The ritual of seeing your GP can be taxing: competing for limited daily
appointments; sitting in hot surgeries swimming with germs; feeling guilty
about taking up the doctor’s time . . .
Yet for many this experience may soon become a rare occurrence. The Government
is encouraging us to see our local pharmacist more often to lessen the
burden on doctors. In February, the first members of a new breed of
prescribing pharmacists, who have taken on many of the roles of GPs, began
to practise.
Ten million of us see a doctor or nurse every month, with 78 per cent of the
population visiting the local surgery at least once a year. Nearly all of
those visits lead to a prescription, and 73 per cent of us will be
prescribed a medication every year, according to the NHS.
Over the past few years there has been a huge rise in the number of drugs and
treatments available over the counter, without prescription, from our local
chemists, from antibiotic eye drops to the morning-after pill. This year, in
a pilot project, even the antiimpotence drug Viagra became available over
the counter at chemists in Manchester. Now the Department of Health has
stepped up a gear, with its scheme to give pharmacists more power to care
for patients with chronic conditions such as diabetes and asthma. And this
could mean a sharp cut in those millions of monthly GP visits.
New rules set in place last year have led to the creation of a special class
of chemist, those who are qualified and licensed to be pharmacist
independent prescribers (PIPs), who are able to offer any medicine for any
medical condition within their competence, as long as it is not a controlled
drug such as morphine. One of the first of these prescribers, Beth Hird, a
specialist in asthma, has started to practise in Nottingham (see facing
page). The Royal Pharmaceutical Society says that by the end of this year,
there could be 1,100 PIPs countrywide.
These pharmacists will have to be commissioned by their local primary care
trust, just like a GP, and then choose a specialist medical area; for
example, diabetes. Many will be employed by the NHS, often based in local
health centres, where they will provide a service alongside GPs and other
health professionals. Independent sector pharmacists — high street chemists,
for example — can also become PIPs. But, like the NHS pharmacists, they will
have to go on a prescribing training course and they will be allowed to
prescribe only in the areas in which they have been trained.
Some NHS pharmacists already run clinics for their local communities. For
example, some assess chest infections to decide whether the GP needs to
investigate further. But when the new system becomes more widespread, rather
than a pharmacist saying to you “I think you need antibiotics for this,
you’d better see a GP for a prescription”, a PIP in a clinic will be able to
say: “Here is the antibiotic you need.”
People with conditions such as asthma, epilepsy or eczema may notice the
changes first. Instead of being supervised by a doctor, they may be seen at
a clinic run by a pharmacist, which could be at the pharmacy, GP surgery or
even in a local hospital. And while initial diagnosis will usually come from
a doctor, a PIP may sort out a treatment plan and revise it over time,
assessing periodically how well a patient is responding to medication. This
is something that pharmacists do not do at the moment and it has to be good
news for anyone with a complicated drugs regimem, such as older people who
may juggle statins to lower cholesterol levels, blood pressure pills, and
tablets to soothe their stomachs from the effect of taking the other drugs.
Will there be a PIP near you? The Department of Health says that the number of
PIPs will be determined not by government targets but by pharmacists and
primary care trusts. In other words, local need and market forces will sort
things out. But the department is keen to promote its new scheme.
“Pharmacists are highly trained; we should use their skills,” a spokesman
says.
David Pruce, a director of the Royal Pharmaceutical Society of Great Britain,
which is backing the new plan, says: “We have five years’ training in
medicines. Our expertise is second to none. And as medicines become more
complicated, so do the interactions between different drugs. Pharmacists
keep up to date in a way that no other health professionals can do, as that
is the area they concentrate on.”
But some GPs are cautious. Pharmacists, they say, are not doctors. Without
proper clinical training, is it appropriate for them to be making diagnoses
and treatment plans, or handing out drugs after a quick consultation? Some
are concerned that, although PIPs will have access to medical records, most
high street pharmacists dispensing powerful medicines over the counter
don’t. That means they can’t be certain what other medications a patient is
taking. Some drugs can be dangerous if mixed: Viagra, for example, cannot be
taken with nitrates (used to ease angina) as both cause blood pressure to
fall and the cumulative effect might lead to collapse.
Dr Satya Sharma is a member of the British Medical Association’s clinical and
prescribing subcommittee and has been a GP in Wolverhampton for more than 25
years. He says: “While I am delighted that pharmacists are seeing their role
enhanced, there are grey areas that need addressing, and the prescription of
drugs is one of them.
“GPs have advantages over pharmacists, aside from our training. After years in
the surgery we often develop an instinct, which may help us when faced with
a difficult diagnosis.”
He is concerned that some more seriously ill patients may be overlooked. Pruce
is reassuring: “Will some patients slip through the net as doctors fear? No;
we’re used to questioning them closely. One of my colleagues was approached
by a man who wanted treatment for a wart. The pharmacist spotted that it
wasn’t a wart: he was 90 per cent sure it was a melanoma or skin cancer. So
he referred his patient to a doctor who was able to confirm the diagnosis.
It’s no different from the way a GP refers a patient to a specialist.”
GPs and pharmacists are in agreement on one issue: communication between the
two professions is vital if the system is to work.
“We are not frustrated GPs,” says Pruce. “We have expertise in medicine and
can complement doctors. We are like different members of one team.”
What you can ask a chemist
High street pharmacists
Your local chemist can dispense an increasing range of medications to you over
the counter — statins, emergency contraception, antiinflammatory creams —
without prescription or a doctor’s referral.
Prescribing pharmacists
Since 2003 more and more NHS and high street pharmacists have trained as
“supplementary prescribers”, prescribing medicines already specified by a
doctor in a patient’s treatment plan. This helps people with long-term
conditions such as diabetes, heart disease and asthma. Ask your doctor for
details.
Specialist pharmacists
By the end of this year there could be more than 1,000 pharmacist independent
prescribers (PIPs) trained in specific areas of health and able to prescribe
medications and provide advice independently of doctors. They will be of
most use to people with long-term conditions. Ask your doctor for details.
Beth Hird is the first pharmacist licensed to prescribe drugs independently
Beth Hird, 29, is the first pharmacist independent prescriber (PIP) in the UK.
She runs an asthma clinic at St George’s Medical Practice, in Nottingham. The
clinic operates once a week and was set up to review and manage patients
with asthma, focusing on those who have recently become worse, who use a lot of
inhalers and who need regular monitoring.
“Patients are generally invited in to see me, but they may be referred to me
from their GP, or can come to the clinic themselves if they have seen me
previously and are worried. I usually follow up patients until their
condition is stable. If they require more complex support which falls
outside my role as a PIP, I refer them back to their GP.
“I’ve developed a deep knowledge of asthma. I can educate patients about their
asthma medications and show them how to manage their asthma effectively,”
she says. “It’s a positive move for patients as there are more healthcare
professionals for them to consult.”
