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AIBU?

To think the new see a pharmacist thing could be a disaster

147 replies

Dancebaby1989 · 06/02/2024 12:44

So really unwell yesterday and today- massive swollen tonsils, temperature, headache, red blisters in throat, tonsil stone. Decided to do an e consultation for GP and they booked me into to the pharmacist under the new government scheme- no issues at all.
get to pharmacist and he gets out a book of flow charts and when I explaining my symptoms is sat googling them and words from the flow chart- asked him if he need me to explain anything as am a nurse and he stated he had received no formal training they had just provided the flow charts.
end consultant and prescription complete but he never actually did any observations or even looked at my throat and while I know I need them I feel this is such a poor role out of this (not his fault) and could be dangerous

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LetsgoLego · 06/02/2024 14:41

oakleaffy · 06/02/2024 14:29

With shortage of certain drugs not having it in stock or rocketing in price is an issue.

I get a branded painkiller, but if the pharmacy can’t order it, they aren’t allowed to give a generic which is nuts.
It’s faff getting a new prescription and the old one cancelled.

I would go for the generic, except it doesn’t seem to be as effective.

Our Pharmacist is rushed off his feet- he’s always busy .
An independent not a chain.

It might be a local decision to restrict prescribing of that branded drug in which case the prescriber is at fault not the pharmacy.

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Jellycatspyjamas · 06/02/2024 14:58

We have had this system in Scotland for a while and I've used it a couple of times when I have had a UTI. I knew I had a UTI, have had them before, no underlying conditions. Quick 5 minute chat with the pharmacist and leave 5 minutes later with a prescription. Far better than seeing a GP.

Im in Scotland too and have had excellent service and advice from our pharmacist. They’ve also been clear when they think something needs a GP to have a look. Saves a lot of time for minor issues.

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ohtowinthelottery · 06/02/2024 15:02

I've had some pretty poor advice from Pharmacists in the past so share your lack of confidence.
One recommended a medication for my DD without asking if she was taking any other medication. If they'd asked that question (or even if she had any other health conditions) then he would have knows she was epileptic and that the medication he was recommending was not to be taken. Fortunately I had previously been told this by a doctor so was able to put him right. The same pharmacist also poo pooed the diagnosis that I was asking advice for medication on with a sneering "who diagnosed that ". When I said the name of the well respected local GP he changed his attitude.

One of the conditions that Pharmacists can now prescribe for is Shingles. A number of years ago I had a rash and tingling which I suspected was Shingles. Knowing that medication was needed sooner rather than later and that getting an urgent GP appointment was nigh on impossible, I went to a local pharmacy (not the same one in the previous events) and asked their opinion. They said the "thought it might be" and I should see my GP within 24 hours. I'm not sure if the "thought it might be" was because they were not allowed to diagnose at that point or if they just weren't sure, but given they will now be dishing out medication for Shingles I really hope that they did know but just couldn't say! Incidentally it was Shingles.

And don't get started on a Boots pharmacist who gave me a lecture on the cost of one of DDs medication - which had been prescribed by her Paediatric consultant.

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ehb102 · 06/02/2024 15:05

It will be good for stuff that is bad but routine to the patient. I get cellulitis twice a year, from mosquito bites. It's just my bad luck, I wear Deet from June to October but have had infected bites due to unseasonably warm temperature as early as Feb and as late as November. That's two appointments a year saved.

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Sidge · 06/02/2024 15:11

We need to move away from this historic train of thought that you need to see a GP for everything. Other HCPs and AHPs are more than capable of seeing certain conditions, especially minor ailments that are usually fairly simple to assess, diagnose and treat.

I just feel a bit sorry for community pharmacists who are getting more and more piled onto them.

For those asking what GPs are actually doing - drowning is the short answer...

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Medusaismyhero · 06/02/2024 15:15

When DS had scarlet fever last year, the pharmacist confidently told my MIL that his sandpaper rash was an allergy and got her to buy Piriton liquid. When I got home (from a funeral), I looked at the rash and checked his temp - he had quite a high fever and what was clearly a scarlet fever rash.

So no, I wouldn't trust them. Though TBF, I currently don't trust a good 75% of the NHS either so....

