Primary care networks are bonkers. It’s old thinking, old ways of failure and old strategy, says Sid Dajani…
There's a little-known fable by the Russian Ivan Krylov who in 1814 chronicled the tale of The Inquisitive Man.
In it, he describes to his friend the detail of a visit to a natural history museum. He speaks of a multitude of things including the most amazing colourful birds and the tiniest of insects... some no bigger than a pinhead.
'Did you see the elephant...' the friend enquires?
'What elephant?’ comes the reply.
That is where we get the phrase the elephant in the room. Something so big, no-one sees it.
The NHS has an elephant in every nook and cranny – whether in secondary care like the wards, operating theatres, out-patients or in primary care, such as social care, community pharmacy and GP practices.
The elephant? The workforce and stinkin’ thinkin’ when dealing with workload problems. We don't have enough workforce or any realistic prospects of getting near capacity and we are using the same old idioms of dealing with growing demand.
The only way to alleviate NHS hospital measures is to keep people out of the hospital, the only way to ensure GP workloads are manageable is to spread the workload.
That means utilising the potential of community pharmacists to ensure value for money, better public access and without compromising health. Making sure we are both the gateway to NHS services through service and referrals as well as the gatekeepers of local NHS resources.
Healthcare is not just the sum of the patient’s conditions or medicines; it requires a holistic approach which in turn requires professional medical knowledge. It is a truth universally acknowledged that community pharmacists in pharmacies are the answer to meeting a gigantic amount of public health, clinical and medical demands.
Bringing simplicity to complexity and selling something that we all believe in: ensuring integrated pharmacy services are part of holistic healthcare for patients at all levels.
If we agree the purpose of community pharmacy is the safe and effective supply of medicines, while also ensuring medicines are optimised for the individual and that patients are supported to get the best possible outcomes from their medicines.
If we agree that pharmacy has a key role to play in improving the public’s health as it is a point of contact for those who are generally in good health but could benefit from a better understanding of elements that could cause ill health in the future.
If we agree GPs are in a dire situation where patients wanting to see a GP are finding it very difficult and receptionist staff are constantly having to apologise. That GPs are generally never able to meet the needs of that day, finishing exhausted after sometimes a 14 or 15-hour day and having to come in the next day.
Then how can we agree that reducing patient access by withdrawing further services from community pharmacy, diverting crucial public funding after years of underinvestment away from the patient coalface and sending more patients to the surgery will NOT address the problems or the elephant in the room?
The response from the Department of Health and Social Care is the primary care network. It’s bonkers. And it will result in more bonkersness!
It’s old thinking, old ways of failure and old strategy. It’s encouraging yet more GP-led organisations, bureaucracy and funding more services at the surgery. The only thing new is the costly repackaging and marketing.
When the community pharmacy contract came into being, the idea of enhanced services was to dovetail into the GP contract and encourage multi-disciplinary working. It failed.
GP-led commissioning right across the boards – PCGs, PCTs, CCGs, HWB – have failed.
"The Royal Pharmaceutical Society seems to only want to be a member-led organisation at election and subscription time and a quasi-governmental body by default. It cannot continue to survive with its growing number of dissatisfied members nor ignore the increasing numbers of non-members."
Despite the widespread evidence of benefits delivered by community pharmacists being picked up by STPs and locally enhanced services and translated nationally, they failed.
Surgery-based pharmacists liaising, referring and working seamlessly with community pharmacists have also failed.
And the current proposals are only going to result in more bureaucracy for overworked GPs and surgery staff including surgery-based pharmacists, thus spending less time on clinical services, further exclusion for community pharmacists and contractors, wasting more resources on unproven stinkin’ thinkin’, divert more crucial funding away from clinical community pharmacy and make surgeries the hub, rather than pharmacies where more patient interaction takes place.
There is no capacity planning because technology and multi-disciplinary teams are expected to be the panacea and the answers to everything, but I disagree.
They are only great tools and as with any tool they are only useful, useable and successful if used properly. That can only happen if we do two simple things.
First, we must ensure we have stronger and ambitious pharmacy organisations, united and undivided and I especially include, above all, the Royal Pharmaceutical Society, which seems to only want to be a member-led organisation at election and subscription time and then a quasi-governmental body by default.
It cannot continue to survive with its growing number of dissatisfied members nor ignore the increasing numbers of non-members.
Secondly, we must remove the institutional cynicism the Department of Health and Social Care has consistently portrayed.
Apart from very powerful GPs at the top table, the problem is pharmacy has the same powerful people of influence, making strategic decisions up on high who are far removed from the interface of patient care.
I include the obvious pharmacy civil servants and those on regional groups who have no, old or very little community pharmacy experience, telling us what we need to do.
The old adage about pharmacies’ failures centering on not speaking with a loud enough voice, lacking an evidence base or poor marketing is utter rubbish. Red herrings designed to divert finger-pointing at the real problem. Poor decisions cannot lie at the feet of ignorance by the decision-makers. Today, there is nothing we can't find out by lunchtime.
Google has unlocked a world of knowledge. Our problem... we don't know what we don't know... but we do know how to find out.
These days, ignorance can only be lack of curiosity, laziness, wilful ignorance or deliberate deafness. It’s that simple and nothing like as complicated as solving the Riemann hypothesis or devising a comprehensive mathematical theory of optimal processes.
Unless the powers that be all suffer from didaskaleinophobia then they should all visit schools of pharmacy to learn about our foundation training and skills and then pharmacies to see theory turned into practice and investment turned into positive outcomes.
Only then will we have hubs being in the community, specialist patient-based clinicians, aka community pharmacists, ensuring we have care wrapped around the patient in a holistic approach and realise expected high satisfaction-based outcomes.
Platitudes and gratitudes and spin with grin only have currency with MPs whose words don’t match their actions. Warm words do not improve patient care or save lives.
Community pharmacy, employees and contractors are the key. Allowing us to lead, involving us right from the beginning at a time when the NHS is consumed with quality, staff morale, recruitment and treating people better... should hit the spot.
And you don’t need to look hard for the elephant in the room to see that.
Sid Dajani is a community pharmacist based in Hampshire.
Picture: mphillips007 (iStock)