Sir, – Plans by some of my GP colleagues to start dispensing medications from their practices have attracted a rather negative reaction from the Irish Pharmacy Union (“Pharmacists concerned by GP plans to dispense medicine”, May 15th).
This response is inconsistent with its own lobbying of the Government to allow pharmacists to take over the care of people with minor illnesses, prescribe and dispense medications. It had previously been successful in petitioning the Government to allow pharmacists to administer the influenza vaccine. Claiming that taking over some GP services “can only lead to greater efficiencies in the health service” is a rather seductive argument. So what is the evidence?
Pharmacies in the UK joined the GPs in administering the seasonal influenza immunisation last winter. This resulted in an extra 250,000 people being vaccinated; however, there was an increase of 1.2 million in the overall population to be vaccinated, so in reality there was an actual drop in overall uptake rate.
More worryingly, the fragmentation of care caused by pharmacies picking the “low-hanging fruit” resulted in more higher-risk patients either missing their influenza immunisation altogether or else missing out on other important items of care that would have occurred if they had attended their own GP for this service.
In the United States, 2 per cent of primary healthcare is provided by retail clinics attached to pharmacies. This model of care has recently been proven to be associated with a modest increase in overall spending by the healthcare system due to a large increase in activity relating to minor illnesses without any associated population health benefits. Funding nurse-led or doctor-led walk-in centres in the UK, as opposed to frontline general practice, has also been found to make care more convenient for trivial complaints. But this was at a significant cost, and it also failed to effect a meaningful change in the health of the population it served.
Healthcare is becoming more complex with advancing technology and an aging population. More healthcare activity based on a disease-centred model is not necessarily good for the patient or the national healthcare budget.
General practice is best placed to provide timely patient-centred care by a senior clinician who has a personal relationship with the patient. This continuity of care makes GPs the best clinicians at managing complexity, risk and uncertainty when making clinically meaningful decisions in the patient’s best interest. Ireland resources a 24-hour, seven-day a week general practice service with less than 4 per cent of the total public and private health budget, which is far less than in other western countries.
If the Irish Pharmacy Union’s efforts to secure a larger proportion of the primary care funding is successful, it will only serve to fragment care and dilute the effectiveness of general practice, resulting in poorer total outcomes for patients and the national health budget. – Yours, etc,
Dr WILLIAM BEHAN,
Walkinstown
Primary Care Centre,
Dublin 12.