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DH alarm over pharmacy drugs access scheme

Exclusive: The Department of Health has requested talks with pharmacy leaders after they gave the green light for the national roll-out of a scheme giving patients access to a wide range of medicines without a prescription.

The National Pharmacy Association (NPA) scheme will be offered to 12,500 pharmacies and would see patients given access to 16 medicines without a prescription, including salbutamol inhalers, trimethoprim and sildenafil.

The DH said it wanted pharmacists to consider if the inclusion of antibiotics was ‘absolutely necessary’ amid fears it could put strategies to combat increasing antimicrobial resistance ‘at risk’.

The GPC also raised grave concerns about the scheme, which will allow pharmacists to dispense prescription-only medicines under a patient group direction (PGD).

The NPA scheme has been piloted by the Day Lewis Pharmacy chain since October, but will be offered to all 12,500 NPA members from January.

Before signing up to the scheme, pharmacists have to obtain additional training online.

Patients will be able to obtain medicines after completing an online medical questionnaire and having a face-to-face consultation with the pharmacist or using a walk-in service.

The NPA says there have been no adverse events in the pilot so far and that all the official guidelines on non-NHS PGDs were followed in the development of the scheme, even though official guidance from the Medical and Healthcare Products Regulatory Agency urges ‘particular caution’ when issuing PGDs for antibiotics.

Deborah Evans, NPA director of pharmacy, said ‘robust protocols’ would be in place.

She said: ‘The service is all about improving access to self-care and increasing patient choice, without compromising quality.’

Kirit Patel, chief executive of Day Lewis Pharmacy, said: ‘The service is convenient, and will make the most out of pharmacists’ skills as experts in medicines while freeing up GPs’ time.’

But after being alerted to the scheme, a DH spokesperson said the chief pharmaceutical officer, Dr Keith Ridge, was requesting a meeting with Day Lewis Pharmacy and the NPA to discuss the plans.

‘Decisions about treatment should be based on an assessment of a patient’s needs and circumstances,’ the DH said.

‘It is important that if getting medicines from other sources, patient safety is not compromised.

‘Particular caution should be exercised in the use of antibiotics. Pharmacists should consider whether their inclusion in a PGD is absolutely necessary.

‘This will make sure strategies to combat increasing antibiotic resistance are not put at risk.’

Dr Bill Beeby, chair of the GPC clinical and prescribing committee, said: ‘PGDs of this nature are not allowed in practices – the asthma nurse cannot give out a salbutamol inhaler, despite her training. How can it be safe for pharmacies to sell them after an e-learning module?’

Dr Kevin Gruffydd-Jones, a GP in Box, Wiltshire, who has been involved in the development of several asthma guidelines, said he was ‘very concerned’ at salbutamol inhalers being made available without prescription and warned it was essential safeguards were in place to prevent patients ‘going from pharmacist to pharmacist getting reliever medication alone’.

Earlier this year, the supermarket chain Asda announced it was to dispense salbutamol inhalers under a PGD without a doctor’s prescription.

Click here to read the full list of drugs in the PGD

Readers' comments (23)

  • Bonkers re all but antimalarials !
    Overregulation has stopped pharmacists from doing "patients a favour" and issuing a script to be signed later by local GP patients were local known to pharmacy and the risk was minimal This now falls on OOH So why pay twice!! Your lack of planning is not my emergency Most practices will deal with stuff like UTIs by phone or email There are WICs etc etc

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  • Vinci Ho

    Do these people know short acting beta agonist like salbutamol IS NOT a disease modifying drug . A well controlled asthmatics , by definition , will require it less than twice a week . So the fact salbutamol can be obtained more easily can have the danger of masking the reality of a poorly controlled asthmatics.
    This is a common problem we face everyday. So we have to presume that pharmacists know how to deal with this .Yes, go back to see your GP!

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  • Ciprofloxacin !!!
    Where I practice we are under massive pressure to reduce all prescriptions for ciprofloxacin because of the risk of C. difficle. What about antibiotic resistance as well. Who came up with this mad idea ?

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  • I think it's an excellent idea myself , and I hope this scheme succeeds, fed up of seeing pts purely for Viagra , uti abx, and inhalers, and pts with coughs and cold that want abx , I think this scheme will actually reduce the number of antibiotics being issued, and possibly reduce Ae attendances as well

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  • Tom Caldwell

    I wonder what microbiological investigation will be undertaken before prescribing antibiotics...........etc, etc, etc. There seem to be a number of large flaws in this plan so doubtless it will become a reality.

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  • I think it is an excellent idea. It will enable pharmacists to use their skill to maximum and decrease load on GPs.

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  • Vinci Ho,
    You may not be aware that pharmacists receive 5 years of training on everything and anything to do with drugs. So I'm sure we know how to/when to prescribe salbutamol.....probably more so than many GP's that I've come across!

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  • I am a respiratory specialst pharmacist running the Asthma and COPD clinic in a GP practice. I have already written to the Pharmaceutical Journal expressing my opposition to the scheme for community pharmacists to supply beta-agonist inhalers on a PGD. The rate of patient usage of these inhalers can be the clearest indicator of over-use either because of deteriorating control or poor inhaler technique. In eirther case, this needs to be checked out by a competent practitioner. Furthermore, these inhalers can be given out two at a time! Why for Heaven's sake? ££££££!

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  • If this scheme is only being piloted by the Day Lewis chain then why is my local NORCHEM pharmacy selling sildenafil and salbutamol inhalers now? They're not part of Day Lewis as far as I can ascertain. Inhalers are £4 each and the 'Viagra' is 'from £20'!!!

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  • This is a great idea! How ridiculous that the establishment resist this - just like they did home pregnancy tests and Patient Information Leaflets in medicines[ "Only a doctor can impart this information".] That looks ridiculous now. Of course care should be taken with antibiotics but least the antibiotics use can be standarised rather than the free-for-all I see in GP land. ( Oh and salbutamol inhalers are over the counter in Australia already, no prescription needed - shock horror! - and their asthma care hasn't collapsed. Come on dinosaurs out there wake up to more patient-centred care!)

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