NHS / Pharmacy remodel?

[HufflepuffRavenclaw]

Frustrating experience with pharmacy this morning. DH has woken up with a rash down one side of his torso which I suspect is shingles. NHS website says no need to seek medical attention if no underlying condition, speak to pharmacist for advice on medication. Fine. DH drives to nearest pharmacy open on a Sunday. Pharmacist says there is nothing he can give, and that DH shouldn't even take piriton or use calamine cream without speaking to his GP first, and that DH absolutely MUST phone the GP first thing tomorrow morning. Which is absolutely not what the main NHS website says. 🙄

It is sensible that pharmacies deal with things which do not require a doctor's attention. We have minor ailments in Scotland whereby pharmacists can prescribe things like antibiotics for a UTI and give medication for common conditions for children and those over 60.

I lived in Spain for a few years and their pharmacy system is so much better. For a start, each town or suburb within a larger city has a rota system in operation so that there is a pharmacy always open 24 hours a day - there is a rota which is published online and in each of the pharmacy shop windows so you know who is on duty that night or weekend. Pharmacists can give medical advice and are well-respected in the community. The pharmacist is always the first port of call in Spain as it costs money to see the GP.

The nearest pharmacy to me which is open on a Sunday is miles away. Too far to walk. There are 15 or 20 pharmacies closer but all open 9-5 Monday-Saturday. And I live in a big city.

Our pharmacists are equally well-qualified and know what they are doing. They SHOULD be advising and helping and not passing the buck back to the GPs who are snowed under and don't need to be wasting time on things pharmacists could be dealing with. Yes there's a pharmacist shortage too, but give them a bit more responsibility and respect - for too long it's been see the doctor for everything, then pop along to the pharmacist to get the prescription dispensed. This needs to change.

YANBU

I grew up in EU country and they still have the pharmacy 24/7 rota you described - in addition to 24/7 rota for minor injuries & specialist help. Which is in addition to the local A&E. It was never a problem to find an open pharmacy on Christmas Day for example.

Hopitals there are now reporting winter pressures at 65% bed occupancy, not 95%. When I mentioned the hours of waiting for the ambulance or at A&E people were shocked. Yes you pay for some treatments but you can access it when needed.

I’m surprised that the nhs website says no treatment required. We usually advise antivirals which should be started within 72hrs of rash appearing in MIU. In my experience pharmacy’s are not confident in treating anything but the most basic conditions otc.

I’ve had great service from pharmicists in France while on holiday. Had an unpleasant, itchy rash on my neck and shoulders and they recommended medications and a cream which cleared it up in no time.

It’s interesting that the comments are largely in support of the OP but the poll is saying YABU (83%).

Who thinks the OP is BU and would they care to say more? I don’t think they are U.

I lived in Spain with small children too. The pharmacist was first port of call and excellent. They weighed the baby and did basic checks. Pharmacist could prescribe & do blood tests. They very quickly sent you to doctor if thought necessary. Much better system.

I'm not sure all UK pharmacists have comparable quals to Spanish ones. I think there's an extra diagnostic component which pharmacists would need to take in order to be able to fulfil the role you're talking about, but it's not compulsory. Can anyone more knowledgeable confirm?

There was a pharmacist talking about this on TV the other day.

They want to help but are overwhelmed by the amount of prescriptions/vaccines/consultations they are doing.

They couldn’t do what op says without considerable investment and of course more pharmacists. Its worn down like the rest of the nhs.

Also in Europe 90% of people working in the pharmacy are actual pharmacists in the Uk it’s just probably more 20%

You are right in that pharmacists should be given more respect and we do need a culture change in England certainly so patients do think "pharmacy first" but YABU for saying pharmacists are passing the buck. They are legally bound by many things, it's very layered and complex depending on individual patient circumstances so they certainly aren't passing the buck. But yes if the system in itself was overhauled to support pharmacists better and allow them more responsibilities across the board then yes it would better support for the NHS. Let's remember pharmacists also have a professional registration that they could lose if they make an error even if it's accidental. And I can assure you at the forefront of any registered healthcare professionals mind is am I making the best call for my patient, what if xyz happens and I could lose my license.

