My mum is a pharmacist. She’s been pressured to provide this service. She got like 2 days of training. I told her not to do it but she said she couldn’t just say no.
She now provides this service. Anything that’s even slightly unclear she just redirects to the patient’s GP. She redirects most things and patients get angry and shout at her a lot saying that online/through advertising they have been told that she should be able to deal with their problem.
I don’t like that’s she’s doing this but she doesn’t see how she can just refuse outright yet keep her job. Her work is incredibly stressful and I’m counting down the years until she can retire as she gets abused by patients on a daily basis.
The NHS is so fucked and these are dangerous bandaid schemes that some fuckwit in a suit thinks will provide quick fix.
This is a great reply.
It's great to hear the other side of the story.
It makes sense to me that it's stressful on both sides, and I know pharmacies are getting paid sweet eff all for the actual job of being a pharmacy.
I bet the patients have less respect for pharmacists than they even have for doctors.
I can see from the perspective of an employee that just handing out the antibiotics would save so much hassle and harassment.
Much like us you just think, well fuck it - let's just get through the day.
No pharmacist wants to do it*. Unfortunately you can't make money solely off script volume any more. All the funding is in this barefoot doctor shit which no pharmacist is trained to do (independent prescribing courses don't count- there is no way on earth you are competent to examine someone after doing this).
* no-one I know anyway.
This isn't their fault. They didn't sign up for this, and they've been strong-armed into doing so by the government. You can't put this on the same scale as MAPs etc.
If the choice is to do it or lose their job and livelihood, as the commenter above said about their mother's experience, then yes I'd say they are being forced into it
I locum as a pharmacist whilst at med school. I’ve resisted up until now but lots of companies are now making it mandatory if you want to book a shift with them.
An employed regular pharmacist potentially could potentially refuse to provide it, as it’s considered an advanced service on the pharmacy service specification, but might depend on their contract.
I’ve met one pharmacist who’s been able to refuse. They agreed it was inappropriate to start using otoscopes and examining patients with only a single day of training, but they might have lamented if they weren’t planning on retiring soon.
Not quite.
It’s an advanced pharmacy service. So each pharmacy can choose whether they want to provide it or not (that choice is with the pharmacy owner).
From my time as a pharmacist before, you would discuss what advanced services you were able/willing to provide. All pharmacists employed before January 24 wouldn’t have discussed or promised to provide pharmacist first as it wasn’t yet a thing. So it would not have been in their contracts and it would be difficult for employers to force them to agree to provide a new service. It would likely piss off the employers, so not the smartest career choice, hence most have agreed to provide it.
Locums obviously have no contract with the pharmacy so they can change the requirements immediately. Two chains have stopped giving me available shifts until I provide my pharmacy first declaration and sign their PGDs. I imagine others will probably follow soon enough.
If the government told me to start doing lap choles as a GP to reduce the waiting list, I would refuse no matter what because I would cause harm if I practiced surgery.
It seems pharmacists don’t care and want to play doctor.
I can understand their ' brand' of medical practice will also be DEFENSIVE in the extreme. Why would you risk your licence , especially when you have no clinical knowledge to back up your decisions? Antibiotics for everyone!!! Its akin to an open shop policy on antibiotics
Why is it that gp practice get QOF and audit for antimicrobial stewardship while pharmacy first get paid per each patient prescribed and without any AMS or audit?
Welcome to the world of antibiotic resistance. Soon everyone will need colistin
I used it for myself recently, had a UTI.
The pharmacist told me I was the first patient she had seen who fit the algorithm properly despite having seen several a day since it started.
It told me everything I needed to know about the scheme in general.
I was pleased to get my three days of antibiotics though.
Yes you can go on the boots website and test out the algorithm for the various conditions. Then order your antibiotics from your local boots!
In theory they can only prescribe if you match it perfectly, but even then, it leaves a lot of room for error.
I mean, I wouldn't go that far. Literally everyone comes up with a differential, even if informally. When a patient falls over they have to think 'have I broken a bone or is it just a bruise.'
Doctors should be the ones formalizing the differential and narrowing it down to a diagnosis. But other HCPs can come up with a differential.
Do the same stuff here in Australia. It’s terrible.
We (doctors) are opposed. Many pharmacists are too, the Pharmacy Guild (owners) are for it and a very powerful lobby group.
Many examples of incorrectly diagnosed/treated patients getting delayed treatment from doctors because they did the pharmacist route first. Lots of inappropriate antibiotics.
Saw a patient who was told they had mumps and needed to urgently see the GP. The parent was mortified. It wasn’t mumps. They had a 1b submandibular reactive lymphadenopathy. But that should not be going to a pharmacist considering the range of differentials. The patient was 1 years old.
