How the British do pharmacist prescribing

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Pharmacist prescribing across community pharmacies and general practices in England has been lauded as a positive strategy in easing the load of overworked doctors

Doctors across England are under “considerable strain” with not enough GPs being trained for the workforce, but pharmacist prescribers have been heralded as a solution, say UK researchers.

In the past few decades, the government has reduced working hours for doctors, which eased their workload but created a greater need to offer prescription services in the community, say healthcare and economics researchers from the University of Leeds and Bournemouth University, UK, in the Journal of Pharmacy Practice and Research.

To combat this, the UK government has implemented measures to allow prescribing by pharmacists, nurses and allied health professionals including podiatrists, physiotherapists and optometrists.

Research shows that independent pharmacist prescribing has been demonstrated to be as safe and effective as doctor prescribing.

A 2010 evaluation of nurse and pharmacist independent prescribing found that there was no evidence that patient safety had been compromised by the introduction of prescribers other than doctors.

Numbers of prescribers continue to rise.

In 2013, there were approximately 3000 (7%) prescribers of the 45,000 pharmacists registered to practice in the UK.

By November 2015, this number had increased to almost 4000, or 8%.

Of these prescribing pharmacists, 13% were in community pharmacy, 30% were in primary care organisations, and 61% were in secondary care.

The number of pharmacists working in general practices is also increasing significantly and steadily in the region.

NHS England has confirmed that the government is investing millions into piloting hundreds of clinical pharmacists.

Researchers say this investment may lead to a potential further 1500 pharmacists working in general practice by 2020.

“General practice is changing with an increasing elderly population with complex health needs,” say the authors.

“Pharmacists could … be further utilised to mitigate the crisis. Graduate pharmacists could be trained as prescribers in six months, after two years on the register, then run clinics and common ailment schemes in GP surgeries.

“Conversely, the clinical pharmacist in practice could deal more with chronic illness and long-term conditions, leaving the GP and advanced nurse practitioner to deal with acute consultations.”

The authors suggest that based on the evidence, it could be a requirement for all practising community-based pharmacists to become accredited prescribers – an ambition actually proposed by NHS Scotland to improve the provision of pharmaceutical care by 2023.

PSA national president Dr Shane Jackson has said pharmacist prescribing in Australia is “imminent”.

However the uptake will be slow-going, with the first step likely to be collaborative prescribing before independent prescribing is considered.

The Pharmacy Board of Australia held a forum nearly two months ago to consider the need and opportunities for expanding pharmacist involvement in prescribing.

“In Australia, non-medical prescribing has been successfully extended to dentists, nurse practitioners, midwives, podiatrists and optometrists applying different prescribing models,” said the Board.

“Next steps could include wider consultation on issues raised at the forum and how stakeholders could be involved to assist in progressing pharmacist prescribing.”

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