Because we're worth it
Theoretically, from spring 2006, pharmacists will be able to prescribe anything they want from the British National Formulary, with the exception of Controlled Drugs (see p621 and pp627–8). In practice, of course, that is not at all likely. However, judging from the response by members
of the British Medical Association, the announcement from the Department
of Health that extended prescribing rights will be granted to pharmacists
and nurses was tantamount to letting these new prescribers loose in
an operating theatre with a scalpel and asking them to perform open
heart surgery.
Before pharmacists (and nurses) are able to take up the opportunity to
prescribe independently they will need training. For those who already
work as supplementary prescribers the additional studying may be limited.
But courses will still need to be devised and their contents accredited,
both of which will take some time.
Pharmacists already work as independent prescribers — every time
they question a customer and recommend an over-the-counter product. In
such circumstances, the pharmacist and customer are making a joint diagnosis.
When it comes to prescribing prescription-only medicines, it is unlikely
that the pharmacist will be expected to make the diagnosis. Rather, he
or she will recommend drug therapies based on the diagnosis made by a
doctor. Moreover, pharmacists, particularly those who wish to take on
the extra responsibility of independent prescribing, are highly unlikely
to stray into unfamiliar territory and will only make recommendations
within their competence.
The belief that doctors know more about medicines than pharmacists is
indefensible. Without doubt, doctors are trained to be diagnosticians.
But ask any community pharmacist whether written prescriptions suggest
that all GPs understand therapeutics, or ask any hospital pharmacist
whether junior doctors are really safe to be prescribing for the unsuspecting
public in February and August each year — and the answer will be
a resounding “no”.
To suggest that independent prescribing by pharmacists will be inherently
dangerous is not just a misjudgement. It may potentially undermine the
future development of independent prescribing. And who will miss out?
Funnily enough patients and doctors have most to lose.
Readers will probably want to reinforce these points by writing to The
Journal but we believe that correspondence — preferably joint letters
written by doctors and pharmacists whose patients are already benefiting
from supplementary prescribing arrangements —would be better directed
to the BMJ, where doctors will read it. It would be good if the BMA’s
Hamish Meldrum and Paul Miller were forced to eat humble pie. But let
us not live with false hopes; let us instead get on with the job of proving
pharmacists’ worth.
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