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Pharmacists slam NPA decision to drop antibiotics from PGD

Business Pharmacists have hit out at the NPA's decision to drop antibiotics from its patient group direction (PGD) service, branding the move as "weak".

Pharmacists have hit out at the NPA's decision to drop antibiotics from its patient group direction (PGD) service, branding the move "weak".

The NPA agreed to remove trimethoprim, doxycycline and ciprofloxacin from its PGD service, which it developed with Day Lewis, after meeting with the Department of Health (DH) last month, saying the decision was "right and responsible in combating resistance".

But pharmacists have criticised the decision to remove the antibiotics from the script-free scheme, which has been piloted in Day Lewis pharmacies since October.

"How you can say we're going to materially contribute and make it worse on the scale that we're likely to operate is beyond me" Kevin Western, pharmacist

More on the Day Lewis-NPA PGD

Dropping antibiotics from PGD scheme 'right and       responsible', says NPA

Peter Dawson: Trust us with antibiotics supply

Xrayser: Have we crossed a line with the latest PGD?

"It just looks weak to outsiders and it probably is," said Somerset pharmacist Clive Strachan. "GPs are prescribing drugs so why would resistance necessarily go up if pharmacists do it as well?"

"It just seems like the NPA have caved in to the DH without putting up a fight," he added.

Pharmacist Kevin Western said it was a "real shame". "How you can say we're going to materially contribute and make it worse on the scale that we're likely to operate is beyond me," he said.

"Pharmacists have not been dolling out antibiotics, so we can't be blamed for the antibiotic resistance that's arisen so far," Mr Western added.

The scheme will be made available for NPA members to buy this month and will still include azithromycin to treat chlamydia as well as 12 other POMs.

The NPA and Day Lewis met with the UK chief pharmaceutical officers on December 18 after the DH raised concerns. Prior to the meeting, pharmacies participating in the scheme's pilot had not been supplying the antibiotics out of courtesy to the DH, NPA director of pharmacy Deborah Evans told C+D.

"Our decision to exclude antibiotics from the NPA PGD service was made in the context of growing concerns about the threat of antimicrobial resistance," Ms Evans reiterated this week.

"It is clear from our discussions with the DH chief pharmaceutical officers that much is expected of pharmacy to improve stewardship of antimicrobial agents," she added.

But superintendent pharmacist Keith Seston questioned why the NPA was "bending to... pressure". "There are other private PGDs with antibiotics available. So if it's deemed suitable in other areas why not the NPA?" he added.

Independent Pharmacy Federation (IPF) chief executive Claire Ward told C+D there was no evidence to suggest pharmacists would dispense antibiotics inappropriately, but she said the NPA was "right to recognise the representations of the DH where broader issues of concern exist".

"This is a sensible, conciliatory approach and in no way should this suggest that PGDs are not an important tool in the right context," she added.

Do you think the antibiotics should have been dropped from the PGD?

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John Schofield, Locum pharmacist

I always thought the new NHS was supposed to be patient centred.

Can anyone please justify why a woman should suffer intense discomfort and pain for 24 to 36 hours from an uncomplicated UTI which could be treated with a three day course of trimethoprim, immediately available from a qualified pharmacist.
This tantamount to saying that nurses know about medicines than pharmacists,as many will see most patients with UTIs.

I would be wary about doxycycline due mainly to its amazingly efficient emetic qualities.

However I can see no real problem with Cipro-I believe one can buy it from pharmacies in Sharm-el Sheikh and many other countries with traveller's diarrhoea problems without difficulty anyway.

Additionally the main reason for common antibiotic resistance is far more likely to be gross abuse of adding them willy-nilly to animal feeds in the sixties and seventies to cheaply increase the meat yield. Human over-prescribing is way down the list imo.

I also harbour suspicions that many medics will use any excuse to keep prescribing to themselves no matter how "good" some of them are it.

Paul Reader, Non healthcare professional

It appears that many pharmacists have indeed been "doling out" antibiotics! However, my understanding of the POM regulations is that they were designed to protect public health. That aspect seems to be a very minor consideration on the part of many pharmacists nowadays. It seems to me to be wrong that PGDs are commercially available; and the law needs to be amended so that they can only be instituted by responsible official health bodies and not by commercial organisations. Who that should be remains open to question since Primary Care Trusts have been abolished. Perhaps the General Pharmaceutical Council and the General Medical Council in consultation?

Janet NQ, Community pharmacist

Hmmm, I do understand that pharmacies want and try to get involved in as many services as possible but let's leave the expertise of diagnosing to doctors especially that we, pharmacists, have way to many things to deal with already considering current cuts and climate surrounding the profession. The resistance could be a problem if targets were introduced and that, as we all know, is widespread.

Stephen Eggleston, Community pharmacist

I hope everyone's concern about resistance will be extended to GP prescribing. I agree pharmacists would have been supplying "blind" but then most antibiotics are ptrescribed "blind" with samples only being taken either whne the patient who presents is particularly unwell or if the first course does not do the job

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