but not 5 months and 3 weeks. What if the one in a longer timeframe had a niggling pain what they’d put down to their IBS and the woman in the shorter timeframe it was a complete different infection. I maybe bias but I’ve always been against PGDs, if you’re going to let a HCP give a POM, yes issue guidance like a NICE guideline GPs have to follow but they don’t let you use your clinical judgement so there’s no nuance, which I believe is dangerous in itself. And I’m afraid it’s obtuse to say pharmacists can’t determine differential diagnoses and red flags, we’ve been signposting patients for years when we know we need to refer.

Press release: 31 January 2024

Over 10,000 NHS pharmacies begin treating people for common conditions

https://www.england.nhs.uk/2024/01/over-10000-nhs-pharmacies-begin-treating-people-for-common-conditions/

Patients in England will be able to get treatment for seven common conditions at their high street pharmacy from today without needing to see a GP, as part of a major transformation in the way the NHS delivers care.

More than nine in ten community pharmacies in England – 10,265 in total – will be offering the ground-breaking initiative, with the health service making it easier and more convenient for people to access care...

Couriered? Don't they do electronic prescriptions to nominated pharmacies in Scotland?

Well said. The pharmacy I work in has almost doubled the number of prescriptions we dispense in the last two years. In the same time we’ve lost three pharmacists, two of whom have left community pharmacy altogether for non customer facing jobs. We’ve hired and lost six counters staff, all of whom left because of the increasingly hostile and abusive behaviour of customers. Now the government has pushed Pharmacy First on us.

So yes, it will take longer for your prescription to be ready, yes, it is very likely that you will be asked to come back another time. Yes, we may not have all the items you need (hello global shortages!) But please try and remember we are human beings and we are doing our best.

@CurlyhairedAssassin

BritneyBookClubPresident
I use a pharmacy as much as I can for colds/headaches etc to minimise use of GP appointments. I'm in Scotland.

The challenge now is my pharmacy is so incredibly busy since COVID. In theory when I collect my prescription which is couriered from the GP to pharmacy it should be ready 3 working days later. It never is, even if I turn up late on day 4 I'll be told to come back in at least 2 hours. They just always seem short-staffed and under pressure. My surgery do not allow prescriptions to be collected in person so having it delivered to a pharmacy is the only option.

I've tried other pharmacies in the area (that do not allow prescriptions to be delivered there) on a walk-in basis for a chat or a drop off prescription they are just as busy.

Couriered? Don't they do electronic prescriptions to nominated pharmacies in Scotland?

No sadly my GP do not do electronic prescriptions. So each working day a van goes to the GP collects prescriptions and drives to the pharmacy to drop them off