I very rarely prescribe antibiotics over the phone. We need to be prescribing fewer of them and in most cases seeing the patient allows me to assess them in a more reliable way, which often leads to the conclusion that antibiotics aren’t needed. One of the exceptions to this rule is otherwise healthy women who present with symptoms of a urinary tract infection (UTI). This is based on a Public Health England guideline from 2019 stating that if a woman has two out of three symptoms of a UTI (dysuria, nocturia and cloudy urine) there is a 74% risk that she has a bacterial infection and therefore empirical treatment is reasonable.
If there is only one symptom then a dipstick test will help to guide antibiotic use, though we should remember that these tests are not infallible. I have certainly been caught out on more than one occasion when I have used a negative dipstick result to reassure a patient, only to be surprised by the culture result a few days later.
On this background, I was interested to see that some pharmacies offer a private urine dipstick service for women with a suspected UTI. At Day Lewis, patients pay £10 for an initial consultation and dipstick kit, and a further £15 for a follow-up consultation and antibiotics if the test is positive. In July, NHS England rolled out a similar pilot for a service that does not have to be paid for. This follows previous schemes that allowed pharmacists to dispense trimethoprim or nitrofurantoin for symptoms of a UTI under a patient group directive, not always involving a urine dipstick.
It makes sense for treatment of some minor ailments such as UTIs to be provided by pharmacists rather than GPs, although as GPs we need to be careful of the effect that this has on the complexity of our clinics. The traditional 10-minute appointment is only possible because some patients will have simple, quick problems. These balance out the time it takes to see patients with complex mental health and multimorbidity issues that cannot possibly be dealt with in 10 minutes. If pharmacists and nurses are handling all the quick and easy consultations, we may have to rethink how many patients we can see in a surgery.
I will be watching with interest to see how much of a success this private service is. I wonder how happy the general public will be to pay for something like this. NHS England guidance telling GPs not to prescribe medicines that are available over the counter only began to be implemented after NHS England wrote to GPs to reassure them that they would not be in breach of their contract for refusing to prescribe paracetamol.
Will the same patient who is unhappy to pay pennies for a packet of generic paracetamol tablets be willing to hand over £25 to have their UTI tested, even if it is significantly less than the cost of a private GP appointment? Time will tell. I imagine that this private service will end up being focused in areas where there are significant numbers of cash-rich, time-poor individuals who feel that the interruption to their day is worth more than the money they will pay for quicker treatment.
Toni Hazell is a GP based in a practice in London