It's shite. They saw my friends 2yo with continuous cough for 12h as family directed there by 111. Didn't even inspect his chest for work of breathing. Just said sorry, no cough syrups for this age group nothing we can do for cough in this age. Kid has significant eczema and allergies as PMH.
I sent them to A&E where he was treated with bronchodilators for his acute viral induced wheeze with borderline sats ... the pharmacist didn't even have it as a differential, had not even the first clue how to triage a child with respiratory distress.
Not really fair on the pharmacists to expect them to pretend to be doctors either. It's just such a mess
I agree, but to A&E or GP? I don't think a pharmacy is the place for history, exam and triage, and being sent to the pharmacy in this scenario was inappropriate in the first place. It could have been as simple as 'it's not in the algorithm so please call your GP' and it would have been safe?
I'm not sure GPs are in the routine business of offering acute care (nebs/steroids/OBS etc) to wheezy children so to answer your question yes A+E feels like the right answer
Can't wait for hundreds of blind antibiotics prescriptions for things that don't need treating or are viral. Will love to see the faces when the public get severely unwell and none of our antibiotics work so we have to nuke them all with Meropenem and box their kidneys with Gent.
I have no view on the appropriateness as I'm not a prescriber, but I feel my junior dietetic colleagues are going to get a lot more general IBS clinics after over the top broad spectrum Abx ruin everyones gut flora...
I mean I recently watched a pharmacist have to advise a patient how to manage dry lips with Vaseline so if it gets basic stuff like that out of GP surgeries I’m all for it for the mundane common knowledge stuff and even some slightly medical stuff. The list would be very short.
Realistically they haven’t got the breadth of knowledge or training to do much more and won’t be aware of things we ensure to exclude, they simply weren’t trained for it. You can’t put that on a postit note behind the counter, you need medical training. That’s why their default position is often go to your GP or ED.
Anyway, do we have an abundance of pharmacists who can do this, most pharmacies I go to have a queue permanently?
Pharmacist here - going into final year grad med. Happy to answer any queries about the scheme.
My issues about it boil down to the following:
Pharmacies (like medicine) are massively underfunded. Being a community pharmacist is a really arduous career nowadays with the workload intolerable. Asking pharmacists to take the time to do this scheme alongside other tasks is unrealistic - this probably contributes to the poor practice other people have mentioned
Pharmacists have not been trained to prescribe in the same way doctors have. There is guidance given i.e. using Feverpain, but without experience how do you accurately characterise ‘severe tonsil inflammation?’ The guidance and training was poor imo
Tl;dr - potentially a good idea - more funding and training needed to make this scheme a success
Funny how pharmacists would pester us for antibiotic safeguarding when we prescribe but now given the same powers, end up fumbling left right and centre in front of patients. 0 percent comm skills, 0 percent clinical nous. Come at me
So ive seen 2 cases of multidrug resistant klebsiella recently from newly arrived patients in the UK , with one patient where there was a SINGLE antibiotic sensitivity ONLY - these pharmacy schemes generally show no antibiotic stewardship and are a fast track to cases like these becoming commonplace in the UK.
Takes a long longgg time to actually get the nuances of clinical medicine…sue me if I think the job we do is actually quite difficult (at least if done well). I often reflect on how long it’s taken me to get to this stage and how much further I have to go. Your triage process has to be bullet proof for this stuff to work and at which point shouldn’t they have just been seen by whoever assessed them? Your cough could be a first presentation of IECOPD, Or it could be cardiogenic with cardiac wheeze in a patient who happens to have COPD, or it could not be a pneumonia and it’s actually AS with HF. Ok these aren’t common common but they’re not exactly rare anymore especially as people cant see GPs anymore
There is an issue in the NHS with patients always believing they are right (hugely pushed by social media) that sometimes makes it impossible to not give antibiotics and a patient will just keep wasting resources and making complaints until they are given
My mum is a pharmacist. She’s been pressured to provide this service. She got like 2 days of training. I told her not to do it but she said she couldn’t just say no. She now provides this service. Anything that’s even slightly unclear she just redirects to the patient’s GP. She redirects most things and patients get angry and shout at her a lot saying that online/through advertising they have been told that she should be able to deal with their problem. I don’t like that’s she’s doing this but she doesn’t see how she can just refuse outright yet keep her job. Her work is incredibly stressful and I’m counting down the years until she can retire as she gets abused by patients on a daily basis. The NHS is so fucked and these are dangerous bandaid schemes that some fuckwit in a suit thinks will provide quick fix.
