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Sector doubtful over pharmacist-only medicine category

Practice One expert predicted a "bureaucratic nightmare" as pharmacy leaders urged caution over calls to create a 'Pharmacy+' medicines category, which would require the direct intervention of a pharmacist.

Pharmacists have expressed doubts over calls to create a new pharmacist-only medicine category that would require the direct intervention of a pharmacist.

Responding to an MHRA consultation on the process for reclassifying medicines, the Guild of Healthcare Pharmacists (GHP) proposed a new ‘Pharmacy+' category to increase public safety.

In its letter, which was endorsed by the RPS, the GHP expressed a "major concern" over the lack of opportunity for healthcare professionals to oversee sales of certain medicines.

"What value would [another category] add? Are we at risk of downgrading the existing P category as a result?" Graham Phillips Manor Pharmacy Group (Wheathampstead) Ltd, Hertfordshire  

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The new category would sit above P medicines, and require pharmacists to make the sale.

But the response provoked a mixed reaction from community pharmacy, with experts voicing fears that it could result in a "bureaucratic nightmare" or the downgrading of the existing P category.

The GHP argued that under the current system, there appeared to be "an automatic progression" for medicines to go from POM to GSL, potentially posing a threat to public safety.

"Consequently there is, in our view, a need for a Pharmacy+ status for medicines that should only be sold to the public with the direct intervention of the pharmacist, as this would improve patient access to urgent medicines and maintain public safety," it said.

"It is our view that many products granted GSL status in recent years should have been subject to further self-medication guidance by healthcare professionals," the GHP added.

The comments were backed by the RPS response to the consultation, which stressed that professional advice should always be available where medicines are sold or supplied. "General retail stores will not be able to offer the expert advice available in pharmacies," it said.

But Graham Philips, owner of Manor Pharmacy Group (Wheathampstead) Ltd, Hertfordshire, questioned whether there was a need for an entirely new category. "Most pharmacists already have an informal [Pharmacy+] category," he said.

"Especially with switches, [they] will always say, ‘these are the products I'm worried about and I want to be consulted on those', and that's done informally."

"What value would [another category] add? Are we at risk of downgrading the existing P category as a result?" Mr Phillips asked.

His comments were echoed by Jonathan Mason, clinical advisor in medicines for North-East London and the City, who welcomed a category "aimed particularly at the pharmacist" but worried that implementing it could be "a bureaucratic nightmare for regulators".

"You can just buy pretty potent medicines over the counter… so I would welcome it in that respect," he told C+D. However, he warned having four medicines categories would put the UK out of step with Europe. "That goes against the European regulations where you only have two categories of medicine – prescription and non-prescription."

How would you feel about the introduction of a Pharmacy+ category?

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Frost, Superintendent

The absence of pharmacist involvement on many P sales, particularly in an era where companies feel able to run 3 for 2 offers, means that pharmacist-involvement should be mandated for certain products to ensure that they are appropriate for the patient. Can we have faith that other potential POM-P switches such as OCP or salbutamol inhalers could be made in the proposed future of self-selection?

Shveta V, Community pharmacist

Would it not make more sense to emphasise that staff should be following correct protocol on P meds anyway? In my pharmacy, things like Levonelle and chloramphenicol are automatically referred to me because that's what Is either required, or what I want. Pharmacists only need to make it clear what they would prefer to intervene on. Seems like a great big fuss to be honest. Staff are either well trained and receptive to what a pharmacist prefers, or they aren't. If they aren't, then we shouldn't need to create a whole new classification to make up for that. I would say put pressure on counter staff to follow the correct processes??

Leon The Apothecary, Student

I agree with this here, I would argue that this already exists in everything but name. Levonelle, chloramphenicol, and quite recently Ventolin - it seems little more then slapping a label onto an already existing service. Though I do agree that this is definitely the way forward for pharmacy as a whole, enhancing our role within the community.

