The Pharmaceutical Journal
Vol 274 No 7340 p294
12 March 2005

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Will community pharmacists really be able to prescribe independently?

A man comes into your community pharmacy and asks what he can take to treat his severe eczema. You recommend a betamethasone cream and write out a prescription. Is this a likely consequence of the consulation on independent prescribing by pharmacists, Tom Moberly (on the staff of The Journal) asks

Last week the Department of Health and the Medicines and Healthcare products Regulatory Agency issued their “Consultation on proposals to introduce independent prescribing by pharmacists” (PJ, 5 March, p257). The document suggests that patients may be able to “consult a pharmacist directly, much as they currently do for ‘over the counter’ products, rather than making separate visits to see a doctor and a pharmacist”. Is this likely to occur in reality, or will independent prescribing only really have an impact on hospital pharmacists and those working in general practice?

A unique opportunity

The consultation document is likely to offer a unique opportunity for pharmacists to develop the way they work and the services they provide to the public. “Together with the new community pharmacy contract, these proposals provide the greatest potential for promoting and developing the role of the pharmacist within the health care system,” says Nigel Simmons, non-medical prescribing lead (Cambridgeshire). “It is unlikely that such a situation will occur again for many years.”

And the broad scope of the document, which includes considering allowing pharmacists to prescribe for any condition from a full formulary, has been applauded by community pharmacists. “I was pleased to see how far the consultation document went with regard to the prescribing options,” Rimal Patel, a community pharmacist and supplementary prescriber from Brixton Hill, London, commented. “I thought it might end up being just an extended formulary, as for nurses.”

Hospital pharmacists

The benefit for hospital pharmacists of moving forward from supplementary to independent prescribing is clear. “The major problem with supplementary prescribing is that you need a clinical management plan,” Mark Tomlin, pharmacist for the critical care directorate at Southampton General Hospital, says. “Supplementary prescribing is designed for chronic disease management and not acute management, so is not suitable for individual single doses. If a patient has his or her spleen removed, it is quicker to write the follow-up vaccines and antibiotics on the drug chart and get a doctor to sign it than it is to draw up a clinical management plan and obtain patient consent,” he adds. Independent prescribing could remove that need.

Independent prescribing would also be helpful to hospital pharmacists writing up discharge medicines. Pharmacists often have more of an idea of what medicines patients need to take home with them than doctors, Mr Simmons says. So, allowing pharmacists to prescribe patients’ discharge medicines independently would be helpful to patients and make better use of a hospital’s skill mix.

Community pharmacists

What the logical path from supplementary to independent prescribing is in community pharmacy is less obvious, although an approach that builds up from basics may work best. For instance, community pharmacists could begin to prescribe independently by initiating fairly simple schemes such as minor ailments treatments.

However, the full potential of independent prescribing is not likely to be harnessed until the NHS IT systems are integrated with those of pharmacies and pharmacists are able to access patient records. Rimal Patel believes that, in the short term at least, the IT infrastructure may prove to be a limiting factor for the development of independent prescribing by pharmacists.

“The access that patients currently have to a pharmacist in the community setting, eg, for advice and over-the-counter medication, can only be paralleled with independent prescribing if community pharmacists can access the electronic patient record during the consultation. This can only happen if strategic health authorities and primary care organisations commit to commissioning new services from the community pharmacy sector, and the supporting IT and clinical governance infrastructure is in place to underpin patient safety,” he says.

As well as developing the IT infrastructure to allow community pharmacists to prescribe, the way in which the pharmacists will be reimbursed needs to be established, Hemant Patel, the Royal Pharmaceutical Society’s Vice-President and secretary of the North East London Local Pharmaceutical Committee, believes. “Two types of cost need to be accounted for: the payment for the work done by pharmacists and the reimbursement of any costs they incur,” he explains. “If the financial basis is not clarified, hospital pharmacists will be able to prescribe and primary care pharmacists will be able to prescribe, but community pharmacists will not, because the finances will not be in place.”

Critical mass

To ensure that details around funding and IT do not stall the whole independent prescribing consultation process, pharmacists need to support the project. “In terms of achieving the stated agenda on access and choice, there will need to be a critical mass of community pharmacists engaged in applying their independent prescribing skills,” Rimal Patel says.

Others agree. “Pharmacists should not be afraid or hesitant to take the process forward,” Mr Simmons argues. “Nurses will be pushing very hard for full independent prescribing in response to their consultation and other health professions will also be developing prescribing roles. Ideally every pharmacist should attend one of the National Prescribing Centre mini-conferences that are running in the coming weeks to get a flavour of what could be achieved,” he says.

Undoubtedly both hospital pharmacists and community pharmacists will be able to prescribe independently but the onus is on them to make the most of that opportunity.

“There are opportunities available to every pharmacist to develop themselves and the services they provide to the public,” Mr Simmons says. “The DoH has listened to what has been said by the profession and has provided the opportunities. Now it’s a case of carpe diem!”