Unintended consequences
It is the unintended consequences that tend to scupper the best-laid plans. The provision of out-of-hours primary health care services is a case in point. It has been suggested that when patients found out that GPs would no longer have to provide an emergency service under the terms of their new contract, they thought there would be no GP-provided out-of-hours service at all. As a result, accident and emergency departments have reported increasing numbers of inappropriate attenders. This problem may have been further compounded by the departure of numbers of A&E doctors in recent months — attracted to general practice by the improved terms and conditions of pay.
There now seems to be a further potential strain on out-of-hours services,
with the announcement of the details of the new community pharmacy contract.
Contractors, it seems, will be able to choose which hours in the week
they open their pharmacies — provided they stick to the hours they
stipulate (p669). This may mean that pharmacies that have close relationships
with particular general practices that are no longer open on Saturday
mornings may choose not to open on Saturdays as well. So patients wanting
some speedy advice or who have a minor ailment that requires treatment
may also turn up at A&E.
However, unintended consequences also provide opportunities. Some pharmacists
have already started to become involved with the provision of out-of-hours
services for primary care trusts. Other pharmacists may realise that
there could be benefits from opening their premises on Saturdays: even
if dispensing is limited, they may, for example, be able to offer prescription
reviews or smoking cessation consultations — at times some patients
will find more convenient than during the working week. And if, in a
particular area, pharmacists are reluctant to open on Saturdays, primary
care trusts may find that they have to make special arrangements with
certain pharmacists in order to ensure that there is a limited primary
care service.
We would like to think that the Government had anticipated all this upheaval
in the out-of-hours service and had planned changes so that what was
no longer being offered by one profession could have dovetailed with
new services offered by another.
The provision of out-of-hours services is special because they are universal.
However, if there is a moral for pharmacists to this tale it is this:
find out what the primary care organisation is finding difficulty in
providing, and see if there is a way that your pharmacy can offer part,
if not the whole, of a solution.
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