A valued alternative to the GP

The section above showed that there is an overlap between the work of doctors and pharmacists in the areas of diagnosing and advising on minor illnesses, and prescribing

treatments for these illnesses, and that people sometimes choose between the two. Analysis of the data suggested specific factors which sometimes encourage the use of the community pharmacist instead of the GP, and these are the subject of this section. The community

pharmacist as a ‘preferred’ source of healthcare, was mentioned by several lay pharmacy users as well as community pharmacists. Reasons for choosing the community pharmacist were accessibility, approachability, perception of the pharmacist as having more time than the GP, not wanting to use the GP for something too minor and wanting to avoid doctors.

Firstly, community pharmacists are recognised as being accessible because they can be consulted without appointment, unlike the GP:

Well I think if people’ve got minor ailments you would go to the pharmacy, especially as you can’t get an appointment at the doctor’s for I think it’s about three weeks...I would think for anything minor...this would be the first port of call, because there’s always somebody here. (Community pharmacy 1 user J)

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... they want somebody there who’s accessible to talk to, and that’s the one thing we’ve got going for us really, you don’t have to make an appointment usually. (Community pharmacist Q)

Interviewer: ...what would you say is unique about pharmacists...?

Respondent: Er, I think we’re more readily approachable, because with other health professionals you’ve got to make an appointment to see them, with us you just walk in, and you can talk to a pharmacist, and I think we’re just more approachable...I’d say that was the main difference between us. (Community pharmacist T)

Lay clients may choose to consult the pharmacist because they think they will give them their time:

That they’re approachable, that they were happy to speak with you, that they’ve got the time to do that, which I always find that they have…(Community pharmacy 2, user C)

Indeed, the community pharmacist is sometimes viewed as better in this respect than the GP, both in that they are more engaged listeners, and also more sympathetic to the problem that the client is presenting with:

Well I can talk to these [pharmacy staff] better than the doctor. He’s just on the computer to be quite honest...(Community pharmacy 2 user G)

... usually you can talk to them better, to a pharmacist better than a doctor...Doctors, you try and talk them about something and they just don’t wanna know, I’ve got a spine problem... went to the doctor’s, they just fob you off…say, ‘well you’re on pain killers’. At least when you come to the chemist they might not be able to give you anything but they’ll listen to you, give you a bit of advice if they can, doctors don’t...(Community pharmacy 2 user K)

This community pharmacist’s understanding of the same issue corresponds closely with that expressed by the lay users above:

Sometimes they just don’t wanna go to the GP cos he’s, ‘’can’t be bothered’. They just fob me off in five minutes.’ Whereas a pharmacist has got the time...(Community pharmacist S)

Similarly, in the community setting, this GP acknowledged that people may not always want to consult the GP, and the pharmacist may sometimes be a preferable alternative. She also points out the potential for user anonymity at the community pharmacy, where users can obtain treatments without having to book an appointment, and she mentions that they can ‘pick up’ what they need, which implies that their visit to the pharmacy, and any encounter with the staff there, will be brief:

...sometimes as a starting point before people even reach the GP, because you know lots more people go to the chemist than would come to the GP, you [have to] make an

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appointment to come and if you don’t like doctors or nurses...or you’ve got a phobia you wouldn’t bother to make an appointment, whereas you can walk into a pharmacy, pick up whatever you wanted...(GP E)

This community pharmacist provided an interesting anecdote, which encompasses the issues of the lay user seeing him as logistically accessible, and also ‘less busy’ than the doctor:

...[a client] came in to me many years ago and said...‘Hope you don’t me asking you see, but I’m asking you because the doctor’s so busy.’ So the inference was that we’re not as busy as the GP, therefore she could take my time and it wouldn’t matter quite so much. That could say in a way she felt the doctor more important, but in another way it was quite a compliment in that she felt she could approach me...It didn’t bother me, it just sort of amused me a little bit. But it led me to think that you know some people, they don’t feel they can ask the doctor often because of time constraints, whereas they could ask the pharmacist so they do perceive us as being more accessible and approachable, because of being under less time pressure. (Community pharmacist P)

This quote from a lay pharmacy user suggests that he will perhaps wait to ‘bother’ a doctor until he knows that the complaint is too serious for the pharmacist to deal with:

... I’ve got two little kids so if there’s something wrong with them I’ll come in and say ‘the eldest one’s woken up and he’s got this that and the other, is there anything you’ve got for that?’...so I tend to come here for that and then bother the doctor, sort of use it for a first port of call...(Community pharmacy 3 user A)

This lay user denotes the pharmacist with an ‘in-between’ role in her system:

I just see a pharmacist as...like a buffer zone in-between...doctors and checking out yourself online. (Hospital pharmacy user G)

Interestingly, this lay user reflects that while the pharmacist can certainly be a convenient source of medical advice for people such as herself, she is not sure whether this is what they are ‘supposed’ to do.

…sometimes it’s easier to speak with them, and then they’ll suggest if you do need to go to the doctor’s. But whether it’s fair on them I don’t know...I don’t know that’s if that, the role they play, their official role. (Community pharmacy 2, user C)

7.2.5

Summary and comments

This section has presented the concept of the pharmacist as a clinical practitioner. Clinical work was considered to be defined by several factors: having information about the patient’s

condition, which allows the treatment to be matched to the individual patient, and being integrated into the clinical team. Both of these were mentioned several times by pharmacists, and there was an inter-sector difference, with hospital pharmacists describing working at the

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individual patient level, with access to detailed information about their condition, and being integrated into the health care team in the hospital, while generally community pharmacists were seen to have less information about patients and also to be less integrated. These issues were raised by pharmacists and by doctors. Some doctors took the view that pharmacists did not examine patients, and both they and some lay users cited this as a factor which

differentiated pharmacists from doctors. However, reports from other lay pharmacy users and from pharmacists, provided evidence that community pharmacists did actually examine physical symptoms, and ‘diagnosed’ conditions and ‘prescribed’ over the counter treatments.

The community pharmacist as a ‘preferred’ source of healthcare (over the GP) was mentioned by several lay pharmacy users as well as community pharmacists. Reasons for choosing the community pharmacist were accessibility, approachability, perception of the pharmacist as having more time than the GP, not wanting to use the GP for something too minor and wanting to avoid doctors. This seems to be a complex area and on every point mentioned there was variation in the views expressed.

7.3

The social carer