The pharmacist will see you now
H. isof Enfield, a comedian, once drew laughs by playing an indecisive chemist who killed his customers. He aggressively asked about their bowel movements, mentioned a woman’s positive pregnancy test after her husband’s vasectomy and interrupted one man in the middle of dating to ask about his herpes. The saintly character was unimportant. “Where there is despair, we bring hope; where there is pain, we bring relief,” he said. “Where there is darkness we bring light: especially when developing images.”
Pharmacists are no longer fun figures. On 31 January England introduced a new scheme called Pharmacy First, which will give them the power to prescribe treatments for seven common ailments, including ear infections, urinary tract infections (in women) and shingles. National Health Service (SNS) believe that this could free up to 10 appointments per year in general practice, where patients can often wait weeks for a GP consultation. The scheme also marks a philosophical shift – away from general practice as the first port of call for all patients.
In some ways, this has been a long time coming. Before the creation of the SNS pharmacists were “father confessors” who spent many (unpaid) hours advising their customers. More recently, they have been entrusted to deliver covid-19 vaccines, contraceptive services and blood pressure checks. It’s “a natural next step”, says Niamh McMillan, the senior pharmacist for Superdrug’s 190 pharmacies across Britain. (Scotland and Wales have already introduced their own versions of the scheme.) The profession is overwhelmed by the additional responsibilities: encouraged by financial initiatives, 90% of pharmacies have signed up to the scheme.
But for Pharmacy First to work well, a lot of things have to fall into place. Pharmacies need more time to cope with additional demand: some are hiring more technicians and using robots to provide electronic prescriptions. They will also need training. Among other things, Superdrug is teaching staff how to use an otoscope, a hammer-shaped device that can identify ear infections from earwax.
Despite money brought in by the scheme – the biggest for community pharmacies in more than a decade – the industry remains underfunded. He gets 90% of his income from the SNS, which has its own funding weight. The number of pharmacies in England has fallen by more than 1,000 since 2015. These closures have affected patient confidence, says William Pett of Healthwatch England, which public body representing patients.
So too have recent drug shortages, caused by global supply chain issues, the lingering effects of Brexit and, in some cases, increased demand for celebrity-promoted products. They have all consulted to create a game of “pharmacy bingo”, says Mr Pett, in which patients have to run around stopping pharmacies to find the drugs they need.
Despite these difficulties, it is easy to imagine the role of community pharmacies expanding further. In the midst of a measles outbreak, for example, it seems unusual that pharmacies still cannot offer the measles vaccine. The department has the potential to save 42m GP positions, or about 12% of all positions each year, estimates the Company Chemists Association, an industry group.
Nick Kaye, who is a pharmacist in Cornwall, is a testament to what has already changed. When he first owned the shop with his father more than ten years ago, there was a cafe upstairs, he sold deodorants and sun cream, and, as Mr Enfield created a comic, processed pictures. Today the coffee and the cameras are gone. “We’re a clinical care place,” says Mr. Kaye, who already offers walk-in consultations. If the general use of the front door is the SNSthen pharmacy is quickly becoming his gateway. ■
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