Singing in unison
For once, the pharmacy bodies seem to be singing from the same song sheet. What they are singing about is the consultation carried out by the Medicines and Healthcare products Regulatory Agency and Department of Health on proposals to introduce independent prescribing for all UK pharmacists, which comes to an end next week.
The leading bodies approached by The Journal all draw the same conclusion
that pharmacists should be able to prescribe from a full formulary and
for any condition, provided they prescribe within their own areas of
competence (p607).
This is the only realistic position to adopt. Community pharmacists are
already experienced independent prescribers of any pharmacy medicine
sold — after a customer describes a set of symptoms which the pharmacist
does not believe requires a GP consultation for a prescription-only medicine.
In addition, pharmacists involved in many of the minor ailments schemes,
for example, are independently prescribing, as are, to some extent, those
pharmacists who supply medicines under patient group directions.
Since many GPs opted out of their out-of-hours responsibilities in April
and practices are now closed at weekends, there is an even greater imperative
to give pharmacists the freedom to prescribe independently. Although,
in theory, pharmacists are entitled to sell emergency supplies of prescription-only
medicines (“Medicines, ethics and practice”, vol 28, July
2004, p12) it is not always easy for patients to obtain supplies this
way. How much time and resources might be saved if patients knew that
their local pharmacist would be able to help them promptly instead of,
say, their having to go to the local accident and emergency department?
The limiting factor for all this will be pharmacists’ ability to
be primary diagnosticians. Some specialist hospital pharmacists may have
the opportunity and access to appropriate tests to develop the skills
and expertise to be able to diagnose and prescribe within a particular
clinical discipline. Community pharmacists, like GPs, are generalists
and tend not to become involved in the management of complicated or tricky
medical conditions. But in the way that medical consultants can make
a primary diagnosis and the GP then prescribes the appropriate medicine,
there is no reason why a GP cannot make the primary diagnosis and a pharmacist
decide on the best medicines for a patient. There are training and clinical
governance issues to be considered but, in this instance, independent
prescribing in many ways is more straightforward than supplementary prescribing.
If there is the will, a way should be found.
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