Private GPs warn patients about Sunak’s “Pharmacy First” scheme

Two Merseyside GPs are warning patients to think carefully before starting antibiotics prescribed by pharmacists. When Knowsley MP Sir George Howarth asked the Prime Minister 3 weeks ago if he supported NHS England’s “Pharmacy First” scheme, Sunak agreed that pharmacists “can do more for us over time“.

Formby GP’s Dr John Cosgrove and Dr Heather Ryan welcome the government’s latest idea for taking pressure off NHS GPs. In many areas, including Southport and Formby, chemists have been able to prescribe medication for common conditions. Since April, community pharmacists in Merseyside and elsewhere have been able to repeat prescriptions of the contraceptive pill.

“Pharmacy First” goes a step further, and promises to begin rolling out to pharmacies nationwide by the end of 2023 the ability to prescribe antibiotics for sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections.

Dr Cosgrove, who has been a GP for 20 years, agreed that impetigo, shingles and urinary tract infections should be easy for pharmacists to diagnose and prescribe appropriately so long as they follow guidance from Public Health England.

Dr Ryan pointed out that sinusitis, sore throat, and earache usually get better without treatment. She warned that antibiotics taken for these conditions can cause more harm than good. “Furthermore, insect bites often flare up badly for a few days, people fear they are infected, but they clear up all by themselves. It can be difficult to tell whether an insect bite is infected and needs antibiotics.”

Common side effects of antibiotics include diarrhoea, vomiting, rashes, suspected allergic reactions, and thrush. Dr Cosgrove warns that patients are more likely to have side effects than to benefit from antibiotics prescribed under Sunak’s plan.

“We also know that if people are prescribed antibiotics unnecessarily for such illnesses, they will – quite understandably – come back sooner next time for the same unnecessary treatment again. There is a real risk that Sunak is opening the taxpayer up here for a totally unnecessary blank cheque.”

The two private doctors, encourage anyone concerned about taking antibiotics prescribed by their pharmacist to consult their GP. Dr Ryan explained, “experienced GPs are second-to-none at advising whether an illness is likely to settle on its own, and what to do if it doesn’t. It’s what we do!”

Dr Cosgrove added: “when working as an NHS GP, I am painfully aware that many patients believe that I withhold tests, treatments and referrals to save me money. This is laughably untrue! So much so, that Heather and I decided to set up Formby GP. In private practice, there genuinely is a temptation to test and treat more so as to generate fees and encourage repeat business. To head this off, we are crystal clear that Formby GP will be ‘ethical’: we will only recommend tests, treatments and referrals if they are appropriate.”


Treating obesity could save NHS money

A private GP sugery in Formby offers help as new research reveals that obese patients cost the NHS twice as much as non-obese patients.

Dr John Cosgrove, Clinical Director of Formby GP, suggested that no-one would be surprised that obesity comes at a cost not only in terms of healthcare but also individuals’ wellbeing. “It is not that people who are overweight do not want to lose weight – it is just that it is really hard to do so. Our appetite dictates so strongly how much most of us eat that it takes a great deal of effort to diet by willpower alone.”

Formby GP, run by Dr Cosgrove and his wife Dr Heather Ryan, offers specialist weight management services. Dr Cosgrove said, “It will be very difficult for NHS weight management services to expand to meet the need. I believe that private weight management clinics such as our own have a great deal to offer. This research suggests that we could help our patients save the NHS money.”

Dr Cosgrove explained that they work in conjunction with diet counsellors, support groups and personal trainers to offer medical support for weight management over and above lifestyle changes.


DNACPR orders

Two Merseyside GPs have expressed their concern following the BBC report on “do not resuscitate orders”.

Formby GP’s Dr Heather Ryan was appalled to hear that an ambulance service had refused to respond to a care home resident simply because his doctors had advised against treatment after cardiac arrest. She said: “Just because CPR is not likely to be successful does not mean that we should not make every effort to intervene to prevent a person from needing CPR!”

Dr John Cosgrove, Formby GP’s other doctor, explained their surprise when setting up their practice to hear that services in Merseyside do not accept the standard ReSPECT form produced by the UK Resuscitation Council and used in many other parts of the UK. This is a standardised form for doctors to use when making recommendations about treatments likely to be in a patient’s best interests should their condition suddenly deteriorate. “Whether CPR is likely to be successful is a medical opinion like any other treatment recommendation,” he explained. “It’s also really helpful to be able to set out on such a form whether a patient would want other emergency treatments such as emergency hospital admission or being put on a life support machine.”

“People dying in Merseyside are being put at risk of treatment that will do them no good, for lack of a standardised form,” he said.

Dr Ryan added: “We have even been warned that our advice might be ignored by paramedics if we use the wrong colour paper! All we want is to support our patient’s wishes to live with dignity even in their last days.”

Formby GP is a private GP surgery in Formby. They offer traditional cradle to grave care. Since they opened in January 2023, they have diagnosed terminal illnesses in patients who found it too difficult to access NHS General Practice, including one in the last days of their life.

Dr Cosgrove remarked that they found it truly an honour to be able to support people so unwell. “I just hope that we can simplify the process of advance care planning in Merseyside and, preferably, nationwide, so that more people receive the dignity they deserve and care they need when they are at their most vulnerable.”


Know your patient before testing for ADHD!

