The law is the law – but sometimes it is unhelpful and it either should be tweaked or changed to support progress in the health and social care services. It can create huge disadvantage to the population and professionals and massive challenges to the Health and Social Care services and a huge waste of time and resources.
Pharmacists genuinely want to help people. Let me give you some suggestions.
I test someone for chlamydia – hey it’s positive. The obvious response is that I supply an appropriate course of antibiotics – azithromycin or doxycycline perhaps, but I can’t as they are Prescription Only Medicines (POMs). I could ask for a Patient Group Direction (PGD) to be in place, but that is rapidly becoming a nightmare and NICE within their Good Practice Guidance may make this more difficult. It might take four weeks to write, three months to get signed of, six months to get trained in and then some pharmacists move jobs and all is lost – a nightmare.
Oh yes – I forgot the legal stat of azithromycin has changed – I can sell it – what’s the price? Bugger that I will send them to the GP – they can do it! Ha even better I can send them to the GUM clinic – get it free there, but the cost of the open access appointment is £142 and they will probably do a full range of STI tests – they ‘hunt in packs’ don’t you know.
In fact small changes in the Medicines Act may allow me to sell a limited range of POMs to a specified group of patients without the need for PGDs or referrals to hard-pressed GPs. This might be a simple start to overcoming the problems that we face – particularly for those with money in their pocket.
If I was a district nurse, I could complete a relatively straightforward training course to become a nurse prescriber and then prescribe from a limited list of medicines in the Nurse Prescriber’s Formulary. The formulary provides an overview of some common conditions that the nurses are likely to encounter in their routine practice and details of the medicines that they can prescribe. They even have their own NPF that is issued every two years. The irony here is that it is printed by the Royal Pharmaceutical Society Press – you have to laugh.
But I am a pharmacist who sees many people in my pharmacy who have common conditions that I could adequately manage. I could sell them some medicines, but a lot wouldn’t pay for prescriptions so I send them to the GP. There are ‘minor ailment’ schemes around such as Pharmacy First, but they are not widespread and there is a ton of paperwork. I could become an independent prescriber, but that would probably take a year, a lot of time and money and the sponsorship of a GP.
You do realise that a District Nurse can treat Head Lice on the NHS, but a community pharmacist can’t. I have to send the patient to the GP if I don’t have a Pharmacy First scheme in place and they don’t want to pay for the products. I bet the GPs love that!
So why can’t we create a ‘Community Pharmacist Prescriber’ status? Create a relatively straightforward training program which can be integrated into the four year university pharmacy degree and a Pharmacist Prescriber’s Formulary. The formulary would provide an overview of some common conditions that Pharmacists encounter in their routine practice and details of the medicines that they can prescribe. We could even ask ourselves to print it. Give me a prescription pad, tear up the locally enhanced services and the PGDs and I am off and running. The Prescription Analysis tools are so sophisticated now that I can be adequately monitored as to what I am prescribing. The prescription tax is currently so high that people can often buy the products cheaper, but for those who can’t – it just might save a visit to a walk in centre, GP surgery or OOHs provider and a whole lot of inconvenience to patients.
Oh and it will safe a whole forest of trees and thousands of hours of administration time, preparing schemes, writing PGDs and other stuff.
If the government is interested in patients and in reducing bureaucracy then this is a jolly simple solution.