In my experience pharmacists are reluctant to advise and just tell you to see your GP. They're risk averse.

You are correct there is an additional element which is optional currently but I believe for future graduates it will be part of their initial university training. Currently prescribing pharmacists for the most part can only prescribe in community pharmacy privately so fees would be attached for all patients and in limited areas/circumstances legally.

I also think there are probably more pharmacists and fewer GPs in Spain - there seems to be a farmacia in even the smallest village.

It is also probably true that a pharmacy degree in Spain is more in-depth than in the UK as it is 5 years as opposed to the standard 4 years for an undergrad degree there.

It does seem though that the constant narrative is that we need more GPs and nurses but in fact, we need more pharmacists too, and more pharmacists who are prepared to give advice on basic health issues, do vaccinations, prescribe basics and not just fob people off and send them to the GP anyway - knowing fine well that at the moment people cannot get a GP appointment within a month.

(DH is fine, I messaged a friend who is a doctor and she suggested getting Zovirax cream and calamine cream and he is less sore and itchy. The NHS Scotland/Inform website says: "Shingles isn’t usually serious, but see your pharmacist as soon as possible if you recognise the symptoms. In most cases your pharmacist should be able to provide treatment, however they may recommend that you need to contact your GP practice for treatment if required.
You should see your GP if you are under 18 years old, pregnant or have a weakened immune system (the body's natural defence system) and you think you have been exposed to someone with chickenpox or shingles and haven't had chickenpox before.")

Who thinks the OP is BU and would they care to say more? I don’t think they are U.

Like so many in health and social care, they aren’t paid enough. Counter assistants and dispensers can earn the same money, working in supermarkets with less responsibility and training. Pharmacists are leaving community pharmacies. They can earn more as a locum, or go to work for a GP practice. Where DD works is always short staffed; they can have job adverts out for years. So, who would do this extra work?

They get abuse from customers frequently. DD is a dispenser - sometimes she’ll say, she’s had 5 abusive customers that day, and they are shouting at her, because they don’t like the pharmaceutical regulations or their GP has got it wrong. None of it is under her control! Her colleagues don’t like working on the counter, because of it.

DD doesn’t know of any pharmacies in the district, with a prescribing pharmacist!

It's not that at all, we can't recommend much. Nearly everything is prescription only in this country compared with the rest of Europe. I can only recommend what I can sell, otherwise I have to refer you to the GP as it's how our system works.

When I had a shingles type rash (I was pretty certain what it was as I'd seen it before) I went to the local pharmacist for confirmation. I too was told I needed to see a GP for antivirals. However, as I called in at the GP surgery on the way home, I was able to say to the receptionist that the pharmacist I'd already seen said I had shingles and that I needed to be prescribed antivirals today (tingling had started a couple of days before rash appeared). I was given an appointment for 30 mins later. That absolutely would not have happened if I hadn't seen the pharmacist first. So the visit to the pharmacist was worthwhile.

Whilst I'm happy to seek advice from pharmacists as a first point of call, they don't know my medical history so I'd be wary of them prescribing medication unless they asked a lot of questions - which would take up more of their time. They'd then not get their day job done!
I once sought advice from a pharmacist about an illness my DD had. Pharmacist firstly poo pooed the diagnosis (made by very experienced and respected GP) then recommended a medication without asking any questions about DDs medical conditions. He recommended an over the counter medication which she wasn't allowed to have due to being epileptic. Fortunately I knew this (as whether to give this medicine or not had arisen before with a GP) so I was able to refuse his recommendation. But if I hadn't the consequences could have been disastrous at best, fatal at worst.

Scotland here too.

