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Opinion: What would you put in pharmacy's Room 101?

If I was asked what aspect of pharmacy should be banished to the fictitious Room 101, the conference room at the end of the first floor of the BBC’s old Broadcasting House and the torture chamber of The Party in Orwell’s 1984, it would have to be... prescriptions, argues Steve Mosley

My reasoning for putting prescriptions into Room 101 is because they give lie to the fundamental flaw at the heart of current medicines regulation, namely that the supply of medicines is illegal. 

The structure of the 1968 Act and everything that has followed it goes something like this: “No person shall…”, followed by a description of manufacturing, packaging, marketing, selling or some other action to do with medicines. Then there is a section headed ‘Exemptions relating to…’ followed by an even longer list of exemptions.

The net effect of this is that pharmacy isn’t anything without being registered (an exemption) and even then can’t function without having a pharmacist (a person with another exemption).  The supply of a medicine isn’t legal without it being a GSL or P (exemptions) or against a prescription (an exemption).


Every action has its intended and unintended consequences. There can be little doubt the legislative framers of the late 19th and early 20th century were acting in good faith to prevent disreputable hawkers of patent medicines and poorly dosed opiates. 

Indeed, it was often because of the lobbying of the Pharmaceutical Society and the BMA that these early restrictions were enacted. Yet those same framers would not, could not, have anticipated the prohibitive legislative environment that exists today.

“Some of the pressure primary care is under right now would be alleviated if the bottle neck that is imposed by prescriptions was removed”

More logical way?

A much more logical system would be one where medicine supply was enabled. A diagnostician would – post-diagnosis – refer their patient to a pharmacy to receive treatment. That treatment would be within a framework (often a cost framework) and the pharmacy would agree with the patient a treatment plan within that framework. After all, this is what used to happen before those pesky patent medicines kept being adulterated with opiates and cocaine.

What started at the turn of the 20th century was being regretted by the end. By 1995, the same Society that encouraged the legislators 100 years earlier was urging for a return to treatment plans and frameworks of care in their Pharmacy in a New Age initiative, belatedly recognising the box in which community pharmacy was trapped. 

A prescription is also a form of payment, and aside from a small block grant, it is worth remembering that hospitals are paid similarly. After referral by a GP, they receive a fixed payment under a framework for treating a condition. 

It seems incontrovertible that some of the pressure primary care is under right now would be alleviated if the bottle neck that is imposed by prescriptions was removed. A simple review of the number of serious shortage protocols over the past two years would support that view. Transitioning entire therapeutic areas to treatment plan referrals rather than prescription-based episodic care could be transformational.

Long have stood the heckles that the commercial interests of pharmacists de-legitimise their role in such systems. But a solution that moves the conversation on must be found, for if a solution is found for community pharmacy, then it is found also for primary care.

The current proposal is that flooding the system with prescribing pharmacists will bring salvation, but that is a smoke screen. There have been independent prescriber pharmacists working in community pharmacy for decades. Yet they can’t actually work as prescribers because the guardians of the treatment budgets won’t share. And without reform of those financial controls, nothing will change.

The same reforms needed to enable the new pharmacist prescribers are those that would enable the devolution of prescribing to treatment pathways. And it could happen now. It is not about the prescription; it is about who controls the flow of money. So let’s get rid of prescriptions and sort out what is really important – the money patient.

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