Changes to the way that pharmacies operate will allow people to buy medicines that currently require professional advice
The counter assistant was struggling to comply with the sales protocol for “pharmacy-only” medicines. The customer, a young man seemingly bursting with health, was impatient, resentful of what he clearly felt to be intrusive and superfluous questioning. Why should there be interference in his right to choose what he wants?
Medicines are classified to promote their safe use. The class of prescription-only medicines has a rigorous evidence base to support its effectiveness. The risk-benefit ratios demand their restricted availability.
In contrast, general sales list medicines are freely available over the counter. Heavily advertised, attractively packaged, they are a triumph of marketing over medicine, of anecdote over evidence. In the absence of clinical trial data, their licences were granted not because the products are effective but because they do no harm. That is why so few are allowed to be prescribed on the NHS. As there is little or no evidence that they work, my usual recommendation for such cough and cold preparations is to return them to the shelves. However, I am a voice in the wilderness: last year their UK sales approached £1.5bn.
Unusually, but not exclusively, in the UK there is a third category, the pharmacy-only medicines. Examples include Sumatriptan 50mg for migraine, Tamsulosin for benign prostatic hyperplasia, the morning-after pill, and larger packs of analgesics and anti-inflammatories. They may only be displayed beyond the reach of customers and sold under pharmacist supervision. Not as hazardous as prescription-only medicines, they are nevertheless potent, with the power to do both good and harm.
The young man this morning was taking ibuprofen 400mg. He told me he used an inhaler for his asthma, which had become worse, but he was unaware that ibuprofen could be responsible. Who reads leaflets? We agreed to adopt an “if it hurts, don’t do it” approach, take paracetamol for a while, and, if necessary, use an anti-inflammatory gel.
The existence of this third category of medicines is predicated on pharmacists having a professional obligation, enforced by law, to protect the general public. It enables effective treatments to be made available without prescription – but, crucially, with the advice necessary to ensure safety and maximum benefit.
But changes are afoot. The General Pharmaceutical Council (GPC), independent regulator of pharmacy practice, has just completed consultations on changes to the regulation of pharmacists and pharmacy premises. The radical new proposals put the onus on pharmacy owners to manage risk in a pharmacy, and to be accountable for doing so. For example, under the new proposals, corporate owners could, on commercial grounds, make pharmacy-only medicines freely available and customers would be able to purchase them like any other item in a pharmacy.
Commercial considerations and patients’ best interests make strange bedfellows. This morning’s customer would, in all likelihood, have self-medicated until his worsening asthma took him to his GP. Episodes such as this persuade me that the proposed deregulation will do more harm than good. Of course, some customers will require no advice. But others could damage their health.
The GPC will introduce the new regulations later this year. Fundamental to its deliberation is the balance of patient choice against benevolent paternalism. Only if we consider medicines to be no different from other consumer goods is there a rationale to challenge a moderate paternalist philosophy. In which case, the walls come tumbling down and a new healthcare model is required, one employing the ethics of commerce. Surely that can’t happen in the NHS
• Peter Dawson is a locum pharmacist in West Yorkshire
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