Prescribing & Medicines Management
Issue no 3, p5-7
May/June 2003

Features

Community pharmacists decide to "wait and see" before prescribing

Community pharmacists have given a cautious welcome to government guidance which spells out how they can become supplementary prescribers.

They welcome the opportunity it gives them to take on greater clinical responsibilities but, at the same time, are concerned at the amount of time it will take up and the lack of funding.

Managers of high street multiples are also taking a "wait and see" approach and are reluctant to pioneer the initiative until it has been properly tested.

Individual reluctance

The National Pharmaceutical Association, which has published its own guidance to complement the government documents, predicts it is unlikely that individual community pharmacists will become supplementary prescribers working in isolation with a local GP.

Head of NHS services development at the NPA Georgina Craig said: "We recognise that the people who will be doing this will be doing it within a larger service framework such as a local pharmaceutical services pilot or a medicines management collaborative.

"They may also choose to take on the additional role as part of a service level agreement with their primary care trust in a specialist clinical area," she suggested.

A key advantage of taking on the new responsibilities within a wider initiative, which has its own budget, is that the community pharmacist is likely to be paid for the work it involves.

She added: "Community pharmacists are going to have to be remunerated in some way for this work. They aren't going to get remunerated just for being a supplementary prescriber but they may get payment for providing a service and part of that service involves being a supplementary prescriber." To date nearly 100 NPA members have requested copies of its supplementary prescribers guidance which has been updated following publication of the Department of Health guidance in March. The uptake is small, which reflects caution. But Mrs Craig said: "Over time I think supplementary prescribing will become part and parcel of practice but at the moment we are in a transition stage."

The Government is hopeful that by the end of next year there will be 1,000 pharmacists who will be supplementary prescribers. Working to an agreed clinical management plan they will be able to prescribe following diagnosis by an independent prescriber. The DoH guidance says only pharmacists who have been qualified to practise for a minimum of two years are entitled to undergo the further training needed to take on this extended role. Lack of experience will not be the only hurdle pharmacists have to overcome.

Strict procedures

The strict procedures that need to be followed rely on the pharmacist and the doctor having access to a common patient record, and any interventions have to be written up within 48 hours which the NPA points out will take time.

Pharmacists will also have to make sure their premises are large enough to be able to provide a confidential patient consultation area.

The costs of employing locums or a part-time pharmacist also have to be taken into consideration because of the time away from the pharmacy for regular meetings with the independent prescriber.

Problems for independents

Community pharmacist Graham Phillips, who is the prescribing lead for St Alban's and Harpenden Primary Care Trust in Hertfordshire, admits lack of proper funding and appropriately linked computer networks could be a deterrent to becoming a supplementary prescriber.

"The extra work is okay so long as you are going to get the rewards for doing it. I can also see a difficulty in finding the GP sponsor you need before you can become a supplementary prescriber — that is not a given and some GPs are quite jealous of their territory," he added.

The Pharmacy Alliance, the organisation that supports Unichem community pharmacists, said supplementary prescribing was a great opportunity for the profession.

Its general manager Alistair Marsh said: " It supports a lot of areas that community pharmacists are already working in, such as repeat dispensing and medicines management. I don't think that every community pharmacist will become a supplementary prescriber, that would be unrealistic.

"It is a new idea in the market place and there will be some innovators who will go for it automatically while others will hold back until they can see what benefits it holds for them," he explained.

Multiple reticence

Boots The Chemist Ltd and Lloydspharmacy are both keen to see the pharmacist role extended. But they were reluctant to reveal how they would be developing supplementary prescribers.

View from Boots

A spokeswoman for Boots said: "We want to be involved as appropriate and we fully support the role of pharmacists in supplementary prescribing. It is too early to say at the moment how we will do this because the schemes are still being modelled. We think it will really help patients in accessing medicines."

View from Lloyds

Andy Murdock, superintendent pharmacist for Lloydspharmacy, was unwilling to reveal any future plans for supplementary prescribers but said the company was committed to the continuing professional development and training of pharmacists.

In a statement he added: "It is important to get pharmacists engaged in medicines management because of the crucial role this will play in the future of pharmacy. To meet this aim we are continuing to invest in the training required to ensure our pharmacists are equipped with the expertise and knowledge required to capitalise on these future opportunities."

Way ahead

Independent pharmacists and the multiples may be reluctant to commit themselves in practice to supplementary prescribing yet, but there is little doubt that they accept the potential benefits in theory.

The pace of change will depend on the minority of the profession who are willing to be innovators and take the risk while the majority hold back to see what works best and how they can ensure they are not left out of pocket — regardless of the boost to professional status the new role is expected to bring.