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Alwaysthesunandthemoon · 06/02/2024 15:21

I get regular infected insect bites which I can self-diagnosis and do need antibiotics so this will be good for that. I have had to go to A&E in the past due to no GP appointments.
On the other hand, my GP surgery already uses telephone consultations with a pharmacist for the majority of appointments. They cannot book you for a GP appointment if needed afterwards. It took me three months to see a GP with this system. The GP referred me to hospital and the wait for the first appointment there was quicker than the wait to see a GP!

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herewegoagainy · 06/02/2024 15:38

My local pharmacies seem to struggle just to fulfil the prescriptions. They are always very busy. And Boots always has quite a queue.

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AppropriateAdult · 06/02/2024 15:41

What sort of training do you get in diagnosis. @Berlioz23? Genuinely interested - as a GP pharmacists have saved my bacon dozens of times and we rely on them hugely for medication advice, but I wasn't aware they get any training in clinical examination and it seems an unfair burden to ask them to (for example) differentiate between viral and bacterial throat infections, or to diagnose rashes.

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WhatInFreshHell · 06/02/2024 15:54

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Berlioz23 · 06/02/2024 15:57

@AppropriateAdult I suppose it depends on the uni, but at mine we got quite a lot for rashes and ent, as I’m sure you can appreciate it would be very difficult to learn about the intricacies of how drugs affect the body, without knowing quite a lot about the human body itself. We get a lot of training on spotting red flags and knowing when to refer. Of course, like in medicine we also learn a lot after we’ve left university, for example for the pharmacy first scheme I’ve had a refresher on otoscope and throat examination, so personally I’m very confident I can spot red flags e.g. quinsy, epiglottitis, glandular fever, glue ear, mastoiditis etc. Of course it also depends on the pharmacist, they may have just remembered stuff to get through the course and not kept their learning up to date just like other HCPs could.
When I worked in hospital I took part in training junior doctors about prescribing, I was amazed at the pressure and responsibility they’re put under when a lot of their drug knowledge was quite poor. Of course that’s not their fault and they went on to be competent at prescribing safely in a couple of years with experience and knowing when to ask for advice, so I feel more confident that pharmacists will be able to do this safely and competently if they’re able to know their own competency and what to do if they need to increase their knowledge. At the end of the day these seven conditions are very easy to diagnose and most red flags easily identified with the right knowledge, the problem comes with the pressure to declare you’re competent before you feel you are. We only got access to the computer system the day it launched, so as you can imagine that was fun!

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Kerfuffleplunk · 06/02/2024 16:12

I just left a pharmacy that had made a number of clinical errors to do with their med dispensing….if a pharmacy hasn’t the time and staffing to offer their
basic services safely I don’t think adding extra services on top is going to help anyone.

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mumda · 06/02/2024 16:18

I want to see the flow charts!

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AppropriateAdult · 06/02/2024 16:20

Berlioz23 · 06/02/2024 15:57

@AppropriateAdult I suppose it depends on the uni, but at mine we got quite a lot for rashes and ent, as I’m sure you can appreciate it would be very difficult to learn about the intricacies of how drugs affect the body, without knowing quite a lot about the human body itself. We get a lot of training on spotting red flags and knowing when to refer. Of course, like in medicine we also learn a lot after we’ve left university, for example for the pharmacy first scheme I’ve had a refresher on otoscope and throat examination, so personally I’m very confident I can spot red flags e.g. quinsy, epiglottitis, glandular fever, glue ear, mastoiditis etc. Of course it also depends on the pharmacist, they may have just remembered stuff to get through the course and not kept their learning up to date just like other HCPs could.
When I worked in hospital I took part in training junior doctors about prescribing, I was amazed at the pressure and responsibility they’re put under when a lot of their drug knowledge was quite poor. Of course that’s not their fault and they went on to be competent at prescribing safely in a couple of years with experience and knowing when to ask for advice, so I feel more confident that pharmacists will be able to do this safely and competently if they’re able to know their own competency and what to do if they need to increase their knowledge. At the end of the day these seven conditions are very easy to diagnose and most red flags easily identified with the right knowledge, the problem comes with the pressure to declare you’re competent before you feel you are. We only got access to the computer system the day it launched, so as you can imagine that was fun!

Really interesting, @Berlioz23 - thanks for sharing!

