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The contribution of pharmacists working in general practice is about to rise sharply. Under the new GP contract, there are plans for thousands of pharmacists to be recruited by groups of practices under the new primary care networks (PCNs) being formed across England. With more than 6,000 placements expected to be filled by 2024, this is a 250% increase on today’s numbers.
These new pharmacists will join the ranks of those transferred from the current NHS England ‘clinical pharmacist’ scheme, with a remit to cover all practices in their area, managing patients with chronic diseases, undertaking medicine reviews and proactively tackling polypharmacy.
This will see GP pharmacists steadily building on the good work they have already achieved, improving patient safety, boosting capacity and enhancing patients’ quality of life. If this comes to pass, pharmacist expertise will be embedded in primary care in a way that would have been thought impossible just a few years ago.
But there is a sizeable group of pharmacists who will be left out of this exciting development. Despite working in general practice — sometimes for many years — they are likely to be relegated to the bench, watching as others are allowed onto the pitch.
NHS England regulations stipulate that PCNs will only receive national funding, worth £37,810 in 2019/2020, for each new pharmacist they hire if they can prove the post is “additional” — above the baseline number of those currently working in a GP practice. Those on the current NHS England scheme are exempt from this requirement and can be transferred over before 30 September 2019, but GP pharmacists who are not employed under this scheme cannot.
In practice, this will block many experienced GP pharmacists from applying for PCN positions. There are no definite numbers in the public domain showing how many GP pharmacists this will affect, but NHS data indicate that 349 pharmacists were working in general practice before the NHS England scheme was introduced in September 2015. Despite the scheme now operating, it is possible that hundreds of additional GP pharmacists have been hired outside of this scheme by practices acting independently.
The Pharmaceutical Journal raised the issue with NHS England and asked for clarity about the role of these pharmacists in PCNs. NHS England responded that its intention was that all staff will benefit from development at PCNs and that it is looking at this as part of the upcoming ‘NHS people’s plan’.
Of course, any GP pharmacist wanting to take up a PCN role could resign their current position and apply for that job; however, under current rules, the PCN would not receive central NHS funding because that pharmacist would not be ‘additional’. Therefore, the PCN would have to fill both the new PCN role and the GP pharmacists’ previous role, with the likely result that some pharmacists will be left in the cold.
These are crucial times for primary care. There are already warnings that the plan to recruit 6,000 GP pharmacists may be unrealistic when current recruitment trends are taken into account. GP numbers are falling, and it cannot be desirable to have a two-tier pharmacy workforce at a time when the most experienced players are needed on the pitch. If there are training gaps, staff should be given the opportunity to fill them, and their considerable on-the-job experience should be taken into account.
We urge NHS England to look again at these reimbursement rules and allow PCNs the flexibility to employ the most suitable candidates for the jobs they are advertising. This would not only be fair to all pharmacists currently working in general practice, but would ensure that GP pharmacists are in positions where they are able to make the most difference.