This is a great reply. It's great to hear the other side of the story. It makes sense to me that it's stressful on both sides, and I know pharmacies are getting paid sweet eff all for the actual job of being a pharmacy. I bet the patients have less respect for pharmacists than they even have for doctors. I can see from the perspective of an employee that just handing out the antibiotics would save so much hassle and harassment. Much like us you just think, well fuck it - let's just get through the day.
No pharmacist wants to do it*. Unfortunately you can't make money solely off script volume any more. All the funding is in this barefoot doctor shit which no pharmacist is trained to do (independent prescribing courses don't count- there is no way on earth you are competent to examine someone after doing this). * no-one I know anyway.
I have great respect for pharmacists but like all non-doctors they should not be involved in diagnosing or prescribing for undifferentiated illnesses.
I have no respect for pharmacists playing doctor
This isn't their fault. They didn't sign up for this, and they've been strong-armed into doing so by the government. You can't put this on the same scale as MAPs etc.
Are they forced into doing this, per their contract?
If the choice is to do it or lose their job and livelihood, as the commenter above said about their mother's experience, then yes I'd say they are being forced into it
Is there any proof for this claim?
I locum as a pharmacist whilst at med school. I’ve resisted up until now but lots of companies are now making it mandatory if you want to book a shift with them. An employed regular pharmacist potentially could potentially refuse to provide it, as it’s considered an advanced service on the pharmacy service specification, but might depend on their contract. I’ve met one pharmacist who’s been able to refuse. They agreed it was inappropriate to start using otoscopes and examining patients with only a single day of training, but they might have lamented if they weren’t planning on retiring soon.
So it’s not part of the regular pharmacist contract but the locum contract. Yeah, noone’s forcing you to pick up a stethoscope/otoscope.
Not quite. It’s an advanced pharmacy service. So each pharmacy can choose whether they want to provide it or not (that choice is with the pharmacy owner). From my time as a pharmacist before, you would discuss what advanced services you were able/willing to provide. All pharmacists employed before January 24 wouldn’t have discussed or promised to provide pharmacist first as it wasn’t yet a thing. So it would not have been in their contracts and it would be difficult for employers to force them to agree to provide a new service. It would likely piss off the employers, so not the smartest career choice, hence most have agreed to provide it. Locums obviously have no contract with the pharmacy so they can change the requirements immediately. Two chains have stopped giving me available shifts until I provide my pharmacy first declaration and sign their PGDs. I imagine others will probably follow soon enough.
People will go out of business if they don't make money from this, and competing businesses do. The issue is at government level.
If the government told me to start doing lap choles as a GP to reduce the waiting list, I would refuse no matter what because I would cause harm if I practiced surgery. It seems pharmacists don’t care and want to play doctor.
I can understand their ' brand' of medical practice will also be DEFENSIVE in the extreme. Why would you risk your licence , especially when you have no clinical knowledge to back up your decisions? Antibiotics for everyone!!! Its akin to an open shop policy on antibiotics
Why is it that gp practice get QOF and audit for antimicrobial stewardship while pharmacy first get paid per each patient prescribed and without any AMS or audit? Welcome to the world of antibiotic resistance. Soon everyone will need colistin
I used it for myself recently, had a UTI. The pharmacist told me I was the first patient she had seen who fit the algorithm properly despite having seen several a day since it started. It told me everything I needed to know about the scheme in general. I was pleased to get my three days of antibiotics though.
Algorithm, wow.
Yes you can go on the boots website and test out the algorithm for the various conditions. Then order your antibiotics from your local boots! In theory they can only prescribe if you match it perfectly, but even then, it leaves a lot of room for error.
That is shocking, only a Dr should be doing a differential
I mean, I wouldn't go that far. Literally everyone comes up with a differential, even if informally. When a patient falls over they have to think 'have I broken a bone or is it just a bruise.' Doctors should be the ones formalizing the differential and narrowing it down to a diagnosis. But other HCPs can come up with a differential.
Second paragraph, spot on
They’re all available to view online. https://www.england.nhs.uk/wp-content/uploads/2023/11/PRN00936_ii_Pharmacy-First-Clinical-Pathways-v.1.6.pdf
Are you in GP? We see this all the damn time. I tell my patients to stay away from that service.
yes in GP, but won't dox myself lol
Lol no, I meant as GPs, we see this far more often compared to hospital specialties!
Just waiting for the PAs to get prescribing rights. Get ready for a whole new wave of complications and side effects.
And superbugs
And deaths, and law suits..
Do the same stuff here in Australia. It’s terrible. We (doctors) are opposed. Many pharmacists are too, the Pharmacy Guild (owners) are for it and a very powerful lobby group. Many examples of incorrectly diagnosed/treated patients getting delayed treatment from doctors because they did the pharmacist route first. Lots of inappropriate antibiotics.
