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Claims Pharmacy First could fuel antibiotic resistance ‘disingenuous’

The long-awaited England Pharmacy First scheme has come under attack from a group of scientists who claim that enabling community pharmacists to treat seven minor illnesses could lead to antibiotic resistance.

Earlier this month (May 9), NHS England (NHSE) announced that a national Pharmacy First service will be launched in winter 2023, “subject to consultation”.

The service is part of a two-year £645m government investment designed to “expand community pharmacy services” in England and will allow community pharmacists to provide prescription medication to patients for seven common conditions.

Read more: Pharmacy First set for national launch ‘by end of 2023’ following consultation

But the new service - announced as part of the government’s primary care recovery plan - has garnered criticism from a coalition of fourteen scientists.

In an open letter to Prime Minister Rishi Sunak, published in The Telegraph last week (May 16), they claimed that enabling pharmacists to treat seven common ailments could lead to antibiotic resistance.


“Unintended consequences”


The letter said that the group “applaud the government’s initiative of empowering community pharmacists to prescribe medicines for some common illnesses in order to reduce GP workload, cut waiting lists and alleviate the pressure on the NHS”.

However, it warned that “unless it is implemented with due consideration given to antibiotic resistance, such an initiative could lead to unintended consequences that would reverse the gains it makes”.

Read more: Pharmacy First: Community pharmacy should wait and see what happens next

The scientists suggested that the scheme could cause the over-prescribing of antibiotics.

The letter highlighted that three out of the seven common ailments in the scheme - ear infections, sinusitis and sore throats - “can be caused by both bacteria and viruses, and viruses are the more frequent cause for all of them”.

“Antibiotics, such as those that would be prescribed by pharmacists, are ineffective for viral infections and could also contribute to the public health crisis and spread of antibiotic resistance,” it said.


“Inappropriate antibiotic use”


The group said that diagnostics would “prevent inappropriate antibiotic use and the rise of antibiotic resistance that it would lead to”.

They would also “lead to better prescription decisions”, they added, giving the scheme “the best chance of avoiding extremely serious unintended consequences” such as “inadvertently escalating antibiotic resistance”.

“Pharmacists would be far better supported in taking on the responsibility of prescribing medicines for these conditions by specific rapid diagnostic tests and appropriate training in their use,” the letter said.


“Don’t accept the premise”


But pharmacists hit back at the claims in this letter, branding them “disingenuous”.

“We don’t accept the premise that allowing pharmacists to initiate antibiotics will increase antimicrobial resistance”, the National Pharmacy Association’s (NPA) director of corporate affairs Gareth Jones told C+D.

Read more: Public ‘overwhelmingly’ backs Pharmacy First, PSNC survey reveals

He stressed that pharmacists are “highly trained and will only initiate treatment after careful consideration of the appropriate options”.

However, he added that where clinical guidance does suggest the use of rapid diagnostics prior to prescribing, all healthcare professionals including pharmacists should incorporate that advice into their practice”.


“Absolute confidence in pharmacists”


Hitesh Patel, CEO of Pharmacy London, told C+D that “to assume that community pharmacists will be prescribing antibiotics inappropriately or overprescribing them is disingenuous”.

“The writers should have spent their energy in promoting rapid diagnostic checks throughout primary care,” he said.

Read more: PSNC: Pharmacy First must not be left to ‘piecemeal’ local commissioning

He questioned whether the authors of the letter are suggesting that GPs and nurse prescribers “are not overprescribing antibiotics” or that they are “trained better in understanding medicines” than pharmacists.

“I would really welcome the opportunity for community pharmacists to be able to use rapid diagnostics to make their antibiotic prescribing choices, but until that happens, I have absolute confidence in community pharmacists using their knowledge and decision pathways to appropriately prescribe antibiotics,” Mr Patel added.


“Experts in medicines”


Dr Leyla Hannbeck, CEO of the Association of Independent Multiple Pharmacies (AIMp), also stressed that “pharmacists are experts in medicines and very much aware of the issues around antibiotic resistance", saying they “have been championing this in their practice”.

She told C+D that AIMp is “aware that antibiotics continue to be prescribed by some GPs over the phone without seeing the patient because GPs surgeries are under pressure”, including in instances where pharmacists advise other treatments without the need for antibiotics.

Dr Hannbeck added that the Pharmacy First scheme “will allow patients to be seen face to face” and pointed out that pharmacists will be following both NICE guidelines and patient group directions (PGDs) that will have been drafted with involvement of a medical director.  


“Guardians of antibiotics”


And James Davies, director for England at the Royal Pharmaceutical Society (RPS), told C+D that “pharmacists play a pivotal role in providing daily advice to patients regarding ear infections, sinusitis and sore throats, many of which are caused by viruses and do not require antibiotics”.

“By offering reassurance and over-the-counter products to alleviate symptoms, pharmacists already contribute to reducing unnecessary GP appointments and act as guardians of antibiotics, ensuring their appropriate use for the present and future,” he added. 

Read more: Step A: Are we creating a bigger problem with a short-sighted solution?

“Pharmacists are already very skilled at providing advice on antibiotics and have a deep understanding of antimicrobial resistance,” Mr Davies said.

He added that the seven ailments included in the scheme were based on “their successful piloting and testing before national implementation”. 

Read more: Strep A: Why battling against antimicrobial resistance isn't futile

“Pharmacists have safely provided antibiotics to patients for many years and have actively contributed to the reduction of antimicrobial resistance in both community and hospital settings,” he said.

“We look forward to these services being implemented within England, ensuring patients get access to the right medicine and advice for their condition from pharmacists,” he added.

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