I feel this would be an excellent idea. There are too many casual sales of eg, chloramphenicol e/d, even fluconazole caps. It is so disappointing when patients coming in to buy these examples and others claiming that they have bought them elsewhere without any/hardly any questions being asked. We ought to be asking questions, or else face even further loss of credibilty

kim humphries, Locum pharmacist

It is fast becoming a time where it looks as though supplies of medicines is being further pushed away from the pharmacist , which leaves us in danger of the pharmacist being seen as unnecessary. If it is deemed that there are a group of medicines which 'relies' on us being there and asking questions/counselling then that is in our favour one would think? We should be doing this anyway , but this step will make us compulsory and necessary rather than being not required/absent/out of a job..................?

A P, Community pharmacist

I trained and worked in Australia where there is also a 'pharmacist only' category. It is brilliant and makes so much sense. When I came to England I too was surprised that it did not exist here. I look forward to the day that this category comes to England.

Alison Sparkes, Superintendent Pharmacist

Agreee rather than have four medicine categories, why not just enhance the pharmacist prescriber role and free up GP time.
Or emtpy the supermarket shelves and give us back our heritage- so we can be proper pharmacists like our Eurpean colleagues! Now wouldn't that be a first- revolutionary pharmacists!

Chris Locum, Locum pharmacist

Agreed ! This is the only realistic way forward. Creating another category won't help us if we are divorced from the safe use and supply of medicines.

The British public were sold the lie that national insurance was set aside for health etc and most of them would not pay if they had to for a minor ailments scheme.

I don't think an extra category would be a roaring success because of the way things have progressed here recently. The big drug companies are restricting products to limited number of wholesaler(s). I would love to see supermarket shelves empty overnight - but it won't happen with screams of competition law.

If you had to pay to see the doctor, the pharmacy will be the first choice before visiting them. So I m not sure P+ would work here - P category could fade away as it is if we are not careful !

Management of chronic conditions is the future for us...and there is a whole new battle ground.

Afroz Farooqui, Community pharmacist

Introducing Pharmacy+ category will help most of the EU pharmacists who are practicing in UK and newly qualified hospital pharmacists who want to practice in community, as I have noticed some of them are not sure when to intervene the sale of P meds. Introducing a new category will remind them when to use their clinical knowledge.

Adina Brown, Community pharmacist

i agree with you Alison, give us back are heritage, the first area to 'clean up' in the interest of public safety is the supermarkets and garages, for heaven's sake!!!!!!!!!!

Michael Child, Locum pharmacist

I've worked in New Zealand where there is a restricted medicines category which includes chloramphenicol eye drops, diclofenac 25mg tablets, emergency contraception and the like. It works well over there and would go some way to address concerns about chloramphenicol being over-used (I've worked in pharmacies where counter assistants have got it out of the fridge to sell with hardly any questions being asked).

That said pharmacy is used much more for minor ailments over there as you have to pay to see a doctor. Some pharmacies here hardly sell any OTC as people get it free on Rx or through minor ailments schemes.

Thomas Wilkinson, Other pharmacist

Agree with the above locum pharmacist's comment.

I did my training in New Zealand where I felt that the "pharmacist-only" classification worked well. When locuming in the UK I was surprised that pharmacy shop staff were very used to selling particular medicines without even consulting the pharmacist.
I would welcome the addition of a pharmacy+ category. If classification was done correctly I imagine it wouldn't significantly impact on pharmacists who are already selling these medicines responsibly.

Think of it as providing a legislative backing for established good practice.

Adam Kerrigan, Non healthcare professional

Aren't all P meds by default ones that require pharmacist intervention? From my admittedly limited experience as a pharmacy student, the level of pharmacist supervision with regards to P meds depends entirely upon the pharmacist. Some products they insist on speaking with the patient/customer, some they are satisfied with the sale of things like chloramphenicol eye drops provided you tell them you've asked the appropriate questions (symptoms and other meds, etc) whereas others like co-codamol are sold almost as if it were a GSL. Surely it makes more practical sense to add pharmacist intervention for specific P med sales to the pharmacy SOP protocols rather than create a separate medicines classification?

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