'GP referral service needs to be urgently implemented'

By Jeremy Meader

At a time of national crisis, when the Government announces the re-structure of Public Health England, to better improve UK ‘health protection,’ it prompts the question, ‘what about any proposed structural changes to primary care access in light of new realities? Are the pre-Covid pharmacy and GP contracts still fit-for-purpose given the changed circumstances we find ourselves in’?

Bold, progressive steps and cash injections are being promised to help protect the UK from future spreads of infection but what about the stoic community pharmacists who have played an outstanding frontline role providing continued access to critical healthcare: not only medication, but also trusted professional health and wellbeing advice at a time when access to GPs and A&E departments were understandably restricted?

It’s not just PHE’s framework that needs to be readdressed – yes, we need to be ready to fight infectious disease – but we need to rethink and reset how we plan, commission and deliver healthcare in England to improve patient outcomes, promote illness prevention, improve access in deprived communities and tackle together, the immense backlog of procedures and appointments created during this global pandemic.

The NHS is facing a daunting task of catching up on postponed procedures and appointments – how will that get resolved? When you merge responsibilities for health protection and prevention, it can cause imbalance – and therefore, the decision to re-structure PHE to focus on ‘protection’ seemingly has its advantages – but here is an opportunity to invest in and restructure other critical pillars of NHS England to help them lead on the ‘prevention’ of ill health and tackling health inequalities.

We need to rethink how integrated care is delivered across professional boundaries, from GPs referring to pharmacy when appropriate to community pharmacy supporting hospital discharge to pharmacy support in care home settings.

And we need funding structures which support that cooperation and coordination rather than encourage service competition. An economically viable GP network is a no-brainer, but so too is an economically viable community pharmacy network increasingly taking the strain off GPs and A&E.

NHS 111 CPCS is a welcome step in the right direction, however the true value of the service remains to be seen as Covid-19 derailed face-to-face consultations.  Much more needs to be done to better ensure we can balance patient demand across GP surgeries, A&E and community pharmacy at a time of unprecedented need. Not least, the stalled GP referral service needs to be implemented as a matter of urgency.

We’ll wait and see what becomes of PHE’s health prevention and improvement functions in the coming months.

Meanwhile, the newly formed National Institute for Health Protection has been given a pathway to meet current and future health protection challenges – so too should NHS patients be given clear, new pathways to provide them with the best advice about who to turn to when they have a concern about their health.