|  Student health may have been compromised by the new GP contract.
It appears that university practices, unlike other GP practices, are
financially
disadvantaged under the new contract because greater emphasis is placed
on the prevalence of chronic diseases that affect older populations.
Granted the vast majority of students are young and healthy and require
little need for medical services. However, their needs are concentrated
in public health and health promotion. University students in particular
are at a vulnerable time in their lives and catering for these needs
now ensures their health in the long-term and reduces the burden on the
NHS in the future.
At the All Party Pharmacy Group meeting held in February at the House
of Commons, pharmacy was viewed as the means for bridging the gaps in
specialist student health services. The pharmacy contract could make
up for the shortcomings in the GP contract, particularly since pharmacy
has a strong role in health promotion and public health, such as smoking
cessation and sexual health. The potential inadequacies in student health
also prompted a House of Lords debate last month.
Survey findings
“Students’ access to healthcare” revealed
that:
· 79 per cent of students (n=1,689) had not applied to the Prescription
Pricing Authority low-income scheme for financial health care support
· Over a quarter cited an over-complicated application procedure
as the reason why they had not applied
· One in seven students does not seek medical help when needed — 48
per cent said it was because the illness was not serious enough
while 13 per cent said it was because of fears about the cost
· Students most commonly forgo treatment for influenza and respiratory
problems, injuries and accidents and mental health problems
· One in 10 students are not registered with a doctor either at
home or in their area of study
· 52 per cent of students do not know if they qualify for free
prescriptions, 59 per cent for free dentist treatment and 51 per
cent for free eye tests |
However, even if medical
and pharmaceutical services to students are strengthened, there is no
guarantee that students will use them. The
National Union of Students believes students are missing out on health
because of worries over cost. National Union of Students health campaign
co-convenor Helen Symons says the statistics provided by the web-based “Students’ access
to healthcare” survey, published on 4 March, are worrying (see
Panel). ‘‘This survey shows that there is a clear need for
students to be informed of their rights regarding current health care
cost exemptions and how to access health care services in general. With
so many students missing out on the support they are entitled to, the
Government needs to simplify the system and remove the red tape that
is currently putting students off applying to what is their right to
receive. Costs and complications should not act as barriers to students
accessing health care.’’
The NUS is now calling on the Government to exempt all full-time and
part-time students from all health care costs, regardless of age. In
the meantime, it is urging all students to check what they are entitled
to. GP contract shortcomings
The British Medical Association’s General Practitioners Committee
met GPs from university practices, including representatives of the British
Association of Health Services in Higher Education, to discuss how students
health services can be maintained.
The shortcomings of the GP contract in the provision of medical services
for students were highlighted. First, a practice with large numbers of
university students would generate a much smaller global sum compared
with many other similar-sized practices because the practice population
is relatively healthier and younger. Secondly, the points system in the
new contract’s Quality and Outcomes Framework (see PJ,
6 March, p284 PDF (50K)) works against practices catering for students because
more points
are awarded to practices with a prevalence to a given chronic disease
area, for example, coronary heart disease, rather than the patient list
size.
More positively, the BMA recognised an opportunity for university practices
to obtain funding by tendering for some national enhanced services, such
as specialised care for depression and sexual health, and local enhanced
services, such as a sports injury service or prophylactic care following
a meningitis outbreak. However, many primary care organisations have
been slow to commission such enhanced services and the BMA has seen little
evidence that university practices are being resourced in this way.
The BMA is concerned that the finances of university practices will fall
relative to their colleagues and that these important services will suffer,
leading
to an adverse effect on the health of their university populations. Opportunity for pharmacy
On-campus pharmacies is the most obvious way of making up any shortfall
in services provided by university practices. However it may not be
the most financially viable for a pharmacy proprietor, according to
Noel Wicks, who co-owns Campus Pharmacy at Stirling University. Testament
to this is the fact that there are only three or four other university
pharmacies that he is aware of and all of those only operate on a part-time
basis.
A campus pharmacy works best when the university and student accommodation
are out of town, and remote from local amenities and community health
services such as local pharmacies and GP practices, says Mr Wicks. Generally
this does not happen: usually students can readily access pharmacy and
other health care services in the local community.
Mr Wicks believes a better approach would be for community pharmacies
in the vicinity of a university to have specific arrangements for dealing
with the particular health needs of students. These pharmacies could
work together and potentially lodge a joint bid with the primary care
trust for a specialist student service under a local pharmaceutical services
scheme.
A student-focused approach is what Campus Pharmacy takes. Mr Wick explains: ‘‘In
our pharmacy 90 per cent of our patients are aged 17 to 24 and the majority
of our prescriptions are for travel vaccines and oral contraceptives.
Their needs are very different from those of a local community and this
allows us to focus on providing different services.’’
Mr Wicks says pharmacy often overlooks the young. However, health promotion
and early intervention, such as getting someone to quit smoking at 21,
is a worthwhile investment. ‘‘Our pharmacy is often students’ first
introduction to the health service. I view the time we spend with them
as an investment in their health and in pharmacy as a whole because it
sets up a good relationship for the future,’’ says Mr Wicks. |
The
Pharmaceutical Journal