A GMC review published in May this year received a lot of attention for its finding that as many as one in 20 GP prescriptions contains an error.
What received less attention was the study’s conclusion that serious errors are rare and the majority of GP prescribing is safe, proportionate and responsible. But despite this, there has been a steady erosion in recent years of the role of the GP as gatekeeper of the FP10.
First there were patient group directions, then supplementary prescribers and independent prescribers, and the dangerous rise in the availability of mail-order prescription-only medicines via the internet.
But most divisive of all has been the drive to make more medicines available without a prescription in pharmacies.
This move – first mooted in Labour’s NHS Plan in 2000 – was designed to increase the availability of prescription-only medicines and enable patients to self-care. A laudable aim, but clumsy in its execution.
The Medicines and Healthcare Products Regulatory Agency (MHRA) made it a high priority, leading to a number of drugs being declassified from prescription only to the pharmacy sales list, including simvastatin, sumatriptan and chloramphenicol.
This was a massive boon to the pharmaceutical industry and the status of pharmacists as a profession – but GP leaders questioned whether adequate safeguards had been put in place and if the commercial imperative in pharmacies could interfere with good medical care.
Then the MHRA approved a trial of making the antibiotics azithromycin and trimethoprim available without a prescription in 2008. This move led to uproar from microbiologists, who argued it would undermine the campaign to minimise antimicrobial resistance.
In 2010, the Government’s own advisers asked the DH to exclude antibiotics from the POM-to-P reclassification drive. It was a welcome injection of common sense into what was becoming a free-for-all.
But as we learn this week, the National Pharmacy Association has continued quietly making prescription-only medicines – including several antibiotics and salbutamol inhalers – available under patient group directions.
The list of 16 medicines it is planning to make available in all 12,500 pharmacies from January has incensed GP leaders and led to urgent talks with the DH after being alerted to the scheme.
Pharmacist leaders claim the service is more convenient for patients and will free up GP time, but that completely misses the point. A prescription may only be a flimsy bit of green paper, but it represents a whole process of medical training, checks and lines of responsibility to ensure that patients are kept safe.
The MHRA guidance is clear that patient group directions must only be used when there is an ‘advantage for patient care without compromising patient safety’.
There were no adverse events in the pilot of the NPA’s scheme but, particularly in the case of antibiotics and asthma medicines, prescriptions should be part of a wider care plan for patients and an appreciation of the wider health of the population.
The DH must call a moratorium on this and all other such schemes, at the very least until appropriate approval procedures are put in place to consider their wider impact.
Nigel Praities is the deputy editor of Pulse
