Equity and access to treatments – free at the point of delivery

When you read that a third of patients in A&E and over 57,000,000 GP appointments are for people with common conditions / minor ailments that could be managed by a community pharmacist you must wonder why? Why do people choose to visit their GP or go to out of hours or visit A&E?

“I don’t pay for my prescriptions, there is no point going to the pharmacy, I can’t get an appointment at the GP today so I might as well go to A&E or wait until the on-call doctor starts”

“It’s a child – they don’t pay for medicines”

The “free at the point of delivery” is actually an urban myth. When you visit a community pharmacy for a common condition the consultation will be free, but the treatment almost certainly won’t be.

We spend so much time talking about equity and fairness, but if you have money in your pocket to buy medicines then you could go to the community pharmacy and buy some treatment for your common condition. Sometimes we might be talking about a few pennies for a simple pain killer, but £5 or £7 might be much more than many people are willing or able to pay for a medicine. There is also a general feeling that treatments for a child should be free.

So if you are unwilling or unable to pay for a treatment for a simple condition then you need to see your GP and get a prescription. If you can’t get an appointment when you want it, then roll up at A&E, a walk in centre or wait until the on-call service to kick in.

To put it in simple terms, this is ridiculous, inequitable as treatment is based on willingness to pay and in the long run costs the NHS much more per episode of care.

There has been some progress. A number of minor ailment / common condition / ‘Pharmacy First’ services have been introduced. Just 12% of community pharmacies were commissioned to provide this service during 2010-11. Some of these services included the supply of treatments and some included PGDs to enable supply of prescription only medicines. But they were not consistent in their contents and their ability to supply medicines free of charge.

If I was NHS England I would seek to remove this inequity and introduce a single service model throughout England which every Area Team could commission. I would include as many common conditions as possible and PGDs that would allow a wide range of medicines to be supplied to those who are exempt from prescription charges. And I would communicate it to people in such a way to change the flow of people to A&E or other more expensive NHS services. I would engage community pharmacy and double the options for access to simple treatment within the NHS.

Parallel to this I would change the law to introduce independent community pharmacy prescriber (limited) status in which community pharmacists were able to issue prescriptions in place of PGDs and as a stage in qualifying for full independent prescriber status. This would allow acceleration and reduce bureaucracy and paperwork.

If ‘Pharmacy First’ schemes are based on advise, treat, refer – then I would introduce two important links to support the ‘refer’ stage. Firstly community pharmacists would have direct access to emergency appointment slots in local practices. And secondly the community pharmacy should have teleconsultation arrangements out of hours so patients sitting in the community pharmacy consultation room could talk to GPs in an out of hours service.

If we are committed to equity and access to treatment, then why is ‘Pharmacy First’ not a standard across the whole of NHS England?


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