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Opinion Primary Colour

Helen Salisbury: Pharmacy First and the new GP contract offer—moving deck chairs on the Titanic

ݮƵ 2024; 384 doi: (Published 06 February 2024) Cite this as: ݮƵ 2024;384:q295
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}phc.ox.ac.uk
    Follow Helen on Twitter

Finance isn’t really my specialty, but even I can work out that an uplift of 1.9% to the value of the GP contract for 2024-25 won’t cover the bills. Katie Bramall-Stainer, chair of the BMA’s GP Committee for England, has described the offer as “grossly inadequate”1—to which I’d add derisory, insulting, and other less printable adjectives.

The living wage has rightly been increased by 9.8%, general inflation is running at 4%, and energy prices have doubled in the past three years, making it hard not see this offer of 1.9% as evidence that the government actually wants general practice to fail.2 Unsurprisingly, practices are struggling to make ends meet, and many have given up and handed back their contract or are planning to do so within two years.34

We’re told that there’s no money, so in this context it was interesting to hear about the Pharmacy First scheme. Under this programme, pharmacists will be paid to offer their customers consultations on seven simple conditions.5 The hope is that this will relieve the pressure on general practices and give patients easier access to treatment.6 However, it’s been calculated that the average payment per consultation under this scheme will be significantly more than that currently given to general practice.7 It very much looks as if there’s no money to help GPs see more patients but that it can be found for pharmacists to offer appointments more expensively.

The scheme may bring practical problems. I hope that these will have been ironed out in appropriately evaluated pilots, although I haven’t found any reports of these. There’s already a shortage of pharmacists in community pharmacies (many are now employed directly by general practices and primary care networks), so it’s difficult to see how those who remain will find the time to do these consultations.

Making sure that antibiotics are given only when clearly indicated—often in the face of patients who are very sure that they need them—can be hard even for experienced GPs, so training in skills for this antimicrobial stewardship will be required. Although we may imagine our local pharmacist managing to squeeze in consulting around their current dispensing role, in reality it seems likely that the big players running pharmacy chains will dominate, most likely by developing remote services (which is permitted for all the proposed seven conditions except otitis media, which requires otoscopy).

I’m not suggesting that this new scheme won’t help—it might—but there’s a definite “moving the deck chairs on the Titanic” feel to its arrival, at a time when general practice is in crisis. And while the band plays on, patients may feel as though they’ve been roped into a game of musical chairs on a sinking ship. Everything is in flux until the music stops and they discover, once again, that services have been reorganised, and it’s now even harder to find an appointment with someone appropriately qualified to help.


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  • Provenance and peer review: Commissioned; not externally peer reviewed.