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Xrayser: Why is the NHS now expecting us to diagnose scarlet fever?

Xrayser asks if NHS England's latest pharmacy awareness campaign is focusing on the correct conditions

When I first registered as a pharmacist, my favourite book was called Minor illness or major disease. This over-the-counter prescribing guide gave differential diagnoses – essential for answering the question: “Is this a nosebleed or a brain aneurysm?” – and was invaluable preparatory reading for the many Ask Your Pharmacist campaigns there have been since then.

I used to like the old campaigns that had pictures of a confused parent staring at a bottle of linctus, with the caption: “A supermarket shelf can’t tell you the best cough mixture for your child.” Of course, these days no one can tell you the best cough mixture – as they’re all just syrup, and anyway, the local pharmacy has closed down.

But never mind, because NHS England launched its latest Ask Your Pharmacist-style campaign last week. Except that instead of ailments like coughs and colds, the issue is that it might be us diagnosing scarlet fever and meningitis. By some perverted logic, someone has said: “There are no GP appointments, the hospital is full of people with sore throats and backache, and there's no one left to deal with measles and sepsis. I know – let’s send them to pharmacy!”

When this hit the headlines, parents and doctors were aghast, adamant that 'smarties counters' can’t possibly tell the difference between a happy healthy kid with a snotty nose, and one that's feverish, blotchy, lethargic and emetic, declaring we'd simply sell a bottle of placebo syrup for both.

Meanwhile, we poor pharmacists are stuck in the middle of all this. We don’t claim to be diagnosticians – even though we do that every day – because the doctors get in a huff, as if they’re the only ones who can recognise a shingles rash.

If there’s one thing our years of experience makes us particularly good at, it’s knowing the limits of the diagnostic support we work with. For all the brickbats thrown at our profession, it’s rare to see such headlines as: “I was vomiting blood and my pharmacist sold me some Gaviscon.”

For objective evidence, consider the cost of indemnity insurance for pharmacists compared to GPs. If there’s one thing insurance companies do well it's assess risk, so they obviously recognise that we are very good at signposting onwards.

What this does emphasise though is our need for preparedness. With rates of scarlet fever on the rise, I’ve ensured the symptoms are on our red flag checklist – along with those of meningitis and sepsis. But we also need national and local guidelines to support urgent referral from pharmacy, as well as bypass numbers for GP surgeries, and for reception staff to put us straight through to a duty doctor for advice.

Because despite having sent several patients direct to A&E, and recently called an ambulance for a lady with “indigestion” that was, in fact, a pulmonary embolism, I don’t want to be a replacement for an emergency medical assessment. But neither do I want to be just a replacement for a supermarket shelf.

Pharmacy Dispenser/ Technician
Bethnal Green North, London
Salary: Up to £30,000

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