Mixed reactions to reforms allowing easier access to prescriptions from pharmacies

Image above: prescription medication is set to become easier to get under new proposals announced by the Government and NHS England

Plans for pharmacies to offer more prescriptions for common ailments announced

Millions of patients across England will soon have easier access to prescriptions for common ailments after the Government and NHS England unveiled plans meant to alleviate the strain on GP surgeries.

Under the proposed reforms, individuals suffering from conditions such as earache, sore throat, sinusitis, impetigo, shingles, infected insect bites, and uncomplicated urinary tract infections (UTIs) in women will be able to obtain medication directly from pharmacies, without the need for a doctor or nurse consultation.

Health leaders have broadly welcomed the proposed reforms, acknowledging their potential to revolutionise patient care. Thorrun Govind, chair of the Royal Pharmaceutical Society in England, has praised the plan as a “real game-changer” for patients.

The primary objective of these initiatives is to alleviate the burden on GP appointments, with the aim of freeing up a staggering 15 million appointments over the next two years. This move comes in response to recent data showing that over the past five months, 24 million consultations were scheduled more than two weeks after the initial patient request, averaging nearly 5 million delayed appointments each month.

But what do people working in local pharmacies and GP practices think of the proposals? I spoke with some of Chiswick and Brentford’s pharmacies and the manager of one of Chiswick’s busiest GP practices.

Image above: Library image, prescription pills

Changes are “not really anything of help” says Chiswick GP manager

The manager of one of Chiswick’s busiest doctors’ practices spoke to The Chiswick Calendar on condition of anonymity about the proposed reforms. They were skeptical of the changes, taking into the wider context of NHS funding.

“I think the Government is very misguided in everything, all the things they’re doing for the NHS. They’re spending money in the wrong way completely.”

“We already have pharmacies who are prescribers and they also work within our practices, they help the doctors quite a lot with prescriptions and prescribing. The pharmacies that we know are already very busy, I think they’re in a worse situation than GPs because they get people complaining and going there and all sorts of queries come to them anyway, so I don’t know what more they’re going to have to be doing having to prescribe as well.”

They also thought once pharmacies started prescribing drugs, GPs would still receive the follow up queries about when and how to take the medication and what the side effects might be. Contrary to the intention, they thought GP surgeries would be likely to see a spike in queries once pharmacies are allowed to prescribe more medications.

“We get more queries about the medications [after patients start a new medication] than anything else” they said.

“What’s going to happen is they may prescribe something, then the patients will still come back to GPs because this side affect has happened. They’ll still want to see a doctor for many things. They feel better reassured seeing doctors.”

Asked why the Government decided to make the change in the first place, the practice manager said:

“I just spoke to one of our GPs, and she said so it shows that they’re doing something to the public. It’s a perception, it’s not really of help.”

Image above: Paracetamol

Government “ought to be more concerned” about level of prescriptions people are taking

The practice manager also said they were concerned the proposed reforms may lead to excessive prescribing, and that they were frustrated with the lack of communication from the Government.

“I think this will lead to an awful lot more prescribing than is required. I can give you one example, my own example from years ago. I would have been very grateful for a pharmacist to prescribe me antibiotics because I had a dental abscess, and I felt that was the way to go. But actually, I didn’t need the antibiotic I just felt I needed it. I saw the dentist, he sorted me out and I was fine without taking the antibiotics. I think in this way there may be extra antibiotic prescribing when it may not be needed.”

Rather than making it easier for patients to get prescriptions, the practice manager said the Government “ought to be more concerned about how many prescriptions people are taking”. They said GPs are not properly monitoring, especially among elderly people on repeat prescriptions, to see how they are getting on with any new medications they have been prescribed.

“Once they’re on them, they’re just on them. They’re not looking at the side effects, they’re not seeing how the patients are feeling themselves, the patients can’t feed back easily to GPs to see what’s causing what… they’re just piling more medications to mitigate effects of other medications.”

“I have an elderly friend who is 86, he’s on repeats. He’s got liver damage. He used to be a keen judo player but he has had two hip replacements. He had twinges of pain and this, that and the other. He was prescribed strong painkillers over a period of time, and they say take two three times a day paracetamol. He never ate very much, he had bleeding ulcers, he’s now got liver sclerosis. He doesn’t drink alcohol, has had a healthy life but this is all because of the medication. 

“He’s now suffering from his lungs filling up with fluid because his liver is so badly damaged, he ended up with a fall, and still they give him repeat prescriptions of paracetamol. I asked him if he was in pain and he said no, so I asked “why are you taking them?” and he said: “they come as a repeat”.”

