Confidence and competence
In 2003, we devoted the first issue of The Journal (4
January) to supplementary prescribing. The Government’s aim was to have 1,000 pharmacist supplementary prescribers in practice by the end of 2004 and, although that target has not been achieved (there were 322 on the Register at that point), the benefits to patients — particularly those with long-term conditions — are increasingly acknowledged.
The Journal now turns its attention to the idea that pharmacists will
be able to prescribe independently before too long. The Government is
on the point of issuing a consultation on the topic, following private
discussions with representatives from a number of interested pharmacy
bodies, and we carry a News feature (pp8–9) that outlines some
of the issues that will need to be addressed publicly.
A stumbling block to speedy implementation may be defining what “independent” prescribing
actually means. If it means being responsible for the initial diagnosis
of a condition and the recommendation of a treatment, many community
pharmacists would argue that this is something they already perform on
a daily basis when they sell a pharmacy medicine. But, realistically,
there are relatively few conditions (many of them minor ailments) that
pharmacists are currently trained to recognise with certainty and, therefore,
treat with confidence. So if the ability to diagnose is considered a
necessary dimension to prescribing independently, many pharmacists will
consider that prescribing is out of reach and that a great fuss is being
made about nothing much.
If, on the other hand, independent prescribing means allowing pharmacists,
once a diagnosis has been made by a doctor, to initiate prescribing or
to change existing prescriptions as they believe appropriate, then the
opportunities become much more exciting. For the treatment of long-term
conditions, for example, the model would be as for supplementary prescribing
but without the pharmacist having to adhere to a clinical management
plan. Instead, the pharmacist would have the freedom to decide the treatment
from which a patient would benefit most. Hospital pharmacists would,
by the same token, easily be able to manage admission and discharge prescribing
without having their decisions approved by doctors.
There are other issues that will also need to be resolved. Will pharmacists
have access to all products in the British National Formulary or will
they be restricted to certain medicines? Will there be different forms
of independent prescribing depending on the sector in which the pharmacist
practises?
Ultimately, the form independent prescribing will take will be determined
by confidence and competence: the confidence of patients and doctors
in the services offered by pharmacists, and the competence of pharmacists
to provide a safe and effective service. Let us hope that by January
2007 these issues will all have been resolved.
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