This week, an opportunity was given to pharmacists. In its guidance on zanamivir (Relenza), the National Institute for Clinical Excellence recommended that the drug should be made available directly from community pharmacies through a patient group direction (p777). The position was backed by the Department of Health and the National Assembly for Wales. A "model" patient group direction was published on the Department's website. Further support came from the British Medical Association.
The NICE decision represents a milestone for the development of patient group directions and for pharmacy. In principle, it seems an excellent idea, but there are issues that will need to be resolved.
The most obvious problems are cost and appropriate use of zanamivir. How will the drug and the service be paid for? It has been suggested that the costs will be met locally but health authorities are unlikely to have allocated the necessary funding.
Does a high-risk patient who claims to have the symptoms automatically get the drug, even if the pharmacist's opinion is that the patient only has a cold? After all, a long-standing view is that a person who can make it into the pharmacy is unlikely to have 'flu. And if a patient sends a representative, can the pharmacist dispense the medicine? Do patients need to prove that they are in a high-risk group? Is it ethical to refuse to supply zanamivir to a patient in a high-risk group?
So, perhaps, pharmacist supply of zanamivir through a patient group direction is not quite as easy as it first seems. However, the opportunity should not be missed. Pharmacists have a chance to prove that they can make patient group directions work.