Introduction Unnecessary visits to their surgeries by patients with upper respiratory tract infections (URTIs) seeking inappropriate antibiotic therapy are a burden on already over-stretched general medical practitioner (GP) services¹ and increase the problem of antibiotic resistance.²
The aim of this project was to reduce demands on GP time by reinforcing to the public that their local pharmacist's advice and recommendations on over-the-counter (OTC) remedies were more appropriate than antibiotic therapy.
Funding was provided by Wiltshire health authority as part of an on-going drive to support the development of the role of the community pharmacist, promote working relationships across the primary care team and help minimise unnecessary GP consultations as has been successful in other areas.³

Method Six general medical practices and five pharmacies took part. A project manager co-ordinated a series of steering group meetings, to establish the project and subsequently to collate and analyse feedback and data generated by the project.
Posters and leaflets containing the key messages (why self-help for minor ailments was best, why antibiotic therapy was not recommended) were produced for display in practices and pharmacies. Pharmacists incorporated leaflets into all dispensed prescriptions throughout the project's duration. A local publicity drive was launched to support the campaign.
Agreed protocols for patient counselling by pharmacy staff were drawn up and circulated to the GPs.
Fast-tracking (a GP appointment within 24 hours) of patients who had been counselled and considered by pharmacists to be genuinely in need of treatment was ensured by provision of a GP referral note. Patients who had consulted their GP but did not require antibiotic therapy were given a referral card to present at the pharmacy for advice and counselling. Such appointments were believed by participating GPs to provide an opportunity for future patient education.
All staff working in participating practices and pharmacies were instructed in the aims of the campaign and their opinions and findings used later in the data-collection element of the project. Postal surveys were circulated to a sample of patients registered with the participating practices to determine their awareness of the campaign and to try to predict behaviour with future URTIs. Practice and pharmacy staff were asked to record all visits, to either surgery or pharmacy, and all sales of OTC remedies, and were later circulated with questionnaires to establish how valuable they believed the campaign to have been in terms of altering patient behaviour and expectations, and furthering relationships within the primary health care team.

Focal points

• Patients were encouraged to seek advice and over-the-counter remedies from their pharmacist rather than seeking antibiotics from their GP for URTIs
• The scheme reduced GP workload and encouraged patients to accept responsibility for their health
• Inappropriate prescribing of antibiotics was discouraged and patients educated about appropriateness of antibiotic prescribing
• Some patients acknowledged that the scheme would change their behaviour next time they had symptoms of an URTI