Images above: Alpa and Jai Parmer, Churchill’s Pharmacy

Churchill’s Pharmacy, Chiswick High Road – The scheme needs proper funding

Jai Parmar, owner of Churchill’s Pharmacy at 202 Chiswick High Road, believes that providing additional services, such as prescribing for UTIs and minor ailments, is a good idea as long as pharmacies are properly funded. He said the change may increase the day-to-day workload of pharmacies but emphasised the importance of keeping up with evolving healthcare practices.

“It’s a good idea if they pay us well,” Jai told The Chiswick Calendar, “or pay us appropriately I should say.”

He added: “To be honest, a lot of pharmacies are doing a lot of the services privately anyway, we do a private service for patients. It’s just moving on with the times with all the electronic prescribing and GPs online consultation, I think it’s just keeping up with what they’re doing now.

“It should have been done years ago. I think they’re building a bit more trust on us, on what we can do now. I think we will probably help them building that trust showing we can actually do the job.”

Asked if he anticipated any problems that might arise from allowing pharmacies to offer more prescriptions, Jai said:

“If it’s antibiotics, the only danger there is patients obliging us to prescribe more and more antibiotics repeatedly which will lead to antibiotic resistance. I think GPs are able to control [antibiotic prescription] much more, not that we can’t I think we are able to control it as well, but I think we’re a bit more friendlier than general practice so if [patients] want something they’ll probably try and twist our arm saying they need it.

“It needs a firm sort of stance on that and when we say no, no means no. It will just depend on the pharmacist and how they deal with it, but as drawbacks go I think the only other drawback will be staffing levels and with the minimum wage going up that’s going to impact us as well. It might not be cost effective to have another member of staff so it could be an issue.”

Images above: Rachel Patel, Sabel Pharmacy

Sabel Pharmacy, Chiswick High Road – Good idea to solve the pressure on GP appointments

Rachel Patel, co-owner of Sabel Pharmacy at 44 Chiswick High Road, likes the idea of more pharmacists being able to prescribe. She highlighted that similar practices are already in place in Scotland and Wales, where pharmacists are prescribers in their own right.

“Theres a bit of a difference between me prescribing something in my own right and this, it would be slightly different,” said Rachel. “For example it would be similar to what we do now with flu jabs and what we do for travel vaccines and numerous other services we do very similar things. So they will lay down strict guidelines, these are the conditions you can use it for these are the patients you can use it for, etcetera.”

Rachel said she believes the reason the Government say they are making the changes. She says there are issues with patients accessing GP services, particularly for acute conditions: “They might not be able to see them as quickly as they would like. We get a lot of people who say they can’t get an appointment.”

Though broadly welcoming, she stressed the need for proper funding otherwise it just would not feasible for pharmacies to take on the extra workload:

“If we’re expected to do it for absolutely nothing on top of everything else, then that’s not going to be feasible. We just can’t do that.”

Rachel did not seem convinced the new rules would lead to a spike in patients accessing antibiotics who might not need them.

“I would hope the vast majority of us wouldn’t give them out willy nilly,” she said, “we make sure we follow guidelines and people have symptoms. We don’t just give them out willy nilly to people who don’t need them… We have seen, where I’ve said no to someone because they don’t need it and then they’ve gone to an online GP and got a prescription for antibiotics… There are some papers done on prescribers, and actually pharmacists were found to be the safest prescribers even compared with GPs.”

Images above: Jude Bostock, Morrisons Pharmacy Brentford

Morrisons Pharmacy, Brentford – Heard about it on the news. It might have been nice to be consulted.

Jude Bostock, a dispenser at Morrisons Pharmacy, was critical of the plans. He said many pharmacies were not equipped to handle the extra workload and worries patients may flood pharmacies with demands for antibiotics without proper assessment.

“We’re lucky to have staff and a proactive pharmacist so it could be worse, but most pharmacies will not have the staffing capacity to handle it. They’ll probably be queueing out the door just to say the news said I can get antibiotics here.

“The NHS is preaching about antibiotic safeguarding, help stop antibiotic resistance by only taking them if absolutely needed, but doctors already hand them out like sweets, imagine if you can just come and demand them.”

Jude worries that with antibiotic stock levels already at what he describes as “the worst I’ve ever seen”, patients who actually need antibiotics could be forced to go without if there is a fresh spike in demand from a new over-the-counter service.

He was also frustrated at the continued lack of official communication from the Government and NHS England, as he and his colleagues only found out about the proposed reforms from reading the news.

“We heard about it on the news, there’s not been any official comms to pharmacies.”