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2 September 2019
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Our panel of leading PMs discuss how to deal with patients who are reluctant to see a practice pharmacist. Compiled by Kaye McIntosh
We have just taken on a pharmacist to help with treatment reviews and minor acute illness, but some patients are reluctant to see them. Receptionists report that patients are requesting appointments with ‘a proper doctor’ instead. How do we respond?
Daniel Vincent advises:
If patients are asking to see ‘a proper doctor’ it sounds like the sales pitch is wrong; these clinicians aren’t doctors at all! But it’s no wonder patients are confused. For the past 30 years, what they saw is that the doctor writes a prescription, while the pharmacist takes the box off the shelf, puts it in a paper bag and hands it over. Now suddenly the pharmacist can discuss, diagnose and prescribe.
It is helpful to introduce your clinical pharmacist, explaining they are experts in medicines, who have enhanced training and that they can qualified to prescribe to help resolve the problem. Be prepared to spend time providing reassurance.
It would be helpful to have a prepared script. This could include the fact the doctors employed the clinical pharmacist to do just this work to free them up to help people who need the specialist skills of a GP.
Raising the profile of clinical pharmacists is going to take some time. Try a range of ideas to introduce your new team member and their role. Your pharmacist could create a series of videos showing off their skills, for instance, explaining what to do when you think you have a UTI.
Daniel Vincent is PM and Managing Partner at Ryalls Park Medical Centre, Yeovil, Somerset
Kay Keane recommends:
We have had this very problem after employing both a nurse prescriber and a physician associate. We found that by stopping telling patients who they are seeing and re-phrasing it as ‘I’ve booked you in with a clinician on…’ works really well. Once the patient has had a successful consultation with the clinician that barrier has been removed and we now have patients asking for the non-GPs by name.
It’s surprising how word of mouth will soon have your population praising the great work of the extended clinical team.
Kay Keane is PM at the Alvanley Family Practice in Stockport, Greater Manchester
Nick Nurden says:
This is a common problem. Many patients still think the GP is the be all and end all and anything else is a fob off! But it does improve – at our practice many patients have found that they prefer the time and care that advanced nurse practitioners are able to provide and now ask for them over a GP. However there are still a few patients where the battle goes on. You could:
• Produce a leaflet that explains what the qualifications, skills and experience of each member of the clinical team are, what they can treat and how this may be better for their care. Reassure them that the GPs are managing this broader clinical team.
• Your receptionists should use care navigation with your reception team. Explain that their role is now to assess the patients’ needs and direct them appropriately.
• The whole team – especially GPs – should use every opportunity to educate patients.
We have produced a standard letter (see below) that we send to people who have been awkward about seeing our ANPs.
Nick Nurden is Business Manager at The Ridge practice in Bradford, West Yorkshire
Letter to patients
who are rude to non-GP clinicians
I am writing
regarding your recent consultation with one of our Advanced Nurse
Practitioners. During the consultation, you expressed dissatisfaction that you
were not seeing a GP and were rude and derogatory to our colleague.
The idea that a doctor is the only clinician that can deal with a medical problem is extremely outdated, both in general and hospital practice. We are extremely fortunate at the Ridge to include within our skill mix advanced nurse practitioners and physician associates as well as practice nurses and health care assistants.
The advanced nurse practitioners are professionals who have worked within the NHS for many years in areas such as child and women’s health, respiratory medicine and care of the elderly. Without these talented and dedicated clinicians, we could not continue to provide a service and access to appointments, which is already stretched, would be needlessly reduced.
The advanced nurse practitioners have undertaken their further training with us and have then been chosen to work with us due to their superior skills as well as their commitment to the practice and to our community. Any of the senior GPs at the practice would be confident and proud to have these professionals consult with our family members.
We would be grateful if you could consider this when you next consult and that you afford the same respect to all our clinicians as you except them to show to you.