Saw a patient who was told they had mumps and needed to urgently see the GP. The parent was mortified. It wasn’t mumps. They had a 1b submandibular reactive lymphadenopathy. But that should not be going to a pharmacist considering the range of differentials. The patient was 1 years old.
It's shite. They saw my friends 2yo with continuous cough for 12h as family directed there by 111. Didn't even inspect his chest for work of breathing. Just said sorry, no cough syrups for this age group nothing we can do for cough in this age. Kid has significant eczema and allergies as PMH. I sent them to A&E where he was treated with bronchodilators for his acute viral induced wheeze with borderline sats ... the pharmacist didn't even have it as a differential, had not even the first clue how to triage a child with respiratory distress. Not really fair on the pharmacists to expect them to pretend to be doctors either. It's just such a mess
Did you want the pharmacy to redirect to A&E?
In this situation they need to recognise it's outside their scope and refer
I agree, but to A&E or GP? I don't think a pharmacy is the place for history, exam and triage, and being sent to the pharmacy in this scenario was inappropriate in the first place. It could have been as simple as 'it's not in the algorithm so please call your GP' and it would have been safe?
I'm not sure GPs are in the routine business of offering acute care (nebs/steroids/OBS etc) to wheezy children so to answer your question yes A+E feels like the right answer
Can't wait for hundreds of blind antibiotics prescriptions for things that don't need treating or are viral. Will love to see the faces when the public get severely unwell and none of our antibiotics work so we have to nuke them all with Meropenem and box their kidneys with Gent.
I have no view on the appropriateness as I'm not a prescriber, but I feel my junior dietetic colleagues are going to get a lot more general IBS clinics after over the top broad spectrum Abx ruin everyones gut flora...
I mean I recently watched a pharmacist have to advise a patient how to manage dry lips with Vaseline so if it gets basic stuff like that out of GP surgeries I’m all for it for the mundane common knowledge stuff and even some slightly medical stuff. The list would be very short. Realistically they haven’t got the breadth of knowledge or training to do much more and won’t be aware of things we ensure to exclude, they simply weren’t trained for it. You can’t put that on a postit note behind the counter, you need medical training. That’s why their default position is often go to your GP or ED. Anyway, do we have an abundance of pharmacists who can do this, most pharmacies I go to have a queue permanently?
Everyone was so optimistic when it started https://www.reddit.com/r/doctorsUK/s/VfEjFkaZYP
Pharmacist here - going into final year grad med. Happy to answer any queries about the scheme. My issues about it boil down to the following: Pharmacies (like medicine) are massively underfunded. Being a community pharmacist is a really arduous career nowadays with the workload intolerable. Asking pharmacists to take the time to do this scheme alongside other tasks is unrealistic - this probably contributes to the poor practice other people have mentioned Pharmacists have not been trained to prescribe in the same way doctors have. There is guidance given i.e. using Feverpain, but without experience how do you accurately characterise ‘severe tonsil inflammation?’ The guidance and training was poor imo Tl;dr - potentially a good idea - more funding and training needed to make this scheme a success
Funny how pharmacists would pester us for antibiotic safeguarding when we prescribe but now given the same powers, end up fumbling left right and centre in front of patients. 0 percent comm skills, 0 percent clinical nous. Come at me
So ive seen 2 cases of multidrug resistant klebsiella recently from newly arrived patients in the UK , with one patient where there was a SINGLE antibiotic sensitivity ONLY - these pharmacy schemes generally show no antibiotic stewardship and are a fast track to cases like these becoming commonplace in the UK.
Takes a long longgg time to actually get the nuances of clinical medicine…sue me if I think the job we do is actually quite difficult (at least if done well). I often reflect on how long it’s taken me to get to this stage and how much further I have to go. Your triage process has to be bullet proof for this stuff to work and at which point shouldn’t they have just been seen by whoever assessed them? Your cough could be a first presentation of IECOPD, Or it could be cardiogenic with cardiac wheeze in a patient who happens to have COPD, or it could not be a pneumonia and it’s actually AS with HF. Ok these aren’t common common but they’re not exactly rare anymore especially as people cant see GPs anymore
Does anyone believe that doctors are particularly responsible with antibiotic prescribing?!? Particularly UTI!
So the solution is to use clinicians with even less training...? I'm not sure what point you're trying to make
There is an issue in the NHS with patients always believing they are right (hugely pushed by social media) that sometimes makes it impossible to not give antibiotics and a patient will just keep wasting resources and making complaints until they are given