Pharmacists in England Will Be Able To Prescribe Antibiotics Without GP Approval From Next Year (BMJ)

William Coni
October 28, 2022

In 2023, more responsibility will be handed over to Pharmacists in the hope of relieving pressure on GP services as well as improving access to healthcare for treatable conditions and illnesses. It can be difficult to secure a GP appointment, especially during the winter months when there is a rise in influenza infections, due to relentless pressure from England’s growing ageing population, the backlog from the COVID-19 pandemic and the limited funding for increasing health needs. Currently, in the UK, pharmacists who have received ‘independent prescriber training’ have a limited range of drugs they are able to prescribe - and these don’t include antibiotics. However, this new plan allows a greater variety of pharmaceutical interventions to be prescribed by pharmacists, managing conditions such as hypertension and high cholesterol, and potentially also antibiotics for common infections. It also includes contraception treatment essential for those who need informative and accessible care without barriers which are often present in the process of booking and attending a GP appointment. Pharmacy degrees will now integrate independent prescribing as part of their training meaning all newly qualified pharmacists from 2026 onwards will be registered and ready to prescribe.

Food for Thought

Will this really work?

In Scotland and Wales, similar systems are already in place. Scotland operates ‘NHS Pharmacy First Scotland’ - an initiative started in July 2020 following effective antibiotic pilot schemes. The implications of this have been seen by the Department for Health and Social Care who say 400,000 GP appointments and £8.4 million could be gained from just allowing pharmacists to prescribe antibiotics for urinary tract infections. Heading in this direction could mean primary care pressure doesn’t fall directly on general practice and the expertise of those qualified in the community can be exercised to a greater degree. Chronic health condition management, provision of acute care and prevention of severe illness will be covered whilst relieving pressure on GPs, allowing for improvement in the quality of care. However, there are some concerns regarding antimicrobial resistance. This is one rising challenge to the NHS with no clear solution, and this new scheme may increase the fears of easier access to antimicrobial drugs. Many previously first-line antibiotics for common infections are now ineffective as the ‘overuse’ of antibiotics has led to pathogen mutation. However, it was stated that antimicrobial resistance and the population’s attitude to the use of antibiotic treatment were considered when this plan was formulated.

Evolving primary care

The ideas driving this proposal of dispersing responsibility to alternative primary care professionals don’t come without controversy. The head of primary care and public health at Imperial College London, Azeem Majeed, believes primary care would become “fragmented” and alternatively increased funding into general practice should be considered. At a critical time for NHS funding (due to economic and political volatility) .It might be wise to first observe similar systems that are already in place, such as in Wales. In April of this year, community pharmacists in Wales could prescribe drugs for contraception, urinary tract infections and upper respiratory tract infections. At the moment, general practice appointments are becoming less and less attainable and healthcare needs are consistently climbing for a variety of reasons, so perhaps it’s time for England to take this next step in the primary care evolution, but is it really worth taking this risk?

Practice Interview QUestions
  1. Why did you choose to study a medicine degree rather than pharmacy?
  2. Apart from the ageing population and antimicrobial resistance, explain another challenge facing the NHS?
  3. Mental illness is  included in the pressure created by the ‘backlog of the COVID-19 pandemic’, why do you think this is?

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