Pharmacists to prescribe antibiotics

A plan to alleviate the log jam in general practice by loosening access to antibiotics so pharmacists can prescribe them has received a febrile reaction from doctors, who describe the plan as “risky”, worded as it was to suggest that it would make it easier to more antibiotics for more ailments. The Department for Health on the other hand estimates that around 1,000 of England’s 27,000 pharmacists have a prescribing licence, and that chemists prescribing antibiotics for urine infections alone could free up 400,000 GP appointments each year. But the message was somewhat tarnished, according to a report in the Times newspaper this week that in proposing the move, Health Secretary Therese Coffey had remarked privately that she had “handed out her own supplies of antibiotics to friends and family who were feeling unwell,” attracting widespread condemnation from the medical profession, who called her “reckless”. So what’s right and what’s wrong with all this? Nick Brown is a consultant microbiologist, an expert in antibiotic resistance, and sits on the British Society for Antimicrobial Chemotherapy Council…

Nick - The recent interest in access to antibiotics has come about because of a statement last weekend that people will be able to go to their local pharmacy and pick up antibiotic prescriptions there without having to go to their gp. And this of course is one initiative that has been proposed to get around the problem of people having to wait a long time to get a a GP appointment.

Chris - But what Therese Coffey also said was 'I dished out some old antibiotics to a mate', which many other doctors have, I think quite rightly, objected to very, very forcefully.

Nick - That is correct. And I think every medical professional would not accept that this was a reasonable thing to do and that people should not share their antibiotics with anybody else. Antibiotics are a very precious resource and we should use them wisely. Part of that means that you should not give them to people who have not been prescribed them. These are prescription only medicines that are a legal requirement. Therefore, you should only access antibiotics by getting them prescribed by a licensed medical practitioner.

Chris - The legal side of it aside, why is that bad practice with respect specifically to antibiotics?

Nick - Antibiotics are absolutely fundamental to the practice of modern healthcare. Without antibiotics, you could not have a hip replacement, you could not have cancer chemotherapy, you could not have an organ transplant. The problem with antibiotics is that the more you use them, the more likely it is that the bacteria will become more resistant to them. And that means that the more you are exposed to an antibiotic, the less effective it becomes. That is unlike any other medicine. Paracetamol is always paracetamol and the drug for high blood pressure is always a drug for high blood pressure. But the more you use an antibiotic, the less effective it becomes. And that means only using them, or accessing them, when there is an absolute need to have them.

Chris - Why did she start talking about this in the first place though? What was the general direction of travel that this became an unfortunate diversion for?

Nick - The statement last weekend was prompted by the national issue with GP capacity at the moment that many people are having to wait for several days or even longer to get a GP appointment. And by increasing use of local community pharmacy capacity, potentially people will be able to get a much more prompt prescription of an antibiotic should it be required.

Chris - Is that altogether safe though? I mean, are we comfortable that people would effectively be bypassing the doctor to get antibiotics? Because at the end of the day, a doctor's a doctor and they know what to treat with what. It just seems a little bit of a short change mechanism, corner cutting.

Nick - Yes. Now the important bit is that there need to be appropriate safeguards around that prescription and there are already a lot, lot of examples of where this is being done very successfully. For example many minor injury units, senior trained nurses can prescribe antibiotics for some conditions. And in Scotland there is an initiative called Pharmacy First, which has been going for some years, where pharmacies already can prescribe antibiotics for some limited number of conditions with appropriate safeguards being put in place. The statement from last weekend seemed to imply that this was about increasing access to antibiotics, which it should certainly not be. In the situations in, say, minor injury units or in the Pharmacy First initiative in Scotland. The number of indications whereby a pharmacist or a senior nurse can prescribe an antibiotic are actually pretty limited and the detail of the patient group direction, which allows them to prescribe, has numerous exclusions on it, which adds another layer of safety. People should only be prescribed an antibiotic in a pharmacy or in another setting if they have a simple infection that is not complicated and therefore can be managed appropriately in that setting.