|  Community pharmacists working in seaside towns and other tourist
destinations are noticing an increase in requests from patients for emergency
supplies
of medicines during summer weekends. This trend, they believe, coincides
with the decision by GPs to opt out of providing out-of-hours care, as
allowed by their new contract. Patients are now turning to pharmacists
for help because surgeries, which had been open on Saturday mornings
or other times at the weekend, are now closed.
John Harding, a locum pharmacist at Regent Pharmacy in the Isle of Wight,
says requests for emergency medicines are not a problem on weekdays because
patients can be referred to a local GP. But, he says: “It can be
an issue for us on Saturdays when the surgeries are closed. We can make
an emergency supply, which we do if it’s something simple, but
if the person has forgotten a whole load of medicines we send them instead
to the doctors’ on-call service at the local hospital, although
they aren’t particularly happy about that, I understand.”
If he supplies an emergency prescription medicine he charges a minimum
fee per item of £3.50. If the medicine is more expensive then the
fee is increased. Mr Harding questions the sense of the statutory regulations
governing the emergency supply, which restrict the supply in general
to a maximum five days’ worth. He says: “Most people come
on holiday for a week. If I make an emergency supply on a Saturday or
Sunday then the person has to come back for more the following Thursday.
It would make much more sense if the supply is allowed for seven days.”
Pharmacist Jolyon Constable manages the only pharmacy in the seaside
town of Padstow, in Cornwall. He estimates that at the start of the summer
season he may get a daily request from somebody for an emergency supply,
but at peak times of year it can be as many as 15 requests a week.
Patients often forget their antihypertensive medicines, for example,
he says. “It can be a nuisance as it takes time. They often remember
to bring one or two of their medicines with them then forget the rest.” If
he decides to give an emergency prescription medicine he supplies it
as a private prescription with a minimum £4 fee, which, he says,
reflects the policy of Alliance Pharmacy, which owns the business.
Along the Cornwall coast in Newquay, pharmacy manager at Kaye & Son
Ltd, David Heap, recalls one patient who had forgotten several medicines
but was unable to tell him their names, the dosage or the strength. He
says: “I had to send her back to telephone her GP and ask the GP
to fax me through the details so I knew what I had to supply.” Patients,
he says, are often surprised when told they have to pay for emergency
medicines as a private prescription. He says: “Those who are genuine
about taking their medicines and are remorseful about forgetting it will
pay. People seem prepared to pay up to £20 but anything above that
and they decide to go to see a GP instead.” Like other pharmacists
he charges a minimum £3.50 per item but has discretion to charge
more and sometimes will add 50 per cent above cost price. The pharmacy
often deals with five or six requests for emergency prescription medicines
a day in high season, particularly from young people for contraception.
Huw Roberts, pharmacy manager at the Castle Pharmacy in Caernarfon in
Wales, estimates he deals with around five requests a week for emergency
prescription medicine. He has also noticed an increase in demand at weekends.
He remembers one patient coming into the pharmacy at 5.30pm on a bank
holiday Monday requesting tablets for depression and blood pressure.
He says: “She didn’t think to come earlier in the day. I
was just shutting. So I gave her one day’s supply and told her
to go and see a doctor the next day.” If he supplies emergency
prescription medicine he does so on the same terms as a private prescription. “A
lot of people won’t pay so I point them in the direction of the
GP instead,” he says.
Pharmacists working on the tourist trail in the Scottish highlands report
that patients are not reluctant to pay for a private prescription if
they forget their medicines. Pharmacist Alisdair Ramsay has been running
the pharmacy in Mallaig for 17 years. He says: “People forget their
medicines regularly but I wouldn’t say it was a problem. For example,
if somebody forgets their inhaler it costs them £5.85p as it’s
an emergency supply. They could go to the surgery but it might take them
two days for an appointment and then they are taking a GP appointment
for something they know.”
Although most patients do not object to paying for their medicines, Mr
Ramsay has noticed that sometimes they do not like the advice he gives
them. He says: “Patients sometimes take umbrage on the protocols
I offer them. They say things like ‘I don’t get it like that
at home’, but it’s no real problem.”
All pharmacists have professional discretion over whether to supply an
emergency prescription medicine, and Mr Ramsay refuses to give antibiotics,
antidepressants or tranquillisers because he prefers the patient to have
a GP consultation.
Michael Hilton, a locum pharmacist at the David Carter Pharmacy in Windermere
in the Lake District refers patients to a local GP for a consultation
if they need a number of different medicines. He says: “People
come in who have forgotten anything from their statins to insulin — a
whole range of things. Often it’s only for one or two items and
we can look after them ourselves but sometimes it can be for their complete
medication, in which case we refer them to one of the local practices.” Patients
are charged a private fee of £6.50, or more if the item is expensive.
They are given a refund if they later produce an NHS prescription for
the item. “People don’t mind paying, but if they need to
pay something like £30 we send them to the surgery instead to get
it on prescription.”
According to the “Medicines, ethics and practice” guide,
pharmacists have to be satisfied that there is a genuine need for the
medicine and that it would be “impractical” to obtain it
on prescription because of the delay the patient would face. But Lynsey
Balmer, head of professional ethics at the Royal Pharmaceutical Society,
emphasises that there is no statutory requirement on pharmacists to supply
emergency prescription medicines although there is a professional duty
to act in the patient’s best interest. She says: “It’s
an important provision for pharmacists, enabling them to be able to care
for patients and ensure that they have the access to medicines that they
need in an emergency. The pharmacist has to exercise professional judgement
to be satisfied that the need is genuine.”
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The
Pharmaceutical Journal