From Mr E. C. Burrow, MRPharmS
SIR,—I have read with interest that the Royal Pharmaceutical Society is to develop guidance on the process of prescribing (PJ, November 20, p814).
For many years I have understood that a pharmacist could prescribe according to the symptoms described by a person present in the pharmacy.
During a recent meeting of the Plymouth branch, a lecturer (professor and pharmacist) described what he found on examining the inside of a man's mouth, adding that there could be no prescribing without a diagnosis.
I wrote to the National Pharmaceutical Association for comments. As expected, there was a prompt reply.
The NPA director stated that the "D-word" had always been difficult for pharmacists and that whenever pharmacists had been in any way involved in diagnosis this had greatly upset the medical profession. Reference was made to the guidance provided by the Standards of Good Professional Conduct.
At the same time I sent an identical letter to the Director of Professional Standards at the Society. Having received no reply, I sent a copy of the letter to the then President.
This prompted a reply from the Director of Professional Standards. She wrote: "I cannot believe that any pharmacist asked by any patient for advice/diagnosis would not offer that advice/diagnosis based upon the symptoms described." She had never met any problems on this point.
A reply to the original letter was later received from a pharmacist adviser in the Professional Standards Directorate, who stated that in his opinion there could not be counter-prescribing without an element of diagnosis. However, a pharmacist who prescribes was responding to symptoms rather than diagnosis. He concluded: "The distinction still applies: medical practitioners are trained to diagnose and pharmacists are not."
It may well be that prescribing by pharmacists for humans and animals should be reviewed. Because of my advanced age and the speed at which the wheel turns at 1 Lambeth High Street, I may never know the result.
E. C. Burrow
Mannamead, Plymouth