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Pharmacists could supply high-dose statins without prescription

Simon Stevens: High-dose statins should be available on the high street

High-dose statins could be reclassified to enable pharmacies to supply them without a prescription, NHS England has announced.

A new review – led by England's chief pharmaceutical officer Keith Ridge and newly appointed medical director of primary care Dr Nikita Kanani – will determine how high-dose statins can be “safely available” over the counter, NHS England announced yesterday (September 4).

Dr Kanani and Dr Ridge’s findings will be presented to manufacturers and the Medicines and Healthcare products Regulatory Agency (MHRA) – which “will have the final say” on whether high-dose statins should be moved from prescription-only to pharmacy (P) medicine status.

Speaking at the Health and Care Innovation Expo event in Manchester yesterday, NHS chief executive Simon Stevens said: “The NHS will now work with the MHRA and industry to see how we can best make this happen.”

“Highly trained health professionals”

“Pharmacists are highly trained health professionals, who are greatly valued by patients,” Mr Stevens said. As the NHS looks to combat the risk of heart attacks and stroke, “it makes sense to consider whether there are a broader range of medicines that patients could access conveniently and locally on the high street”.

Making high-dose, cholesterol-lowering drugs available over the counter “could prevent thousands more deaths and countless more heart attacks and strokes”, NHS England claimed.

Dr Ridge said: “Hundreds of thousands of people could benefit if industry committed more research and investment in bringing high-dose statins to the high street, and the NHS is going to be driving forward these efforts, as we save thousands of lives from deadly heart attacks and strokes as part of our long-term plan.”

Commenting on the announcement, Pharmaceutical Services Negotiating Committee (PSNC) director of NHS services Alastair Buxton said it “is good to hear” Mr Stevens “speaking so positively about the skills of community pharmacists”.

“We are keen to work with NHS England to explore the potential for pharmacies to provide statins without the need for patients to obtain a prescription from their GP,” Mr Buxton added.

GPs wary

However, Royal College of General Practitioners chair Professor Helen Stokes-Lampard said GPs “have concerns about making these drugs more easily accessible without a prescription”.

GPs only prescribe these when it is in the “best interest of patients” and after they have “a frank conversation” with them about statins-associated risks, she added.

Earlier this week (September 3), NHS England announced that from October 1, pharmacies will start piloting a new heart check service as part of the five-year funding contract.

PSNC told C+D that the service is “still in the planning stages” and NHS England has not yet chosen the pharmacies that will pilot it.

13 Comments
Question: 
Would you be confident to supply high-dose statins without a prescription?

Sam Pharmacist, Community pharmacist

It’s all theory as the decision makers don’t understand the laws hence says subject to MHRA allowing it. Zocor 10mg was the only product branded P status and now discontinue. Either all statins/strengths would need to change to P or a massive PGD to provide all strengths on consultations.

Thomas Wilde, Community pharmacist

I just love how GPs are making out we shouldn't be doing this because we don't have the knowledge base, when I have to explain to ones near me why they can't keep telling patients to take simvastatin in the morning because they don't know how any of the medications they prescribe actually work.

RS Pharmacist, Primary care pharmacist

Seems everyone has expressed the same concerns as me. We need baseline lft and lipids and who is going to do the follow. Also what happens when patients complain of muscle pain.... 

SP Ph, Community pharmacist

""what happens when patients complain of muscle pain....""

May be they would expect a tube of Ibugel to go with the statin :-))

Snake Plissken, Student

Can't see this taking off as primary prevention mainly because there has been too much bad press around statins that has put patients off statins and even persuading those in secondary prevention is tough enough.

As HCP, at the very minimum, it would be nice to have baseline LFTs, Lipids, U/Es and HBA1C for obvious reasons. How is this going to happen?

If we were ever to be able to get these results and calculate Qrisk through health check that incrporates a BP test, weight..etc, that doesn't equate immediately to prescribing Statins (what about lifestyle, or there's a pill for every ill the route we're going down). And then what do we do if a high intesity statin is unable to lower lipids in pts with hypercholestrolaemia, do we have referal pathway to lipid lowering clinics?

As someone has mentioned earlier, simvastatin 10mg was available as a P med and I never found a single person buying them. New concerns from pts now include memory loss, so it's tougher than ever to get anyone on them aside from cost reasons and the nhs providing prescriptions for free in the majority of patient likely to need them.

 

Joan Richardson, Locum pharmacist

Don't I remember low dose simvastatin going OTC - Zocor I think?  Sales were minimal as the patients were not happy to pay the price and it disappeared into the mists of time!

Kevin Western, Community pharmacist

I think it looks more like a PGD supply and why not? assuming we are paid sufficiently.... yes, I know

N O, Pharmaceutical Adviser

"""Is this all just a ploy to distract """

... the public, in continuation to a massive WRONG information about ALL pharmacies in UK providing free blood pressure checks.

Really? Wow, Superintendent Pharmacist

Is this the Pharmacy equivalent of filibustering??

I agree with Charles, this is so non-sensical that its laughable. 

There is a desire to initiate a long term therapy without a full CV examination and baseline bloods including renal, LFT, FBC? 

In the words of Ken Clarke from the house of Commons last night " ... is being disingenuous" 

Is this all just a ploy to distract the world of pharmacy from the shoddy deal that has led to yet another cut? 

Charles Whitfield Bott, Pharmacist Director

This could be the daftest thing I have ever heard. Everyone buying their high dose statins with no tests or follow up.

But on the other hand just think of the savings!

Apply this logic to all the other big selling drugs and save the NHS?

Tired Manager, Community pharmacist

I have yet to meet a single person who is truly happy to be on a statin so I can’t imagine this will generate many sales

N O, Pharmaceutical Adviser

"""person who is truly happy to be on a statin"""

And pay for it, without seeing a GP !!! That would be a deadly combination!!

Paul Samuels, Community pharmacist

Coudn't agree more--the old Zocor fiasco referred to by another was a great failure,what makes our erstwhile chief Pharmaceutical officer think this will be any different.

Majority of Joe Public will NOT PAY  FOR THESE MEDS when they can get them from their GP at no cost(the majority) or minimal cost(the minority).

Besides a service with poor returns & increased indemnity insurance needed where do we find the time---knicker elastic will break at some time!!

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