You might have fallen outside the Pharmacy First scheme if the pharmacy he went to isn’t your usual nominated one. My pharmacy is pretty good but I can only go to the one connected to my GP records. Makes sense — they will have my medical records on file.

So if he just turned up at a pharmacy he doesn’t normally use, I’m not surprised they were reluctant to prescribe or recommend anything. They have no medical context.

Also, PF isn’t just for kids or over 60s. I can get all sorts ‘prescribed’ solely by my pharmacy, from paracetamol to fungal foot powder to earwax drops, and I’m neither a child nor over 60.

I work in pharmacy and we have one pharmacist who has to check repeat prescriptions, do consultations for Pharmacy First, serve the queue, check walk in prescriptions, do usual Pharmacy jobs like checking controlled drug cupboard, measure and pour methadone, makes sure no mistakes are made, do emergency supplies when people have forgotten to order their meds or the GPs have forgotten to send the scripts. There is never enough time in the day and the queue is always massive. I don't know how they're meant to do it all. They work long hours and are expected to do everything. And not a single customer gives a shiny shite how they treat them either. It's shocking.

Pharmacist here (previous NHS employee, not currently practising as pharmacist)

The UK degree is equivalent to EU ones - when we were member of EU, we could all work in each others' countries with no conversion (language tests required for obvious reasons).

The biggest problem in community pharmacy in UK is the focus on dispensing medication rather than clinical services. If pharmacist's time is taken up dispensing and checking prescriptions, it leaves less for vaccinations, consultations etc. The community pharmacy model needs to mirror that in most hospital dispensaries where the pharmacist provides a clinical check when the prescription is received (to ensure drug and dose is safe and appropriate for patient) and the rest is taken over by qualified pharmacy technicians. Pharmacists don't need to spend time sticking labels or checking the labels but they do because of poorly run pharmacies. This would then allow them to spend more time consulting. My personal experience with many has been reluctance for all things clinical because they are so overworked with dispensing so they automatically say go to GP

The other issue is prescribing. Pharmacists have not previously been able to prescribe - it is an additional qualification. Many are doing the course now but it is not easy - they need another prescriber (usually doctor but could be experienced pharmacist) to mentor them which takes up the mentor's time but they are not paid for it. They also need to shadow clinics and conduct their own in work time which the employer has to facilitate. The government have just started funding the course for community pharmacists so that removes the uni fees but they still have the other barriers.

There needs to be a complete overhall of roles which leads to pharmacists focusing on seeing patients and the dispensary run by qualified technicians (they are much better at running it than us anyway!). There are some independent pharmacies near me who do this and focus the pharmacist time on advice, specialist clinic (depending on pharmacist expertise), vaccinations, travel clinics. They are fantastic and the model needs to be more widespread

I saw a pharmacist about my shingles and he advised a Gp appointment so I could get the antivirals - really made a difference as I caught it early.

YABU. What “overhaul” are you expecting? The pharmacist has diagnosed and knows what the correct treatment is but they aren't allowed to prescribe it. That isn’t their fault. I don't think that pharmacists in the EU can prescribe antivirals for shingles either which is what you need soon as possible.

There needs to be a complete overhall of roles which leads to pharmacists focusing on seeing patients and the dispensary run by qualified technicians (they are much better at running it than us anyway!). There are some independent pharmacies near me who do this and focus the pharmacist time on advice, specialist clinic (depending on pharmacist expertise), vaccinations, travel clinics. They are fantastic and the model needs to be more widespread

It's only going to be widespread if it is seen as profitable by the businesses that own the pharmacies though.

I’ve had shingles 4 times. I’ve always seen my Gp for anti vitals to reduce the pain.

The NHs site is incorrect. You need to catch it early.

Which NHS website are you looking at? No mention of see the pharmacist here www.nhs.uk/conditions/shingles/

The reality is that we can't provide prescription only medicines without a prescription.

Surely pharmacists could work under PGDs like they do for vaccinations though? That’s what we (nurses) did prior to becoming prescribers