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PharmaLlama · 06/02/2024 16:22

@AppropriateAdult Training depends on the Uni and also when you trained. I qualified relatively recently and my course had a strong focus on clinical skills and interpreting blood results. We learnt how to do full clinical examinations in all body systems and had practical exams on this. I’ve spoken to other pharmacists who definitely didn’t do as much clinical skills, particularly pharmacists who qualified many years ago.

The MPharm program has changed so much now that in the next couple of years all newly qualified Pharmacists will also be prescribers.

All pharmacists should keep up their skills though through CPD, and this is part of revalidation.

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ThursdayTomorrow · 06/02/2024 16:32

It’s the government’s policy to run the NHS to the ground. I truly don’t understand why they don’t fund it better. It’s so understaffed those who are left are quitting with burnout.

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Spacecowboys · 06/02/2024 16:55

Our pharmacist is an extremely valued member of the team and his advice is sought by junior drs and consultants in equal measure ( hospital based). I would have no concerns being seen by one in the community and it would actually be much more convenient for me than spending two hours on the phone trying to get through to a gp practice.

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TheShellBeach · 06/02/2024 17:25

Do pharmacies operate an appointment system now?

Or do people just drop in?

How is the other necessary and essential work of a pharmacy carried out if pharmacists are inundated with people asking for medical advice?

Our village pharmacy has no room for private consultations. This means that patients will have no privacy when asking for advice.

How will this work in practice?

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guineverehadgreeneyes · 06/02/2024 17:29

Midwinter91 · 06/02/2024 13:14

I imagine it will work well for simple issues like skin conditions, repeat prescriptions, gastro problems.

It's not intended to be used for requesting repeat prescriptions:

https://healthmedia.blog.gov.uk/2024/02/01/pharmacy-first-what-you-need-to-know/

Patients can now get treatment for seven common conditions directly from their local pharmacy, without the need for a GP appointment or prescription.

The Pharmacy First scheme was launched by the government and NHS England on 31 January 2024 to give patients quick and accessible care and ease pressure on GP services.

What is Pharmacy First? 

Pharmacy First will enable community pharmacists to supply prescription-only medicines, including antibiotics and antivirals where clinically appropriate, to treat seven common health conditions without the need to visit a GP.

  • What are the seven common conditions?
  • Sinusitis
  • Sore throat
  • Earache
  • Infected insect bite
  • Impetigo (a bacterial skin infection)
  • Shingles
  • Uncomplicated urinary tract infections in women.
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ALongHardWinter · 06/02/2024 17:33

Every single time I've asked for a pharmacist's opinion on something (infected insect bite,sore throat, possible ringworm patch) I've always been advised to see my doctor!

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TheShellBeach · 06/02/2024 17:38

Are pharmacists allowed to prescribe for babies and children?

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TheShellBeach · 06/02/2024 17:43

I asked our pharmacist for treatment for something once. It was on a list of conditions which could be treated by her.

She sent me to the GP and he told me to go back to the pharmacy. So I did and she told me she couldn't treat me.

So I gave up and bought what I needed from an online pharmacy.

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telestrations · 06/02/2024 17:47

I don't know about the new scheme but I do know that pharmacists can be great and for non-prescriptions I've had much more help from them then 111 or GP.

For typical prescriptions like the pill or antibiotics where there are no complications or long term health conditions or repeat prescriptions where no follow up is needed they are imo perfectly appropriate to prescribe and should be allowed to

What does need to be insured is that it is pharmacists and not just people who work in a pharmacy. And that it is flagged when someone does need a GP.

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PerfectYear321 · 06/02/2024 17:51

annonymousse · 06/02/2024 13:58

I wonder how long it will be before pharmacists start to crumble under the extra workload or find it's not financially viable and we end up with a situation like the nhs dentists.

Pharmacies are closing every week. Community pharmacy is dire at the moment.

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PerfectYear321 · 06/02/2024 17:59

Does anyone else get the feeling they're slowly replacing GPs? With GP surgery pharmacists doing medication reviews, hospital discharges and signing repeat prescriptions, physicians associates, advanced nurse and paramedic practitioners seeing illnesses and interpreting bloods, signing sick notes etc, soon what will be left that only doctors can do?

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