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Insight: Prescribing now and in the future


Insight: Prescribing now and in the future

By Alexander Humphries*

I’m half expecting to having to start performing open heart surgery in the pharmacy soon such has been the demand and the complexity of the problems of patients who are arriving at my door...

What used to be the occasional trickle of frustrated patients unable to see their doctor has become a torrent. I hardly know where to turn. We are effectively having to triage everything from potential cancers to severe eczema to tonsillitis.

As an independent prescriber at least I have been able to offer treatment in my area of competence to desperate patients who would otherwise have had very long waits.

However, frustratingly for everyone involved, despite saving huge expense for the NHS and causing massive inconvenience for patients, we are not trusted to write NHS prescriptions – so patients are having to pay sometimes very large sums in order to receive treatment.

Impossible position

One patient I saw recently with acute tonsillitis was struggling to speak or swallow. While this was not strictly in my scope of practice, I’ve been a community pharmacist for decades and I was confident in the diagnosis and management to be able to safely treat the patient.

She was concerned that she would not be able to swallow penicillin V tablets, so opted for the liquid, but the cost price for the recommended course was around £40.

By the time we added a consultation fee on top (only fair given the time taken, the clinical risk and the professional resource) it was costing her more like £60 – a lot of money for anyone during a cost of living crisis.

She understood we were trying to help her and also keep the costs reasonable and, having been told that she wouldn’t get a GP appointment for five weeks, she happily paid.

We are being left in an absolutely impossible position and, unlike general practice, there is no sign of the cavalry coming over the hill by way of extra resources. All deeply frustrating.

Current system relies on trust

We have seen an explosion in patients presenting private prescriptions from all sorts of random online providers in recent months, which is just a symptom of people not being able to see their GPs.

The GPs themselves will be unsighted to all of this activity which, in itself, will no doubt present serious safety problems in the future.

But when I think about all pharmacists being prescribers in the years ahead, I do hold concerns that more regulation and oversight will probably be inevitable.

The current system for pharmacist prescribing essentially relies on trust, with little oversight concerning an individual’s competence or scope of practice after achieving their IP status.

When I wrote about this subject recently, I received an email from a pharmacist who said that he didn’t think that pharmacists had any business in diagnosis. I disagree.

We are used to triaging patients and referring appropriately. We carry out a diagnosis every time a patient asks for OTC advice.

What is different now is the scope and complexity of conditions being seen in pharmacy. There is an urgent need for Health Education England to support community pharmacists with additional training in diagnostics – but please not another CPPE course.

We also need academics and companies to help us with more evidence-based tools to support diagnosis, whether this is something like Feverscan, or other validated tools that allow us to treat patients empirically without further tests.

All pharmacists are capable of prescribing – and doing it well – but it is essential to have the right support, accreditation and quality control processes in place to protect the public and, ultimately, pharmacists too.

We cannot afford to lose prescribing privileges as these are essential for our future success and the next generation of community pharmacy services.

*Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine.Are you an independent prescriber? If not, will you train to become one? Email

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