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When can we have a health secretary who knows something about health?

Reports that Thérèse Coffey handed antibiotics out to family and friends overshadowed her announcement that she would like to see pharmacists giving out antibiotics. GP Toni Hazell explains why this matters

"No one in this world has ever lost money by underestimating the intelligence of the great masses of the plain people." It is debatable who actually said this, and as a comment it’s pretty offensive.

But perhaps in our current times it should be rephrased to: "No one in this world has ever lost money by underestimating the intelligence of politicians."

I thought that everyone knew that antibiotic resistance is a bad thing. It’s 2022. Three years since the World Health Organisation declared antimicrobial resistance to be one of the top ten threats to global health. Eight years since the UK government raised a concern that minor surgeries could become high risk procedures if we can no longer effectively treat infection.

Read more: The Thérèse Coffey antibiotic-sharing reports leave a bitter aftertaste

Antibiotic resistance is on the national curriculum and has even featured on Newsround. If it’s on the radar of primary school children, it shouldn’t be too much to hope that it’s on the radar of the secretary of state for health and social care.

Yet astonishingly, media reports have emerged that Ms Coffey told civil servants in September that she had shared her leftover antibiotics with a friend who was ill. In one fell swoop, this points to to a criminal offence under Section 214 para 1-4 of the Human Medicines Regulations Act 2012 and to promoting resistance by not finishing a course of antibiotics that she was prescribed.

Social media up and down the country was littered with facepalm emojis and words that are not suitable for a published blog.

Read more: Thérèse Coffey: What is the new health secretary’s history with pharmacy?

This admission hit the headlines and in many ways overshadowed discussion of the substantive point – her plan that more pharmacists should be able to give out antibiotics. This isn’t new – in many areas pharmacists can already prescribe for a simple urinary tract infection (UTI) in a woman who isn’t pregnant, for conjunctivitis, and for bacterial sore throat.

So, leaving aside the justifiable ridiculing of a woman who thinks that primary care is held together by doctors, dentists and chiropractors (but apparently no nurses, healthcare assistants, pharmacists or physiotherapists), is it a good idea for antibiotics to be made more widely available in pharmacies?

The main argument for this scheme is probably access. As of August 2022, we have 1,850 fewer whole-time equivalent GPs than we had in 2015. With the aftermath of COVID-19 to deal with, and a media that seems determined to ratchet up demand for appointments, it’s no surprise that getting to see a GP can be difficult.

In that context, I would fully support schemes that allow women with a UTI to get antibiotics over the counter. There are clear guidelines under which antibiotics can be given out based solely on a patient's history. Because a urine dip won’t add much to the positive predictive value of the history, the schemes have sensible safe exclusions, and the courses given are usually short.

Read more: Liverpool pharmacists to treat UTI and sore throat in extended service

I’m a bit more dubious about antibiotics for sore throats and conjunctivitis. I can’t remember the last time I gave penicillin for a sore throat. Even if someone has a full house Centor score (pus on the tonsils, fever, enlarged lymph nodes and no cough), the likelihood of a bacterial infection is 56% at most.

A course of antibiotics only shortens symptoms by about 16 hours, and even when there is a positive throat swab for Streptococcus, you have to treat four people with antibiotics for one to benefit.

With up to 25% of people getting diarrhoea from antibiotics, it is debatable whether the likelihood of benefit outweighs the risk of harm. If anything new is going to be made available over the counter for a sore throat, it is arguable that it should be a single dose of dexamethasone rather than antibiotics.

Similarly, conjunctivitis is often viral and, even when bacterial, usually resolves within five to seven days without treatment.

It’s a very stressful thing for parents to go through when they have a miserable child with an itchy, watery eye. The temptation to get them on chloramphenicol is strong, if only to feel like you are doing something and to fit in with school or nursery rules that often require two days of drop use before the child can go back, despite clear public health advice that exclusion is not needed.

But it’s often not the right thing to do medically. I’m not sure that we need to be widening access to antibiotics for conditions that rarely need them.

And then there’s the wider picture. I groan inwardly when a single-issue pressure group goes on the radio and says GPs are ideally placed to do the thing they want providing on the NHS.

I wonder what, out of our current workload, they want us to drop, in order to do this thing. With a current shortfall of 3,000 community pharmacists in England, I can’t imagine that there are many pharmacists sitting around, twiddling their thumbs, waiting for the secretary of state to find them some work to do.

I wonder what Ms Coffey would like you to stop, in order to have time to give out loads of antibiotics?

Read more: Shortfall of 3,000 community pharmacists in England over 5 years, CCA claims

Sigh. I suppose the only light at the end of the tunnel is the fact that at current turnover rates, by the time you are reading this blog, we’ll probably have been through another few health secretaries.

Surely sooner or later, just by random chance, we must get one who knows what they are talking about. Mustn’t we?

Toni Hazell is a GP based in a practice in London

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