You may have seen the report of the Pharmacy Voice audit of the non-supply of OTC medicines. It’s fascinating. The audit was conducted in over 5,000 pharmacies and analysed situations in which a decision was made not to sell an OTC medicine that a patient/customer had requested. In nearly two-thirds of cases, the reasons for not supplying were either because advice was given instead, or an onward referral was made to other healthcare providers or services; over 20 per cent were referred to their GP or out-of-hours GP service, a further 5 per cent to a walk-in centre, and 1 per cent to the local A&E department. In another 8 per cent of cases, sales did not take place because people were unable or unwilling to pay for the medicine.
For me, the most important finding of this audit is the unambiguous evidence that pharmacists make decisions based not on their desire to make a sale, but in the best interests of the individual concerned. And yet there is more than a sneaking feeling that we could do more. The ‘more’ is highlighted in the report.
It says we could do more if we were able to receive direct referrals from the NHS 111 service. That’s something we have asked for several times. So far, our pleas have fallen on deaf ears.
It says we could do more if all pharmacies were part of a national minor ailments and advice service. The Department of Health’s lack of appetite for this seems perverse. In 2014 it was estimated that 5 per cent of A&E consultations and 13 per cent of GP consultations for minor conditions would be better managed in community pharmacies, with massive savings for the NHS; the DH’s own estimate puts these at £300 million a year. And yet that same department seems willing to decimate the community pharmacy network so it can save £170 million. Really?
The report also says we could do more if we had ‘read and write’ access to individual patient records. This has been a bone of contention for some time now. It seems that unregulated, often poorly-trained, GP receptionists can be allowed to access patient records, but community pharmacists don’t have the same level of trust. My understanding is that it is mainly GPs who are reluctant to allow us access – more deaf ears.
It’s understandable, up to a point: if information is power, whoever has control of that information is in a powerful position. And allowing another group to access that information means surrendering at least some of that power. But is it in the best interests of patients for this straightjacket on health information to continue? And – if patients knew – would they want it to continue?
There’s an interesting series of articles on the King’s Fund website at the moment, asking the question ‘what if..?’ (www. kingsfund.org.uk/reports/thenhsif/). One of the articles explores the question: “What if patients controlled their own health information?” It offers a tantalising glimpse of the future, where patients control their own health records from an app on their smartphone.
Imagine the situation where you could ask a patient directly: “Is it okay for me to access your health record so Ican make a note of the advice I’ve just given you, or record the medicine I’ve just recommended for you?” The patient – not their doctor – gives you access through the app. Patient choice. Patient power.
We pharmacists have long been used to the idea that every patient or customer can choose which pharmacy they favour with their custom and their trust. For community pharmacy, I believe choice is a good thing: it keeps us all on our toes.
I like to think that if I were to ask my patients for permission to access their health record, for the vast majority of them the answer would be “certainly”, especially if I were able to give a good reason for my request. If patients controlled their own health records I’m optimistic that most would choose to allow access to pharmacists. They would see the sense of it, even if GPs don’t.
Withering is the pen name of a practising independent community pharmacist. Withering’s views are not necessarily those of ICP