Bayer can no longer market its heroin brand painkiller – even in countries that allow the OTC sale of firearms – even though we have seen a dash from POM to P including chloramphenicol, sumatriptan and levonorgestrel, and previously blockbuster prescription drugs such as ibuprofen and ranitidine are now available in Poundland.
The legal supply of medicines obviously has as much to do with commercial reality and opportunity as it does with safety and pharmaceutical care but, with the recent plethora of PGDs, the question is: have we crossed a line?
Does the law around the sale of medicines protect us from harm, or is it still true to say: "caveat emptor"?
All pharmacists support PGDs in principle. We point to the PGD provision of Tamiflu or private flu jabs and say: "Look, Mr Commissioner – we can provide effective, popular and beneficial medical services!"
My concern is not so much one of safety but one of the direction of the profession
Almost all pharmacies operate PGDs for EHC as a local enhanced service and dread April 1 and the uncertainty of continued provision. But when it comes to the NPA scheme to provide 16 POMs script-free there seems to be an unequal response.
The role of the pharmacist has moved away from the physical compounding and dispensing and towards clinical services and patient optimisation – epitomised by the rise in pharmacist independent prescribers. So it is a logical progression to extend our repertoire of treatments that may be supplied OTC – which is effectively what these PGDs allow.
My concern, however, is not so much one of safety but of the direction of the profession.
A few weeks ago, I heard a senior pharmacy executive discuss these PGDs. I was concerned by his fervour about the opportunity for profit that this scheme presented, because if we turn pharmacy simply into a shop for drugs we can never compete with large online discounters and we will go the way of bookshops.
Our future must lay in demonstrating we can provide clinical services – especially at a time when the commissioning of NHS services is moving into GP hands while we end up being paid below living wage to source out-of-stock drugs.
POM supply through pharmacy must bring benefit to the NHS and justify public money being spent. Our strength over other supply routes is our accessibility and our approachability, and the ability to offer services more cost effectively. In the brave new world of coalition NHS, with public health services moving to the local councils, patients are key.
We must demonstrate we can provide improved patient access to drugs and demonstrate that our services can reduce health inequalities, and that is how we should be developing PGDs. Otherwise it will only be a matter of time before – having created our own self-fulfilling prophecy of medicines becoming items of commerce – we are crushed by the might of an off-shore internet-based PGD provider, and the cry will not be "caveat emptor" but "caveat apothecary".