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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)

  • I'm not so worried about salbutamol - after all (but little known!) theophylline and aminophylline are available OTC - they are not POM status.

    I think its more historical anomally than anything else...

    Antibiotics does concern me - as does the commercial imperative for selling these.

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  • Can anybody explain to me why, in 2012 we still needs pharmacists in shops? It seems a waste of 5 years training to have a skilled professional selling evidence based treatments such as cough mixture....Patients would prefer to collect medicines after they have seen a GP. Technology has made the role of the high street pharmacist essentially redundant. The NHS could save millions scrapping the current system and opening up pharmacy to more competition - patients would chose to gets their medication at a Drs surgery. The pharmacy lobby perpetuate this expensive ridiculous system and continue to scrabble about to find a role that should no longer exist.

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  • PGDs which allow the supply of salbutamol inhalers and antibiotics for cystitis should place tight limits on the frequency of supply and make it a requirement that pharmacists inform surgeries each time these medications are supplied. Some PGDs used by pharmacists already have these requirements in place.

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  • I understand pharmacists will do an on line course before being allowed to prescribe and dispense antibiotics . I wish I could have done an on line course at medical school. It would have saved at least 1 year of learning to examine respiratory systems, abdominal etc. There is of course no conflict of interest in prescribing and dispensing by pharmacists where as dispensing doctors are accused by pharmacists of having a conflict of interest with the chant that Drs prescribe and pharmacists dispense. What about about patient confidentiality when the patient has to give all sort of symptoms over the counter to the the pharmacist. This is a scheme dreamt up by the pharmacist lobby!

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  • Yes you can buy OTC salbutamol in Australia as often as you like. You can also Dr shop and be seen by any GP in town with no need for continuity of records or care. The only asthma preventer that ever seems to be prescribed is seratide, so the drug rep in this town has obviously done his job well. Is asthma care here of the same standard I was used to in the UK, No. No where near.
    Just as we cut back on superbugs in the UK we now want to start selling antibiotics like ciprofloxacin over the counter. Crazy idea.

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  • Necessarily comments here are based on a lack of familiarity with the protocols and procedures specified by the PGDs concerned. All PGDs are written to address the sort of concerns expressed in previous comments. PGDs are authorised by registered organisations and specialist doctors and pharmacists from those organisations. They are written to be applied in specific contexts and to be applied by specified trained practitioners, in this case pharmacists.

    One comment has made the point that patient confidentiality may be compromised if a patient gives information at a pharmacy counter. Pharmacies usually now have consulting rooms for the exchange of private information.

    To repeat a previous comments, PGDs for the supply on salbutamol inhalers and trimethoprim can and do in some cases included a requirement for GPs to be informed with each supply.

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  • Correction of typos past paragraph previous comment:

    "To repeat a previous comment, PGDs for the supply on salbutamol inhalers and trimethoprim can, and in some cases do, include a requirement for GPs to be informed with each supply."

    Additional comment:

    Where antibiotics are supplied by PGDs they take a account of HPA (Health Protection Agency) and other prescribing guideline and follow practices widely followed in GP practice and out-of -hours practice.

    There is debate and a lack of consensus on these matters, which include considerations of access and extending the role of community pharmacy These factors and other matters have been considered in legislation and guidelines covering the writing and use of PGDs.

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  • I think the scheme is a good idea. I am asthmatic and suffer quite badly. There is nothing more annoying than running out of salbutamol because of a chest infxn or losing the inhaler down the loo, or by pt poor planning. The surgery I attend is only open M-F 8am-18:30. No Saturday hours, so if you run out; you're stuffed for at least 4 days. This is because of weekend and also due to the 48hr Px turnaround!!

    Pharmacists spend their entire course studying medications; how they are made; how they are absorbed/excreted and also the Dz process that leads the pt to be started on a particular Mx. To be fair; I personally think that the pharmacist is more qualified to explain about the Mx use and side effects to the pt. I am not saying that doctors are unable to Dx, what I am saying is that both professions should compliment each other.

    Yes, I can see the level of concern. I can also see the benefits too. If a pt uses the same pharmacy time and again; realistically there shouldn't be an issue. It's if that pt goes to A N other pharmacy that pt details and info could be missed. It would be useful to know if the big chains of pharmacies have their computer systems interlinked. Can anyone tell us that please?

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  • 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?’

    No they just print a prescription and shove it under the nose of a GP between appointments.

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  • Let me tell you, this situation is very similar in vet practice!! Nurses are unable to hand out Px without the vet being on site, regardless of the item being a PML/P or GSL (NB Categories are different in vet medicine but have equivalents to human Mx! E.g a POM becomes POM-VPS (VPS stands for veterinary prescribers only).

    There are many, many jobs RVN's (Registered, Listed, Vet Nurses), can do but due to legislation passed by pen pushers in the ivory towers, whom know nothing of practice, allow to pass, leaving frontline staff angered and bemused as to why!!

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