The BBC has got it wrong: we are not ‘GP substitutes’

Twitter sometimes lands me in hot water, but my tweet criticising the BBC news article ‘The GP substitute will see you now’ seemed to resonate with many of my peers.

The article, published on 31 January 2019, reported on NHS England’s plan to recruit 20,000 physiotherapists, pharmacists and paramedics to help to relieve pressure on general practice; but, sadly, it did little other than diminish the profile of these professions and may erode the trust that patients have in us.

Clickbait headlines may generate traffic for the BBC, but for professionals building a career in general practice, they do no favours in persuading the general public that we can meet their needs and expectations. This representation in the media serves only to perpetuate the ‘GP-centric’ model of primary care. 

In the mainstream media, there is plenty of coverage of the recruitment crises facing general practice — GPs aged over 55 years account for up to a third of the total workforce in some areas, but I am cautious of the often-quoted mantra that pharmacists in general practice exist primarily to ‘relieve pressure’ on GPs.

We will indeed be seen as ‘GP substitutes’ by practices if our particular skill set is not recognised and used appropriately. Pharmacists’ training and expertise are invaluable in the promotion of the safer use of medicines, which can reduce inappropriate polypharmacy and prevent combinations of medicines that may lead to hospital admissions. As the population ages and as the number of people living with multiple long-term conditions increases, the use of multiple drugs increases, as well as the risk of drug­–drug, disease–drug and person–drug interactions.

As the only pharmacist in a building containing two GP surgeries (not including the community pharmacy), with a combined list size of nearly 20,000 patients, it is important that I don’t take on work that could be done equally well (if not better) by other professionals. I instead concentrate on areas where I can add the most value.

We need the right professional for the right job. For musculoskeletal problems, this would usually be a physiotherapist and, for most long-term condition management in general practice: a nurse. Medicine reviews and the promotion of safer use of medicines should surely be undertaken by a pharmacist.

Some members of the public will only ever see pharmacists as GP substitutes, no matter how hard we work to raise our profile

At the moment, I spend around half of my time in face-to-face consultations with patients and the other half doing ‘administrative’ work — medicine reconciliation from discharge summaries, actioning safety alerts, and running searches to identify patients on high-risk drug combinations or who are prescribed a large number of medicines to target for review. I do not see any acute presentations at the moment; I do not feel equipped to do so, especially when there are other clinicians available with a more suitable skill set. However, I would like to expand my scope once I have acquired better physical assessment skills.

This kind of pharmacist involvement in multidisciplinary working has been commonplace for years in hospitals, yet it is still in its infancy in primary care. The funding available to practices as part of the ‘General practice forward view’ to recruit ‘clinical pharmacists’ has no doubt helped the rest of the healthcare system to understand the value of pharmacists, although it remains to be seen what will happen once practices must fund the roles entirely themselves — many roles have been advertised on a fixed-term basis.

A survey commissioned by the General Pharmaceutical Council in 2015 demonstrated that trust in pharmacists is high, and that the general public is largely aware of pharmacists’ knowledge; however, there is still some work to do to encourage the public to trust advice from pharmacists to the same extent as advice given by a GP.

Perhaps some members of the public will only ever see pharmacists as GP substitutes, no matter how hard we work to raise our profile. However, many of my colleagues will have come across enough patients who have valued our input to outweigh ill-informed BBC headlines that misrepresent the additional expertise we bring to general practice.

Tom Gregory, clinical pharmacist, New Court Surgery, Weston-super-Mare