As BBC’s Panorama investigates the reliability of online ADHD diagnoses, two private doctors in Merseyside say this is an unfortunate example of why diagnostic tests should only be arranged if recommended by an experienced clinician.

In this case, the tests in question were questionnaires or structured interviews, potentially just as misleading as high-tech scans of those with no symptoms of physical illness.

When they set up Formby GP, a private GP service in Formby, these doctors were keenly aware of the temptation for private doctors to sell unnecessary tests and treatments. They describe Formby GP as ethical because they explicitly strive never to recommend unnecessary tests and treatments. They argue that GPs can really help patients by recommending referrals only after excluding other explanations

Formby GP’s Clinical Director, Dr John Cosgrove, worries that it can be difficult for those that are not doctors to recognise good clinical practice. “Panorama compared ‘mystery shopper’ style consultations with online clinics to a consultant who had explicitly invited television cameras in. Panorama rightly referred to NICE guidelines. Guidelines, however, are not protocols, and are often simply the opinion of one particular panel of experts. It would not be appropriate for clinics always to follow guidelines blindly. This is really difficult for regulators such as the Care Quality Commission, whose approval of services could be mistaken for endorsement of the quality of clinical care, rather than just governance processes.”

Dr Heather Ryan, Managing Director, explained that they started Formby GP so as to be able to offer unhurried face to face consultations to anyone that wanted it. She enjoys getting to know her patients in person, which also provides so much more information than an online chat.

Dr Cosgrove said, “Around 5% of children are believed to have ADHD. Left untreated, it can significantly impact upon a child or adult’s life, so it’s great news that there is more awareness of this condition now, and various effective treatments are available. On the NHS, it can be hard enough to get an ADHD assessment for a child; in adults it is almost impossible. Clinics that can carry out proper assessments are invaluable, and we could use more of them, whether private or NHS!”


Why these local private GPs don’t agree with pharmacy antibiotic plan

As the Government announces its recovery plan for NHS General Practice, GPs at a private surgery in Merseyside have expressed concerns about proposals for community pharmacies to start prescribing antibiotics.

Under the Government’s new plan, pharmacists will be able to prescribe antibiotics for the treatment of certain infections, including earache, sinusitis, and sore throat. Yet evidence shows that, in most cases, antibiotics are not needed as these infections will get better on their own. If antibiotics are taken, they risk causing harm – by increasing rates of antibiotic resistance, or by causing side-effects such as diarrhoea. For this reason, doctors at Formby GP, a private practice in Freshfield, have spoken out against the plans.

Clinical Director, Dr John Cosgrove, says: “As GPs we know that the vast majority of upper respiratory tract infections do not require antibiotics. At Formby GP we pride ourselves on offering our patients whatever treatment they need, based on the highest quality evidence available. As highly experienced GPs, we are particularly concerned by the risks posed by unnecessary antibiotic treatment.”

Formby GP is a private GP service in Freshfield, run by married couple Dr Heather Ryan and Dr John Cosgrove. Heather and John launched Formby GP in January, a private surgery that promises unhurried appointments with a continuity of care. They describe their service as “ethical” because they aim to avoid unnecessary tests and treatments.


Why these Merseyside GPs are branching out into private practice

Two Merseyside GPs have set up their own surgery in a bid to offer face-to-face appointments to people in the area.

Married couple Heather Ryan and John Cosgrove, from Formby, have 24 years’ experience of working in NHS General Practice between them. But recent events and changes have led to both doctors becoming increasingly frustrated at the level of care they are able to offer patients.

For many years, work has shifted from hospitals to GPs, and new treatments have become available that increase the workload for GPs, without additional  funding. At the same time, there has been a political drive to improve access to GPs, and offer telephone, video and email consultations.

These consultations are much less efficient than the old-fashioned 10 minute face-to-face consultation, which they must replace, as there is not the capacity to offer both. This was mandated by NHS England, and coincided with but was not entirely due to the Covid-19 pandemic.

Heather and John launched Formby GP in January. Formby GP is, a private surgery that promises offers a more ethical service, as people can receive unhurried appointments andwith a continuity of care. They describe their service as “ethical” because they will only recommend treatments that their patients need. They take a targeted approach to testing which reduces the dangers of unnecessary treatments. In offering a private service to those who can afford to pay for it, they hope to relieve some of the pressure on local NHS GPs.

Heather, who grew up in Netherton, said: “We came up with the idea of opening a private GP surgery as both patients and doctors grow more annoyed with the status quo. We both love the essence of General Practice but are put off by the challenges of delivering good care in the underfunded NHS system.

“Because patients are paying for our time, we can offer 30 minute face-to-face appointments at a time that suits them. We can also offer referrals and treatments when these might be discouraged or difficult to access owithin the NHS.”

Heather and John, who both still work in the NHS part time, say that as patients choose to use Formby GP, this will free up more NHS appointments for others.

John added: “Despite political promises, GPs have been driven out faster than the government has replaced them. NHS general practice has now reached a tipping point; there are truly not enough GPs. While some practices are undoubtedly doing a fantastic job, it seems unlikely that NHS GP can ever again meet patient expectations.

“There has long been a market for private healthcare, just as there is for private schools, and even privately owned cars as an alternative to public transport. We haven’t moved into the private sector with the intention of undermining the NHS, on the contrary, we hope to take some pressure off local NHS practices by offering an alternative for those who choose to use it.

“If our society would prefer there not to be a need for private general practice, it needs to make the necessary political decisions to improve the NHS”.


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