Why not let pharmacists prescribe medication?

It started as a small red shadow on my nose that gradually began to spread as the inflammation took hold. Soon the lesion was painful. A golden crust appeared and my suspicions were confirmed: impetigo.

Impetigo is an incredibly infectious skin condition – and if left untreated, it can scar. Topical antibiotics – fucidin ointment – work a treat, but I had just moved to London and had no GP in the city.

I wasn’t too worried, though. The importance of the ‘multidisciplinary team’ had been branded on to my brain from day one of medical school and so I called my nearest Boots. ‘I have impetigo,’ I told them, ‘and I’m looking for fucidin.’ I was to come in and ask for the pharmacist, they said. So I did exactly that.

Peering over the top of his glasses, the pharmacist wrinkled his nose. ‘It does look bad,’ he murmured, and then shuffled the papers in front of him and pulled out some form of impetigo checklist. It didn’t feel necessary. I clearly met the criteria. He asked me some questions. I answered them. ‘You’ll have to go to your GP,’ he said at last. ‘You need an antibiotic for this.’

‘I was told I could get that here,’ I replied. He shook his head, eyes already on the customer behind me. ‘We can’t prescribe you antibiotics without a prescription from your GP.’ ‘My GP is in Glasgow,’ I said, and it was a Sunday. ‘Phone 111,’ he advised. ‘You need to get it treated quickly. Today.’ Really? I could see the cream only a metre behind him.

I phoned 111, listened to the pre-recorded message about going straight to hospital if you have chest pain, and felt like an idiot. An hour later, I was still on the phone. ‘You’ll have to go to your nearest A&E,’ the woman on the line told me. A&E? I had a rash on my nose.

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Simon Cook

Pensioners have never had it so good

If I’d felt like an idiot phoning 111, it was nothing compared with how it felt to be sitting, three hours later, in an A&E waiting room with a patient vomiting on one side of me and a groaning man, head in his hands, on the other. I kept apologising to the staff. They didn’t seem especially surprised. ‘This is what happens on weekends,’ one said.

A&E waiting times have reached record highs in recent years. Trying to get an appointment with your GP is a challenge, too: doctors are overworked and patients aren’t getting seen quickly. The issue isn’t a lack of money (when it comes to health spending, the UK is the fifth highest in the 32-member OECD), it’s how the money is spent. The way the system is organised needs to change.

Why couldn’t that pharmacist simply have passed me the cream? The problem is that pharmacists are not automatically allowed to prescribe when they graduate after five years of education. Despite their courses being the same length as a medical degree, pharmacists lack the clinical decision-making their medical counterparts see as vital for any clinical setting. No, if pharmacists want to prescribe the medicines they’ve spent so long studying, they have to do an additional course on top of their five years. This is optional, and so many haven’t done it. Of almost 27,000 community pharmacists in England, only 1,000 have completed an additional prescribing qualification.

It doesn’t have to be this way. In France it’s easy to get wound care, such as stitches, at the chemist. In American states such as Florida, independent pharmacists have been prescribing for years, and in other states chemists can prescribe alongside a doctor. In Canada, pharmacists with prescribing rights can write up scripts independently, while in New Zealand, legislation has been introduced enabling appropriately qualified pharmacists to prescribe.

There are signs that change might be coming to the UK – albeit slowly. In December 2020 the General Pharmaceutical Council approved new standards for education and training, ensuring that pharmacists who graduate in 2026 will leave as prescribers. ‘With these course changes, all pharmacists will be prescribers and so will be able to treat urinary tract infections, ear infections and upper respiratory tract infections,’ a senior pharmacist working in medical education told me. ‘The aim is for pharmacists to run COPD (chronic obstructive pulmonary disease), asthma and diabetes clinics.’

Data from Scotland suggests that enabling all pharmacists to prescribe antibiotics for urinary tract infections alone could save 400,000 GP appointments a year – and approximately £8.4 million.

This year, the Core Advanced Pharmacist curriculum was introduced by the Royal Pharmaceutical Society to help bridge the gap between the scientific and clinical sides of their work. Scotland is a slight step ahead with its ‘Patient Group Directive’ and ‘Pharmacy First Plus’ service which allows independent prescribers to treat patients with common conditions, but this remains a contrived, tick-box process. Next year, a trial of independent prescribing services for pharmacists in England will begin, a test for a wider rollout of independent prescribing services: the first NHS-funded independent prescribing service in England.

While the vision is admirable, the timeline is not. Former health secretary Sajid Javid was ready to roll out ‘Pharmacy First’ plans for England last year, but the scheme was squashed by Boris Johnson’s No. 10 at the final hour due to fears that it could look too anti-GP. But emergency departments are crumbling now; patients are struggling to access GPs: 2026 feels too far away. As the NHS struggles to deal with the post-pandemic fallout, the volume of patients who require help is multiplying all the time.

And then there’s medication supply-chain problems and prescription waiting times in pharmacies that already are usually upwards of 20 minutes. If the plan is going to succeed, patients also need to be prepared to stop calling their GP and go straight to the chemist for minor ailments.

My impetigo has gone. Thankfully I wasn’t left with a scar. It worked out fine, if you can call a five-hour hospital wait ‘fine’. But if I’d been prescribed fucidin by my pharmacist, I wouldn’t have taken up a space in the virtual phone queue – or the very real hospital one.